Long Term Conditions
Commissioning Plans
Dr Adrian Mairs
LTCANI Meeting 13th August 2012
LTC Service Team
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Reports to Commissioning Programme Board
Sponsor
Joint PHA/HSCB Chair
Linked groups
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Cardiovascular Commissioning Group & Network
Stroke Strategy Implementation Group
Respiratory H&W Group
Neurological conditions Sub-group
NIVASC
Remit
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Regional commissioning guidance
– Framework for local plans
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Annual commissioning plan
Review TDPs
Clinical linkages / partnerships
PPI
Scope
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Cardiovascular services / Framework
Diabetes
Respiratory services / Framework
Neurological conditions
All ages
Commissioning Drivers
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PfG
TYC: integrated care, “shift left”, diagnostics
McKinsey
Quality 2020 Strategy
NICE
Service Frameworks
PPI
Programme for Government
(PfG)
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Enhance access to life-enhancing drugs for conditions such as
rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis
and increase to 10% the proportion of patients with confirmed
ischaemic stroke who receive thrombolysis
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Identify and evaluate the current baseline of patient education and self
management support programmes that are currently in place in each
Trust area
TYC - LTC
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Self care & prevention – partnership working
Personalised care plans - home based mx.
Named contacts for patients
Use of information systems to support care pathways
Medicines management – community pharmacy
Admissions protocol
Telehealth
McKinsey
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Quality & productivity improvements
Better management of LTCs
Reduced LoS
Enhanced /effective home & community
services
Shift to lower cost settings
NICE Technology Appraisals (TAs)
For each Technology Appraisal, the HSC Board will submit a
Commissioning Plan to the Department within 15 weeks
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TA 236 - Acute coronary syndromes: Ticagrelo
TA 244 - Chronic obstructive pulmonary disease: Roflumilast
TA 248 - Diabetes (type 2): Exenatide (prolonged-release)
NICE Clinical Guidelines
For each Clinical Guideline endorsed by the Department, the HSC Board
will submit a Board Response to the Department within no more than 15
weeks
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CG 36 - Atrial fibrillation
CG 87 - Type 2 Diabetes – Newer Agents (update of CG66)
CG 101 - Management of chronic obstructive pulmonary disease in adults
in primary and secondary care (partial update)
CG 105 - The use of non-invasive ventilation in the management of motor
neurone disease
CG 119 - Diabetic foot problems - inpatient management
CG 126 - Stable Angina
CG 130 - Hyperglycaemia in acute coronary syndromes
CG 134 - Anaphylaxs
CG 137 - Epilepsy
Commissioning Context
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Programme for Government
Commissioning Plan Direction
Commissioning Plan
TDPs
Population Plans
Commissioning Plan Direction
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AAA Screening – June 12
Thrombolysis: increase to 10% - March 13
Telemonitoring: 400k monitored pt. days –
March 13
Unplanned admissions:↓ 10% - March 13
Performance indicators
Unscheduled Care Specification
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Proactive Mx of LTCs
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10% ↓ unscheduled hospital admissions
↓ LoS
Local economies
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Practice registers / risk profiling
Regular primary care review
Patient education & self-management
Integrated community teams
Escalation procedures
Medicines management
Tele-monitoring
Commissioning Plan
Specific Targets
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By March 2013, increase to 10% the proportion of
patients with confirmed Ischaemic stroke who
receive thrombolysis
By March 2013, achieve 400,000 Monitored
Patient Days (equivalent to approximately 2,200
patients) from the provision of remote telemonitoring services through the Tele-monitoring NI
contract.
Commissioning Plan - LTCs
Key Deliverables
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Implement COPD Integrated Care Pathway
Expand provision of insulin pumps to children &
adults with Type 1 diabetes
Identify & evaluate current baseline of patient
education & self management programmes in
place in each Trust area
Self Management / Patient
Education Programmes
Baseline Audit
Wendy Thornton
Public Health Agency
Monday 13 August 2012
1. Background
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Key commitment (priority 2) in PfG 2011-15
Key
Commitment
Milestone
2012/13
Milestone
2013/14
Milestone
2014/15
Enrol people who
have a long term
(chronic) condition,
and who want to be
enrolled, in a
dedicated chronic
condition
management
programme
(DHSSPS)
Identify and evaluate
the current baseline of
patient education and
self management
support programmes
that are currently in
place in each trust
area
Health & Social Care
Board / Public Health
Agency should work
with key stakeholders
to develop and secure
a range of quality
assured education,
information and
support programmes
to help people
manage their long
term conditions
effectively, alongside
full application of the
Remote
Telemonitoring
contract
People with a long
term condition will be
offered access to
appropriate education,
information and
support programmes
relevant to their
needs, including
innovative application
of connective health
2. Key characteristics?
Patient Education
Programmes
Self Management
Programmes
Support Groups
KEY CHARACTERISTICS
KEY CHARACTERISTICS
KEY CHARACTERISTICS
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Part of care pathway
Referral from health
professional
Likely secondary care
setting
Time limited
Condition specific
Clinically/health professional
led
Robust QA mechanisms
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Examples include....
Cardiac & pulmonary rehab
programmes
Various diabetes education
programmes
Not currently part of care
pathway (but ideally should
be?)
Likely self referral
Likely primary or community
care setting
Time limited
Fully or partially peer led
Holistic approach
Can be either generic or
condition specific
QA mechanisms less robust
perhaps?
Examples include....
CH&S – “Taking Control” programme
Arthritis Care – “Challenging your
Condition”
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Not part of care pathway
Likely community care
setting
Ongoing – not time limited
Peer led
Unscripted & informal
Focuses on social aspect
Lack of QA mechanisms
Examples include....
Various respiratory support groups
3. Audit scope
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Specific programmes only (not support groups)
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Programmes for patients only (not carers)
Physical AND mental health programmes
LTCs – key 4 - diabetes, asthma, COPD, heart
failure, plus others...
Includes Condition Management Programme
(CMP) – DEL/Trust partnership programme
Includes Trust and I.S provided/funded
programmes
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4. Methodology
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Questionnaire (in form of Excel
spreadsheet)
Distribute to Trusts & IS orgs during Autumn
6 weeks timeframe for completion
Info collated and analysed by PHA/DHSSPS
LTC Regional Implementation Steering
Group