Quality Assurance within the NHS Health Check: Oxfordshire's example of delivery Stephen Pinel, Health Improvement Practitioner, Oxfordshire County Council. Stephen.Pinel@Oxfordshire.gov.uk Dr Eunan O Neill, Consultant in Public Health, Oxfordshire County Council. Eunan.O Neill@Oxfordshire.gov.uk
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
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)
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
Phase 1: Assessment / Visit OCC adapted PHE s self-assessment tool to Quality Assure: Approx. 1 1.5 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
Phase 1: QA Visit Outcomes
Phase 2: Data Extraction Outcomes Read Code data collected (Quarter 1 & 2 2014/15) Assessed Data Compliance for the elements in Standard 3 Provided feedback on invite Read Coding (Standard 1)
Phase 2: Data Extraction Outcomes Read Code data collected (Quarter 1 & 2 2014/15) Assessed Quality Outcome Indicators within Service Specification and elements outlined in Standard 7:
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 email to discuss dashboard / offer support
Progress to date (as of 13/02/15) 1% (1) 23% (18) 76% (61) Completed Booked Declined/Not booked
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%
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)
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
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
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