‘town planning’: can it help?

‘Town Planning’: can it help?

Sue RobertsFor the Diabetes Team

‘Then you should say what you mean’ the March Hare went on

‘I do’ Alice replied ‘at least – I mean what I say…’

What do these mean to you? Do they all mean the same?

Integrated care pathway. Patient pathway Patient journey Care pathway A ‘pathway approach’

Diabetes Do Once and Share

Planning Levels

Level 1

Level 2

Level 3

Level 4

National & generic

Locally defined

Level 1 : Like a map

DiagnosisInitial

ManagementContinuingCare

PREVENTION

EVENTSEVENTS

Non diabetes admissions

protenuria

heart disease

stroke

ED

Pregnancy

Institutional care

Foot issuesEye

problems

ketoacidosis

Severe hypos

life events

treatment change eg

insulin

new complications

Diabetes NSF

Level 1 : Like a map

Diagnosis

Continuing management

specialist renal advice

Pre RRT treatment and choices

Dialysis and transplantation

End of life care

Renal NSF

Planning Levels

Level 1

Level 2

Level 3

Level 4

National & generic

Locally defined

Level 2: drilling down – the ‘town plan’

Quality criteria

Workforce competencies

NICEGuidance/

HTAs

Do Once and Share

Data items for EHR

Continuing Care

Care planning

Structured education

Psychologicalsupport

Planning Levels :National

Level 1

Level 2

Level 3

Level 4 Locally defined

NSFs,

More definition, Quality criteria, NICE, HTAs competencies etc

Level 3: The local diabetes / renal community: Designing and building

Your model of care

Your workforceDesigning your town

2ry3ry

1ry com

………and commissioning

IC

Planning Levels

Level 1

Level 2

Level 3

Level 4

NSFs,

More definition, Quality criteria, NICE, HTAs competencies etc

Local Model of care – matched to local need

Level 4: ‘Running the show’ How the model works in

practice Who does what / when / In what order Referral pathways What the patient can

expect to happen With knowledge support

Can be presented as algorithms

Should be audited The town council

Care pathways!

Planning Levels

Level 1

Level 2

Level 3

Level 4

NSFs,

More definition, Quality criteria, NICE, HTAs competencies etc

Local Model of care – matched to local need

Care pathways

Responsibilities at each level

Level Responsibility

1 National responsibility, Diabetes / Renal NSF already published

2 National working groups

3 PCT Commissioning: Local diabetes networks need to develop models of care to inform this

4 Providing: Local diabetes networks should develop their local care pathways once model of care has been agreed

What local services like to do!

Level 1

Level 2

Level 3

Level 4

NSFs,

More definition, Quality criteria, NICE, HTAs competencies etc

Local Model of care – matched to local need

Care pathways

Roles for networks on behalf of Local Health Communities (LHCs)

Role Action Level of activity

Commissioning Design, Advise (possibly commission) local models

Level 3

Co-ordination Co-ordinate (possibly manage) local services once model agreed

Level 4

Audit and Monitoring

Audit / monitor to feed into service improvement and future commissioning (and demonstrate contract compliance)

Level 4

Conclusions

The NHS needs clinicians and patients to get involved

The language of levels Explains what needs to be done Clarifies national vs. local Helps people see their roles Enables discussion within /between

disciplines and services So that…

Patients experience high quality services matched to their local need

Thank you!

Level 3: The local diabetes / renal community: Designing and commissioning

Designing your town

2ry3ry

1ry com

IC

Your model of care

Your skill mix

Diagnosis

Continuing management

specialist renal advice

Pre RRT treatment and choices

Dialysis and transplantation

End of life care

Level 2: drilling down

Quality criteria

Workforce competencies Knowledge

Support

Do Once and Share

The EHR

Continuing Care

Care planning

Structured education

Psychologicalsupport

Level 2: drilling down

Quality criteria

Workforce competencies Knowledge

Support

Do Once and Share

The EHR

Continuing Care

Care planning

Structured education

Psychologicalsupport