Evidence-based guides to support co-commissioning Alison Turner, Sharon Stevens and Shiona Aldridge Strategy Unit, Midlands and Lancashire Commissioning Support Unit Results Background and aims The West Midlands Clinical Senate commissioned the Strategy Unit to create a resource to support local primary care development strategies. The resource aims to summarise available evidence on aspects of primary care quality which impact on health, patient outcomes and service utilisation in order to enable local health economies to discuss and decide local priorities for development. Primary care development is a priority area for local health economies, driven by the shift towards co-commissioning and the new care models proposed in the Five Year Forward View. However, the evidence base on quality in primary care is variable. Even where evidence is available, the application of learning from research and evaluation needs a deep understanding of local context. Local strategy and planning will therefore need to be driven by consensus built through engagement with stakeholders and informed by evidence where available. This resource is intended to provide a framework for commissioners and providers to instigate conversations locally. Our methodology included the following stages: Present draft review Test key findings Conduct the search Filter search results Write a narrative Summarise and appraise papers Present final review The main themes identified were: The patient persepective - Developing patient centred culture - Access for patients - Continuity of care - Empowering patients - Information and technology The clinical perspective - Ways of working - Dignosis and referrals - Prescribing Urgent care - Population management - End of life care - Community engagement The practice perspective -Collaboration and partnerships -Workforce - Continuous Improvement -Leadership - Change and transformation - Physical environment Next steps Our approach Scope the work The resource is organised from three perspectives: patient, clinical and practice, reflecting themes which emerged from the evidence review. The key messages have been summarised in the form of graphics for each of the three perspectives, to provide visual aids for commissioners and providers to instigate local conversations. A set of questions has also been included in the appendix which may help to frame local discussions. Dissemination Our final report is being presented to the Clinical Senate in March 2015 with a view to disseminating across the West Midlands over the Spring period. Initial feedback suggests the resource will provide a useful framework for local discussions; for example, a local CCG plans to use this resource to prompt conversations with patients regarding what excellence in primary care looks like for them. The CCG is planning to use the patient feedback to co-produce Key Performance Indicators in the GP contract. Our work to date will inform ongoing and future work. We are working with several local CCGs on their primary care development strategies and in particular, supporting the next phase of the Future Fit programme, which is focused on supporting primary care to manage the shift of care closer to home. The review included a search of Medline, Embase, HMIC, Cochrane Library and sources of grey literature. The final report included a summary of evidence supported with published case studies where available. www.strategyunit.co.uk Transforming commissioning with evidence Alison Turner, Shiona Aldridge and Sharon Stevens Strategy Unit, Midlands and Lancashire Commissioning Support Unit Introduction Methods Commissioners in the NHS face the challenge of identifying high-value interventions and initiatives which offer a significant return on investment (improved outcomes and reduced burden on health services) in a climate of significant financial pressures. The Five Year Forward View sets out significant change through new care models. There is a clear need to learn from interventions and initiatives which have successfully improved outcomes for patients. Before investing in new initiatives, it is prudent to begin with a review of the evidence base to understand what works, in what context, and why – also, how interventions can be adapted and implemented locally. This can help avoid the risk of investing in initiatives which offer only marginal benefits or possible harm. However, research* has shown that commissioners vary greatly in their use of evidence in decision making. Understand requirements Supplement with data collection Write a narrative Scope the work Appraise and summarise papers Test key findings Conduct the search Filter search results Present findings *Clarke A et al (2013) Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011, BMJ Open, 3, e002714. Doi: 10.1136/bmjopen-2013-002714. Aims Results Our evidence reviews have contributed to large scale change in a number of ways, informing: The Strategy Unit exists to help clients improve health and care. We combine advanced, yet practically grounded, skills and expertise in analysis, evidence review, strategic financial planning, policy and strategy development, consensus building, programme design and implementation and trusted advisor support for senior leaders. - - - - - - - Specifically, we produce bespoke, detailed syntheses of the published evidence base on clinical/service topics and a series of ‘methods reviews’, on mechanisms and methodologies of potential application in achieving service change. Our key challenge is in balancing timeliness alongside rigour and quality. We often find the evidence base is underdeveloped, highlighting the need for rigorous evaluation of commissioning interventions, thus building a stronger evidence base. Methods We start change programmes with a review of the relevant evidence base. As much of our work tends to be to tight deadlines, we have developed a pragmatic process for producing evidence reviews, which aims to achieve the optimum balance of rigour and timeliness. Our process follows 9 steps. the clinical design of a system reconfiguration; a redesign of intermediate care; a redesign of respiratory services, leading to wider availability of pulmonary rehabilitation; the specification of a community diabetes service; the evaluation of a virtual ward pilot; the evaluation of an integrated care service; decommissioning and disinvestment of services. Conclusions Commissioners are generalists, often responsible for a number of different service areas. They need tailored evidence products, offering high level, “ready to use” guides and tools. The volume of the knowledge base for commissioning can be significant but the quality is variable and for some key initiatives, the evidence base remains underdeveloped, risking high cost and low value investments www.strategyunit.co.uk