Small group Discussions 6112009

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					                             Results of small group discussions: Future Services – Forward Planning 6th November 2009

    Item                              Arrhythmia                                           Rehabilitation                                  Prevention

Priority 1   Joined up 2º and 3º services                                    Incorporating 1º and 2º prevention of      NHS Health checks – Risk assessment and
                                                                             CVD including HF and high risk             management programme
                          Help                         Challenge                    Help             Challenge                   Help                   Challenge
1            Encourage relationship           Trusts competing for           Long term cost
             building between 2º and 3º       patients                       benefits but       Initial pump            Use of QOF targets /      Doing checks with
             clinicians – i.e. having a                                      needs initial      priming                 other national targets    limited funds and
             shared post between                                             investment –       investment                                        duration, PCT Priority
             primary & secondary             Challenges in                  people benefits    needed
             (the arrow was meant to          communication & transfer       & engages the
             show that this in itself would   of information across          family
             bring challenges)                organisational boundaries

             Ensuring specialist groups       Shared post challenge – to
             of patients (i.e., ICC) are      demonstrate enough
             sent straight to specialist      demand for this & the
             clinics (tertiary setting) for   impact on other resources
             initial diagnosis &              e.g., technicians
2            Outreach clinics                 Lack of resources              Increase             Current structures    Variety of providers      Engaging with target
                                                                             flexibility          don’t support         with different delivery   populations
                                                                                                  flexibility – small   models and ease of
                                                                                                  disease focused       access

3            Redistribution of work           Lack of agreement on           More patient         Will need out of      National Campaign –       Long term adherence –
             amongst the current              referral pathways              focused options      hours services        tag line ….               keeping the work going
             facilities – shared models       (development and use of)       to streamline        (outside of 9-5)      Consistent message
                                                                             care on onward
4            Joining up AF & HF               Managing patient               Staffing and skill   Change                Primary focused           Reducing inequalities –
             pathway                          expectations                   mix design,          management            evidence base             particularly with some
                                                                             funding and          issues                leading to cost           hard to reach groups
                                                                             availability                               benefits & increased
5            Move toward a sector             Patient choice (re. Location                        Recruiting the        Looking a differences     NHS pace – variable
             approach                         of care and treatment)                              right skill mix       in workforce skill mix    PCT implementation
                                                                                                                        and social marketing      plans.
77aaaa13-48fa-4560-bc33-acf3ae14de37.doc                                                               Page 1 of 4                                23/02/2010
                             Results of small group discussions: Future Services – Forward Planning 6th November 2009

    Item                Arrhythmia                                  Rehabilitation                                            Prevention

Priority 2   Identification of patients in        Model(s) for sector wide, joined up SWL menu        Cardiac rehabilitation: Primary and Secondary
             primary care                         driven rehabilitation that is cost effective,       prevention
                                                  appropriately costed and commissioned

             Help             Challenge           Help                        Challenge               Help                         Challenge

1            AF – GRASP       Following the       Tariff + money to fund it   Failure of NACR to      Mix and match of patients    Money & PCT priority
             tool kit         referral pathways                               support menu driven     groups – put 1º & 2º
             available                                                        rehabilitation          together, quitters with
                                                                                                      current smokers, Post MI
                                                                                                      with possible MI

2            Local            Commissioning       Flexible service which      Change management       Brokering of packages –      Buy-in from:
             expertise                            has a variable menu and     issues                  different ways of working     Some GP’s & other
             including the                        meets the patient                                   with these broader           clinicians
             ACC’s                                choice/need – address                               groups of patients            Patients
                                                  logistics, space, venue,                                                          Families

3            Community        Finding             Better uptake, increasing   Lack of clarity re.     Menu driven services –       Maintenance of behaviour
             treatment        asymptomatic        profile of CR,              Funding streams, what   pick and choose              change over the longer term
                              patients who are    communication,              is included, getting    approach to tailor the
                              at risk                                         funding transferred     product to the patient
                                                                              between PCTs etc.

4            TIA clinics      Lack of patient     Engagement &                Issues re onward        Ongoing Checks – not         Is what we are doing of
             picking up AF    awareness           understanding, of           pathway linking gym,    just one off intervention.   proven benefit? Need
                                                  clinicians, medical and     private providers,                                   evidence.
                                                  surgical colleagues,        other referrals
                                                  patient, manager and

                                                  Advantages of good multi                            Long term follow-up –
5                             Increasing          disciplinary planning and   Recruitment             links to NHS HC              Assertive outreach
                              demand and the      varied skill mix            challenges & funding    call/recall system [5yrly]
                              impact it would
77aaaa13-48fa-4560-bc33-acf3ae14de37.doc                                                        Page 2 of 4                             23/02/2010
                            Results of small group discussions: Future Services – Forward Planning 6th November 2009
                                 potentially have
                                 on secondary
                                 care services

    Item                                Revascularisation                                                                Heart Failure

Priority 1   CABG                                                                   Clinical leadership & Workforce development

                          Help                              Challenge                                Help                                    Challenge
             MDTs for patients with 3          Competition for operating theatres   Plenty of heart failure registrars         Heart Failure consultants not seen as a
             vessel disease and Syntex         and ITU beds (hospital priorities)                                              priority by Acute Trusts
             scores – Group MDTs/
             surgical differences and

             Scheduling                        Surgical working practices           Working in the community is effective      Experience and knowledge of working
                                                                                    and autonomous                             in primary care

             Managing demand                   Surgeon’s preferences                Integrated care within Heart Failure       Managing the roles between
              ITU beds, Pooling of                                                                                            community nurses and HF nurses
              Operating lists

             Communication                     Rehabilitation –                     Mentorship within HF Nursing               Having the right consultant access and
                                                Patients homes safely (hospital                                               response for specialist advice
                                                Early discharge

                                               Repatriation from North London       Recognition of HF services and             Other MDT members investment and
                                                                                    investment in academic studies             funding

77aaaa13-48fa-4560-bc33-acf3ae14de37.doc                                                           Page 3 of 4                                23/02/2010
                           Results of small group discussions: Future Services – Forward Planning 6th November 2009

    Item                             Revascularisation                                                              Heart Failure

Priority 2   ACS                                                                    Seamless pathway of care

             Help                            Challenge                              Help                                   Challenge

1            Drive through angioplasty –     Achieving Angioplasty within 72        Strong relationships &                  Lack of HF nurses in some PCTs
             treatment & Transfer            hours                                  communication between hospital and      No commissioned pathway so no
                                                                                    community staff and between            incentive to work together
                                                                                    community nursing and hospices

2            Ambulance training              Transportation costs                   Strong diagnostics – ECHO and          Not having sufficient in-patient teams
                                                                                    BNP – access and reporting
                                                                                    One stop clinic for HF

3            ACS evaluation in hospitals     Weekend working & staffing – key       Cheap to set-up a HF service – no      The way in which pathways are
             (units) make it clear –         to length of stay                      expensive equipment                    commissioned with disincentives rather
             realistic targets. ICP across                                                                                 than with incentives
             all hospitals in SW London

4            IHN for collaboration           Diagnosis – co-morbidity of patients   Potential of polysystems to treat HF   Lack of awareness by hospital staff that
             between centres in SW                                                  patients - e.g. diagnostics            patients can be treated in a community
             London - < 24 hour received                                                                                   setting rather than admitted to hospital
             by tertiary centre

5            LAS                             More ACS nurses & repatriation         BNP available across sector            Lack of shared patient information (no
                                             from North London                      including palliative care and          linked IT system)
                                                                                    symptom control & guidance

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