Map Of Medicine
Dr Andrew O'Brien
Islington CCG
Islington
• Most densely populated local authority in England and Wales
• Population of 206,100 (Census 2011) over 14.86km²
• 34% of population born abroad and 26.1% BAME
• 57% of population under 35
• Paradoxically Islington ranks within the top 20 of most
prosperous boroughs in the country (Local Future 2010) whilst
at the same time being ranked as the 8th most deprived
boroughs nationally in 2010
Data Source – ONS – Life Expectancy for local areas in England and Wales 2008-2009.
NHS ISLINGTON. June 2010. Closing the Gap, Tackling Health Inequalities in Islington.
Source - Paper 2: Health Inequalities in Islington. The Islington Fairness
Commission
Context
• Number of 1st outpatient appointments in Islington rising
• Variation exists in management of patients between
practices in the borough
• Large number of local services and providers and very
difficult for primary care clinicians to be kept abreast of
these
• Referral management centre approach not locally palatable
Why the Map of Medicine?
• One stop source of local and international clinical guidelines
• Directory of local services
• Communication Tool – e.g. Contact Details & Waiting Times
• Potential for being a central repository of referral forms
• Ensure patient seen by right service at the right time using the
right form… and help CCG to meet QIPP savings in process
Story so far..
• Negotiations and preliminary work commenced April 2013
• Initial local pathway development began August 2013
• ‘Familiarisation Event’ took place 26th September 2013
• Map ‘live’ in Islington October 2013 with 26 local pages
published
Story so far..
• Training of all 37 local practices completed between October
2013 and January 2014
• Currently 64 pages of localised content have been published
and on course for 100 page target by end of October 2014
• Testing of auto-population of referral forms currently on-going
in parallel with collation of all referral forms to create central
repository of referral forms
Engaging with stakeholders
•
•
Practices – Use and take up of tool tied in with the GMS contract
via QP markers. Points gained by:
1.
Attending the Familiarisation Event
2.
Configuring (setting up) the tool for each user (50% of clinicians must have logged
on since launch to qualify)
3.
Utilising the training offered to practices
4.
Completion of survey at end of QOF year
Further event for MoM for GPs planned for December 2014 with
new LCS incorporating engagement with MoM & regular updates
via GP Bulletin and education events
Engaging with stakeholders
• Providers
1.
Engagement with secondary care clinicians in creation of
pathways via working groups
2.
Empowerment of providers to edit local information to
improve maintenance of local content
3.
Stakeholder event (Providers and Neighbouring CCGs)
planned for September 2014
4.
Consideration of adding engagement with MoM in
contracts
Generating Content
Adapt existing local pathways and service information for the map
Develop Map of Medicine versions for local pathways already in development
Work with Providers, 3rd sector, GPs and Patients to identify and develop new pathways and content for the map
Generating Content
• Small core team of Project Co-ordinator, administrator and
Clinical Lead
• Training on map editing delivered to all of primary care team,
members of medicines management team, joint
commissioning (mental health & children’s services), CSU
and Public Health team
• Use of Map Editor to design and edit pathways live during
meetings with clinicians present
ICCG
MoM Governance
Structure
Published Local Maps
Clinical Pathways
Hepatitis Pathways –
• HBV and HCV Testing
• HBV vaccination
• Management of Hep B sAg +ve
• Management of HCV RNA +ve
•Paediatric Pathways –
• Acute Wheezy Episode (2-5 yrs)
• Acute Asthma Attack - Management for
known asthmatic Children (5-18 yrs)
• Constipation in children & young people
• Epilepsy
• Weight management (4-17yrs)
• Reflux
• Allergies in Children
• Diabetes Pathways–
1. Glycaemic Control
2. Oral anti diabetic agents
• Vitamin D Pathways
• Vitamin D Deficiency in Children
• Vitamin D Deficiency in Adults
• Ophthalmology
• Low Vision Service
• Respiratory
• COPD
• Acute exacerbation of COPD
•
•
•
Oxygen Prescribing
Smoking cessation
COPD prescribing guidelines
Published Local Maps
Mental Health
Community Services
• Mental Health Services
• Substance Abuse Pathways
• Locally commissioned direct access mental
health services in voluntary sector
• Physiotherapy & Podiatry referral
forms & waiting times
• District Nurse Service Structure &
Contact Details
• Locality Navigators
Medicines Optimisation
Referral information & Criteria
1.Antimicrobial Guidelines
1.DVT referral pathway
• Erectile Dysfunction (Prescribing)
• Management in Undernutrition in Adults
(MUST)
• Prescribing Guidelines
• PoLCE guidelines
Referral Guidance
Form Directory
Usage
Usage
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Feedback
Challenges
•
Keeping it relevant and up-to-date
•
Generating more content whilst maintaining quality & control
•
Overcoming IT barriers to usage
•
Proving impact
•
Keeping GPs and providers engaged
Still work in progress...
come back in 6 months for
clearer answer
Thank You
Dr Andrew O'Brien
andrew.obrien@islingtonccg.nhs.uk