Shared Decision Making –No decision about me, without me

Kim Teasdale and Sam HoodCommissioning Managers

South Tyneside and Gateshead CCGskim.teasdale@sotw.nhs.uk

sam.hood@sotw.nhs.uk

STCCG - What did we do and why?• Shared Decision Making key component of our Referral

Improvement Scheme (RIS) for 2012/13 – Demand Management project working with our GP practices to improve the quality of their referrals

• System pressures around elective activity particularly OP appointments in 3 specialities - General Surgery, Orthopaedics and Gynaecology – and focussed on 6 specific conditions within these

• Used SDM as a tool with the clinical teams to drive up the quality of GP referrals

• SDM is best practice and as a CCG we wanted to build it into our clinical culture and practice in South Tyneside

Referral Improvement Scheme (RIS)

How did we implement Shared Decision Making?

Outcomes

• Better management of patients with these conditions – more confident GPs with more satisfied patients (questionnaire)

• Financial savings of around £500k in 1st OP attendances for those 3 specialities

• Engagement with secondary care to adopt similar practice – early stage involvement in top tips / BDA development etc.

Next steps.....

• Advanced consultation skills - continuing to train GP trainer and embed in training culture in South Tyneside

• READ coding of MAGIC consultations with practice continuing promotion

• Developing SDM skills into Supported Self Management as part of our Improving Care Scheme for 2013/14 (STICS)

Why SDM?•Opportunity to improve the quality of consultations in Primary Care•Improve quality of referrals •Improve outcomes for patients•Increase patient engagement in their care – “no decision about me without me”•Add value to the Q&P QOF process for practices through training in a new skill – SDM•SDM ethos ties strongly with GCCG vision and values•Improve patient experience of care

How?•2013/14 Quality &Productivity element of Quality and Outcomes Framework (QOF) indicators, applied to secondary care outpatient referrals (Q&P 1 – 3) •Encouraged use more widely within general practice than just Q&P QOF •Worked with the Newcastle SDM Team to put in place training for all Gateshead General Practices

• Training of CCG Core team and Executive GPs• General awareness training July 2013 TITO

locality meetings• Shared Decision Making Skills Workshops

September 2013 TITO – at least 2 GPs from each practice to attend

• Practice Nurse Workshops September TITO and September Diabetes Masterclass

Outcomes

•68 GPs from 33 practices trained in SDM•2 x Practice Nurse workshops held focusing on SDM in LTCs•Some GPs would like further training on practical application in consultations•Positive response from Practice Nurses•Practice Managers keen to begin to use Ask 3 Questions materials in their practices

Learning from implementation to date•Support from CCG Executive GPs crucial to success so far•Difficulty in training GP trainers locally•Practice Nurse Trainers more success locally•SDM v Pathway approach•Practice Managers interested – links to patient participation, benefits for CQC inspections

Future•Evaluate uptake of SDM at end of March 2013•Role out Ask 3 Questions materials to practices•Look at how we can embed in Gateshead beyond 2013/14 and Q&P QOF

Issues to tackle•How do we know it’s made a difference to patients and empowered them?•Once SDM team disbanded how do we grow our own support – particularly amongst GPs?•Changing culture of General practice and patients to change their relationship with each other•Evaluating impact on health system

Thank you