Sue Thomas is Chief Executive of NHiS Commissioning Excellence. Her background is in nursing, with extensive experience in primary care and commissioning. Sue is a Florence Nightingale Scholar, a Winston Churchill Fellow and has published over 150 papers and 20 book chapters. She regularly speaks at national and international conferences.
January saw the publication of ‘The Invisible Patients’ by the Neurological Alliance (NA 2014). The report showed that neurology patients are tumbling through the gaps, because many commissioners have an alarming lack of understanding around local neurological populations and their needs. At a time when NHS England has approved the first set of GP led clinical commissioning groups (CCGs) that will take on the responsibility for commissioning GP services in April (NHS England 2015), it has never been more important for local commissioners to actively improve their engagement with and understanding of neurology. It’s not impossible to get these services right – models of excellent practice across the country show it can be done. The major hurdle is knowing where the problems lie and the steps to take, many which the report highlights. Plus, delivering good services for long-term conditions tends to cost less overall – a great incentive for CCGs.
Various changes in the NHS are having a positive impact on neurology services and many of these are down to expert commissioning support services (CSS) which can help ensure changes are successfully implemented so that patients benefit from prompt treatment and management.
CSS can also help identify problem areas, like the top reasons for urgent care in neurology,which is very often not much different for other urgent care admissions – UTIs, chest infections and falls are common causes of admission but in neuro patients may result in a longer length of stay than someone from the general population. Managing patients with more proactive, preventative care could result in better patient outcomes and reduced admissions.
NHS Vale of York CCG recognised their need for expert neurology support and in partnership with a CSS identified how services were meeting need. They also consulted with a wide group of neurology patients to co-produce a new neurology strategy for York mapping and building separate process pathways for epilepsy, multiple sclerosis, Parkinson’s and motor neurone disease (MND), so that everyone knows what to expect along the disease journey.
Helping York understand their neurology data intelligence, the CCG discovered that compared to other matched CCGs, admissions for MND patients were low. This was the result of support from a specialist MND nurse Doreen Foster whose salary was supported by a local charity. The CCG saw the value this nurse provided and took over funding for the post. This is an excellent example of how data can uncover efficiencies in the system as well as inefficiencies! GPs also highlighted a need for more neurology education, and so the CCG has introduced training in neurology for GPs and a new referral support system has also been developed in partnership with Neurologists in the provider unit so that GPs can make more effective referrals. It’s too early to show results yet but neurology has been prioritised in the York CCG QIPP programme (Quality, Innovation, Productivity and Prevention).
Hull and East Yorkshire Hospitals NHS Trust worked with CSS to map the Multiple Sclerosis patient journey from diagnosis through the continuum of the disease process.Through this they identified that there were significant delays in referral to treatment time post diagnosis due to on-going specialist nurse referral delays. By developing a new patient pathway, which included converting an existing clinic into a new patient clinic, waiting times were reduced from twelve to two weeks – a remarkable improvement for patients.
Finally,with the help of CSS the Strategic Clinical Network in South East Coast has developed individual neurology data dashboards for each of its 21 CCGs.This has been really helpful for raising the profile of neurology and to help CCGs to understand their neurology intelligence. Moreover, data is essential for the CCGs to understand why there are demands on acute services so that steps can be taken to rectify issues and bottlenecks in the system.
These are just a few examples of CSS in action – demonstrating the value of expert neurology advice. The key to ensuring effective commissioning of neurology services is to make sure that CCGs have a baseline understanding of how services are currently working and also understand what models of care can provide better value. Right care defines value as:
- the value that the patient derives from their own care and treatment
- the value the whole population derives from the investment in their healthcare
Many relatively simple measures can help guarantee that in the future neurology patients are no longer ‘invisible’ but placed firmly on the NHS agenda.
Neurological Alliance (2015) The Invisible Patients, Neurological Alliance London
NHS England (2015) First CCGs take on commissioning of GP services http://www.england.nhs.uk/ccg-details/ last accessed 24 February 2015
NHS Right care programme (2015) htcare.nhs.uk/index.php/programme/ last accessed 24 February 2015