1. Audiology & Primary Care: Improving the process of seeking help for hearing loss Sarah Bent Principal Clinical Scientist & Lead for Clinical Improvement (Audiology) Therapies & Clinical Support CPG Leadership course Sept 2014-Feb 2016

2. Audiology & Primary Care  Project choice: Development methodology Scoping Project team Project aim & measures PDSA cycles  Test change: Self-referral to Audiology Process Results  Implementation & future work

3. Scoping: Voice of Customer  Patient story: “I found everything very positive....The only negative was that my GP asked “Would you wear a hearing aid?” but I said “Of course I would”, that was why I had gone, I would have done whatever was needed.... I didn’t know I was going deaf, I thought it was everyone else’s problem... So it was about 2 years before I went, as soon as I realised....When I went to the GP that was all I asked about. I do think that a lot of people have them and don’t wear them and it must annoy him that that happens, so maybe that was why he asked.”  Lessons learnt:  Process - additional question asked by GP, went about hearing only, clear about the outcome wanted  Timing - delay in process was in realisation, pathology addressed appropriately

4. Scoping: Voice of Staff  Stakeholder consultation & analysis WIIFM: Significant others, patients, surgery receptionist.... through to Audiology and ENT

5. Scoping: Voice of System  Strategic drivers for focus on access to Audiology: Meets principles of prudent healthcare Engage in Primary Care workforce planning Raised in consultation for WG National Plan for Audiology in Wales  National drivers: Primary Care workforce Aging population Dementia

6. Scoping: Process mapping

7. Scoping: Idea generation  Letters to clinical inboxes  District Nurses syringing housebound only  Dedicated ear syringing clinic  Patient education on ear syringing  Walk into Audiology for assessment  Online booking for Audiology  Online checklist for Audiology self- referral  Move away from GP gatekeeper  Shorter first appointment with Audiology  Audiology performing all wax removal (with resources)  ENT performing all wax removal (with resources)  Referral done other than by GP  Nursing homes complete own syringing  Benefit of Audiology even if don’t want a hearing aid  Extend current self-referrals  Linking or saving referrals directly  Audiology appointments sooner - already 4 to 6 weeks  Get in touch with Audiology directly  Housebound coded by GP  Dates available asked by referrer

8. Project team  Project lead  Audiology representatives Business manager Local head of adult rehabilitation  Primary care representatives GP cluster lead Panton surgery The Laurels surgery  District nurse representative

9.  Aim Statement:  5 month trial to improve process of seeking help with hearing by reducing number of steps in Adult Hearing Loss Pathway through self-referral in Holywell Primary Care Cluster  Measures:  Primary measure: Number of steps in process  Secondary measures: Uptake, satisfaction, effectiveness of referrals Project aim & measures

10. Test change: Self-referral to Audiology  PDSA cycle 1 Plan – Referral criteria, pathway, resources, practice staff informed Do – Oct 15: change to self-referral Study - Monitor data, interim team meeting Act – Implement change as PDSA cycle 2  PDSA cycle 2 Plan – Detail for cycle 2 agreed Do – Jan 15: self-referral via other professionals, promotion event to accelerate awareness Study – Monitor data, final team meeting Act – Decision on future implementation

11. Self-referral process

12. Results  Primary measure: No change - majority still referred via GP  Secondary measures: Uptake – low (11), GPs reported no reduction in forms given out Satisfaction – mixed (wax, none attendance) Effectiveness – no clear change in motivation, lower age mean (61 years, usual mean 71 years)  Cycle 1 versus cycle 2 Increase in second period (not thought due to changes made)  Recommendations Assurance that no dramatic increase in service uptake Possible use for lower age group, but alongside referral by professional Longer trial period recommended

13. Implementation & future work  Implementation Results back to Audiology department Consideration in light of other developments  Other referral trials (Sept 2015-March 2016) MDT (Ffordd Gwynedd vanguard project) referrals Falls Pathway (Physiotherapy) referrals Memory Care Pathway (Audiology) referrals  Advanced Audiology Primary Care Practitioners Three practitioners – East, West, Centre Development of service over 3 years – focussed on primary care referral by Audiology professional instead of GP To be rolled out to all Primary Care Clusters

14. Thank you for listening