Tower Hamletsmanaged practice networks

John Robson GP Reader QMUL

NHS Tower Hamlets networks

NHS Tower Hamlets networks

Tower Hamlets in numbers 36 GP practices 150 GPs, 300 nurses, 100 health care assistants

Tower Hamlets in numbers

2000 staff 250,000 peopletwice size of Cambridge

NHS Tower Hamlets networks

• Health needs • How networks change provision and impact• Scaleable • Key levers

Outline

NHS Tower Hamlets networks

Welcome to Tower Hamlets

Newham Barking

RedbridgeWaltham Forest

Hackney

City

Tower Hamlets

East London Diabetes belt

1 in 20 have T2 diabetes

NHS Tower Hamlets networks

NHS Tower Hamlets networks

Where we are today

Iraq

East India

Albania

USA

UK

Japan

0 10 20 30 40 50 60 70 80

Tower Hamlets

United Kingdom

Male life expectancy 2002-9

NHS Tower Hamlets networks

NHS Tower Hamlets networks

The story

4 yrs top in UK and London

bottomquartileUK spend &performance

£2m

Diabetes CVD

Immunisation COPD

2008

36 practices in 8 local area networks

8

6

5

*

123

4

5

6

8

9

10

7

1112

15

13

16

14

17

18

19

24

2122

20

23

25

2627

28

29

30

31

32

Pop: 28,956

Pop: 23,868

Pop: 38,529

Pop: 33,948

Pop: 25,549

N7

N6

Practice Networks

33

35

34

36

NHS Tower Hamlets networks

NHS Tower Hamlets networks

Care Packages20102009

DiabetesCVD

cardiovascular

ImmunisationCOPD

chronic pulmonary disease

NHS Tower Hamlets networks

Success

• Childhood Imms 1st in London • Diabetes 1st in 2012 National Diabetes Audit

• CVD - BP and cholesterol control 1st QOF Statins 1st nationally

• COPD Spirometry/MRC rating 1st QOF

Resources for local complexity

Network manager• Performance

dashboards

• MDTs

• Target support

• Outreach

Practice managersClinical leads

• Finances collective target• Admin problems• Target resources• Educational needs• Peer to peer learning

Nurse Forum NHS Tower Hamlets networks

NHS Tower Hamlets networks

Priority, Guidance and Audit

Education: in-practice facilitation

NHS Tower Hamlets networks

NW1 NW2 NW3 NW4 NW5 NW6 NW7 NW8 BoroughApr-11 7.63 7.97 7.91 7.56 7.44 7.70 7.80 7.65 7.71May-11 7.67 7.95 7.93 7.56 7.45 7.68 7.78 7.63 7.71Jun-11 7.67 7.96 7.92 7.56 7.45 7.66 7.77 7.62 7.70Jul-11 7.70 7.94 7.95 7.63 7.50 7.71 7.78 7.66 7.73Aug-11 7.74 7.92 7.97 7.62 7.54 7.74 7.80 7.63 7.75Sep-11 7.72 7.91 8.00 7.59 7.52 7.74 7.78 7.60 7.75Oct-11 7.71 7.89 8.00 7.56 7.50 7.72 7.75 7.60 7.73Nov-11 7.69 7.85 7.97 7.52 7.51 7.76 7.75 7.59 7.72

7.10

7.20

7.30

7.40

7.50

7.60

7.70

7.80

7.90

8.00

8.10

Ave

rage

by

netw

ork

Network Average HbA1c

GP Network average for HbA1c for patients on register (excluding diagnosed within last 6 months)

VISUALISING CHANGE Diabetes HbA1c by network

Spitalfields

Thameside

NHS Tower Hamlets CCG

NHS Tower Hamlets networks

Network/practice monthly RAG red amber green chart

CVD

Target

Network AB AS CS LH GW

% Count % Count % Count % Count % Count

% new MI reviewed in 4 weeks post discharge

 67.0%

    57 4/7 50 5/10     60 3/5                     

80%                     

 

100 3/3         100 5/5    

Network - practice engagement

NHS Tower Hamlets networks

NHS Tower Hamlets networks

Did we make a difference?

NHS Tower Hamlets networks

% T2 diabetes all 8 care processes Tower HamletsNational diabetes audits 2008-12

2008 2009 2010 20110%

10%

20%

30%

40%

50%

60%

70%

80%

90%

NHS Tower Hamlets networks

TOWER HAMLETS

Bottom

25%

Diabetes network

care package

1st

in E&W

Equity: age, ethnicity, deprivation

NHS Tower Hamlets networks

NHS Tower Hamlets networks

Inclusive & area based

• Inclusive: 3rd party providers & practice federations

• Based on LA local boundaries Local community and Integrated Care

NHS Tower Hamlets networks

• Widespread interest EVALUATE DISSEMINATE & PUBLISH

Directly influenced

• Newham clusters and federation: • Camden, South Wales, Waltham Forest• Scotland to Torbay

Generalisable

Natural experiment Tower Hamlets vs Newham & Hackney

NHS Tower Hamlets networks

Blood pressure control CHD (QOF)

Natural experiment Tower Hamlets vs Newham & Hackney

2004 2005 2006 2007 2008 2009 2010 2011 201275%

80%

85%

90%

95%

100%

EnglandLondonTower HamletsCity & HackneyNewham

% B

P <1

50/9

0mm

Hg

Blood pressure control CHD (QOF)

NHS Tower Hamlets networks

NHS Tower Hamlets networks

% Coronary heart disease: cholesterol <5mmol/lQOF no exceptions

2004 2005 2006 2007 2008 2009 2010 2011 201250%

60%

70%

80%

90%

100%

England

London

Tower Hamlets

City & Hackney

Newham

% c

hole

ster

ol <

5mm

ol/l

NHS Tower Hamlets networks

Impact

• 10% increase in antihypertensive and statins• 3m people with CVD diabetes• 40% reduction in events• 3000 CVD events and death every year

Impact

NHS Tower Hamlets networks

Myocardial infarction mortality under 75 years per 100,000 DSR ONS

2004 2005 2006 2007 2008 2009 201050

100

150

200

250

300

EnglandT HamletsNewhamHackney

MI m

orta

lity

rate

/100

,000

NHS Tower Hamlets networks

Key points

Key levers

Review & recall

IT DecisionPrompts

ActBelief Motivate

Guideline Education Comparative Feedback Incentives

Translational science

Three ducks in a row

NHS Tower Hamlets networks

Key points

Priority setting – choose carefully for maximum (evidence based) achievable impact

Engage stakeholders – consultants, prescribing advisors, LMC, nurses, practice managers – GP champions

Project or network managers

IT systems VISUALISE Performance - dashboards

Key levers

NHS Tower Hamlets networks

What happened next?

• Extended scope Atrial fibrillation, Cancer early diagnosis, Integrated care +++

• Networks as providers Took over failing practice

scaleable

• Entire CCG federatedprovider network

NHS Tower Hamlets networks

What happened next?

• Entire CCG federatedprovider network

Patient & community

benefit

NHS Tower Hamlets networks

Networks are a step change

20082014

NETWORKSPatient impact

Wider relevance

Transformational provision