Quality Assurance within the NHS Health Check: Oxfordshire's example of delivery

Transcription

1 Quality Assurance within the NHS Health Check: Oxfordshire's example of delivery Stephen Pinel, Health Improvement Practitioner, Oxfordshire County Council. Dr Eunan O Neill, Consultant in Public Health, Oxfordshire County Council. Eunan.O Neill@Oxfordshire.gov.uk

2 Oxfordshire's Programme Started Locally in April 2011 Part of an Approved Provider List (APL) agreement from April 2014 GP Service only 80 GP s 2013/14 Performance: 21.2% Invitations 10.2% Done 45.9% Uptake 09/02/2015

3 Quality Assurance (QA) options Public Health England (PHE): Programme Standards (Feb 2014) Self-assessment framework (July 2014) Meeting with Practice Managers Shared intentions with CCG and LMC Oxfordshire County Council (OCC) Business Case Submitted four QA options (July 2014)

4 Preferred Options 1. QA Visits to 80 GP s (commissioned externally): Developed Service Specification (August 2014) Observed procurement law with at least 3 expressions of interest obtained and bids assessed (Sept 2014) 6 month Contract (1 st October 2014 to 31 st March 2015) Referred to as Phase 1 2. Data extraction from 80 GP s using Read Code data: Downloaded from The Computer Room (TCR) Analysed and interpreted internally by OCC (Nov 2014) Referred to as Phase 2

5 Phase 1: Assessment / Visit OCC adapted PHE s self-assessment tool to Quality Assure: Approx hours 1. Invitation and Offer (Standard 1 and 2) 2. Risk Assessment (Standard 3 and 4) 3. Communication of Risk (Standard 6) 4. Risk Management (Standard 7, 8 and 9) Meeting with Practice Manager / Administrator Shadow HCA / Nurse during consultation Incorporated a local scoring system to objectively measure each Provider against each of the Standards Provided overall % to RAG rate Note that Standard 5 and 10 are not applicable locally

6 Phase 1: QA Visit Outcomes

7 Phase 2: Data Extraction Outcomes Read Code data collected (Quarter 1 & /15) Assessed Data Compliance for the elements in Standard 3 Provided feedback on invite Read Coding (Standard 1)

8 Phase 2: Data Extraction Outcomes Read Code data collected (Quarter 1 & /15) Assessed Quality Outcome Indicators within Service Specification and elements outlined in Standard 7:

9 Feedback Process to GP Providers QA Dashboard sent to Practice Manager within two working days of visit with Phase 1 and 2 outcomes Follow-up phone call to Practice Manager within five working days of to discuss dashboard / offer support

10 Progress to date (as of 13/02/15) 1% (1) 23% (18) 76% (61) Completed Booked Declined/Not booked

11 Impact on Public Health Outcomes Framework Indicators Pre-QA Pre-QA QA Start Q1 2014/15 Q2 2014/15 Q3 2014/15 % Invited 5.4% 6.4% 5.2% No. Invited 10,232 11,747 10,009 % Done 2.2% 2.8% 3.2% No. Done 4,249 5,217 5,970 % Uptake 41.5% 44.4% 59.6%

12 Phase 1: Service User Feedback* Was sufficient information about the visit provided in advance? Yes: 100% Were dates and times offered convenient? Was the booking process conducted in a professional manner? Yes: 100% Did the assessor conduct the visit in a professional manner? Yes: 100% Did the assessor have enough expertise? Yes: 95% Yes: 100% Was the visit beneficial to the Practice Manager? Was the visit beneficial to the HCA/Practice Nurse? Yes: 84% Yes: 100% *19 responses (out of 61 completed)

13 Helpful Phase 1: Service User Feedback Very professional assessment - many thanks Overall experience was favourable & informative Excellent process and very helpful in ensuring all elements of the Health Check were being carried out to a satisfactory standard. I would be very happy to be involved in the process again The assessor gave additional info re resources which was very useful The assessor who attended our practice was a very delightful and professional person. The visit lasted approx. 1 1/2 hours Some of the questions which the HCA was asked should have been directed to the PM, as the HCA was not aware of all the answers

14 Next Steps: 2015/16 and beyond 1. Invitation and Offer: Improved awareness with Practice Managers/administrators of the current protocols 2. Risk Assessment: Review clinical template used to ensure includes: GPPAQ, AUDIT-C and Dementia Awareness and imbedded Read Codes are correct 3. Communication of Risk: Developing local Results Booklet based on PHE s example 4. Risk Management: Address lack of knowledge on Service / Programme changes with HCA s/practice Nurses 5. Tailor local face-to-face training content 6. Repeat Phase 1 on request and by exception. Repeat Phase 2 on a Quarterly basis, include information within Quarterly Activity Dashboards

15 Summary QA Provider with clear understanding of pathway Include GP s / key stakeholders in planning process Need an agreed action plan for follow-up support Provide prompt, clear and constructive feedback with an opportunity to ask questions And finally. Dangle carrots Don t prod with sticks