Quality Assurance within the NHS Health Check: Oxfordshire's example of delivery Stephen Pinel, Health Improvement Practitioner, Oxfordshire County Council.
[email protected] Dr Eunan O’Neill, Consultant in Public Health, Oxfordshire County Council. Eunan.O’
[email protected] 26/02/2015
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)
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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 (1st October 2014 to 31st 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 26/02/2015
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)
Meeting with Practice Manager / Administrator
2. Risk Assessment (Standard 3 and 4) 3. Communication of Risk (Standard 6) 4. Risk Management (Standard 7, 8 and 9)
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 26/02/2015
Phase 1: QA Visit Outcomes
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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)
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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:
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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 26/02/2015
Progress to date (as of 13/02/15) 1% (1)
23% (18)
76% (61)
Completed 26/02/2015
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%
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Phase 1: Service User Feedback* Was sufficient information about the visit provided in advance? Yes: 100% Were dates and times offered convenient? Yes: 95% 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: 100% Was the visit beneficial to the Practice Manager? Yes: 84% Was the visit beneficial to the HCA/Practice Nurse? Yes: 100% 26/02/2015
*19 responses (out of 61 completed)
Phase 1: Service User Feedback “Helpful”
“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” 26/02/2015
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 26/02/2015
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
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