Cost savings and better care as North Tyneside acts on variation

30 August 2017
Steps to address unwarranted variation in clinical pathways and spending highlighted by NHS RightCare data need to be mainstreamed and not seen as an add-on, according to Christine Briggs, deputy chief executive at NHS South Tyneside Clinical Commissioning Group (CCG).
 
The CCG aimed to deliver significant savings and improved patient care when it revamped care pathways to address variations in spending on respiratory, cancer and cardiovascular services. This year the CCG is reviewing further opportunities in gastroenterology, musculoskeletal and diabetes pathways.
 
Briggs said: “Right care is an indicator that you are different and a starting point for discussion. Local demographics can explain some of the variation – some variation might be warranted. For example, our rate of chronic obstructive pulmonary disease (COPD) is 35% higher than our ten comparator CCGs but we still looked at our respiratory spending and services.
 
“You must resist the temptation to just deny the data,” she said.
 
In deciding which pathways to redesign, the CCG considered the RightCare data alongside statistics provided by the local authority, the acute trust and other partners.
 
They chose COPD/respiratory services and cardiovascular services as these offered the greatest potential savings while cancer services offered opportunities to improve care.
 
“We adopted a formal structure in the CCG with a multi-agency steering group for each of the three pathways. The respiratory steering group, for example, had representation from the foundation trust, public health, community teams and the local authority – as well as a patient representative.
 
“We had a standardised workplan for each of the three and they fed into the CCG delivery plan that we monitor regularly.”
 
The steering group for each stream researched best practice to identify potential interventions and opportunities and did baseline mapping of existing pathways.
 
The steering groups were responsible for the on-going review of data.
 
Securing buy-in from the foundation trust at the clinical and managerial levels and having strong clinical leadership across the system were essential elements of the programme, Briggs suggested.
 
“Relationship building did take a lot of time but we are in a really positive place on that now,” she said.
 
The redesigned COPD pathway is budgeted to save £555,000 with a new pulmonary rehabilitation service expected to avoid around 200 hospital admissions. The new respiratory pathway, including a self-management pilot, was launched at a GP education session.
 
The cancer group’s work has resulted in a new lung cancer screening pilot but Briggs said that the CCG is prioritising care improvement rather than savings in this area.
 
The new heart failure pathway includes a single point of access referral form and the provision of pulse-checking kits to practices to help with atrial fibrillation identification.
 
Download the full edition of Commissioning Excellence September 2017.
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