1. Map of Medicine – NHS Wirral Andy Poole Project Manager – Map of Medicine NHS Wirral 17 th September 2009

2. Overview of the Map in Wirral The Map is commissioning based but clinically driven It helps to engage local health community (LHC) staff and clinicians to drive pathway development It is used to review, redesign and find gaps in existing pathways and services Recommendations from pathway development carried forward

3. Modernisation Teams Typical membership of 12-20 people: PCT Medical Director (Chair) Lead Consultant(s) Programme Manager Locality GP representatives Nursing/Midwifery Staff Patient/Public representative Other provider representatives Meet quarterly, with informal task & finish groups set up for pathway work

4. Robust Governance Procedure Pathway targeted Map of Medicine consulted Pathway published! Circulated to GPs Discussed and agreed by Modernisation Team Signed off by PEC/providers

5. Overview of the Map in Wirral Pathways: 44 pathways published 3 pathways awaiting PEC approval COPD and AMD pathways published before national versions existed Users:

6. What we’ve done so far: Some examples…

7. Commissioning a service using the Map Dyspepsia pathway: Review of dyspepsia pathways using Map of Medicine by cross-sector team Gap identified in current service (H. pylori testing) New pathway adds choice and convenience

8. Commissioning a pathway from scratch Wet Age-Related Macular Degeneration (AMD) service Rapid redesign of pathway facilitated by use of the Map New pathway publicised on Wirral view of the Map Waiting times cut from 10 weeks to 10 days

9. Commissioning a new community service Low vision assessment pathway Drafted by: Primary & secondary care clinicians Community optometrists Social services Voluntary & educational agencies Patient reps Next steps: Service spec Collaboration vs. tender process

10. Collaborative Commissioning Directors of Commissioning targeted spinal services due to inappropriate referrals for expensive interventional procedures Cross-region discussions based on Map spinal pathways, jointly led by NHS Wirral and NHS Warrington Standardised care for patients across the C&M region Local administrative information able to be amended for each area Cheshire & Merseyside spinal pain pathways:

11. Use in Practice Based Commissioning Musculoskeletal pathways undergoing review Targeting: ◦Reduction in inappropriate referrals ◦Improved patient journey MoM used as commissioning/ redesign/ educational tool Wirral musculoskeletal pathways:

12. Wirral now involved in NHS Institute Rapid Improvement Programme NHS Wirral chosen as one of ten sites nationally to participate in children’s programme Selected pathway, ‘Wheezy child’, will be configured using the Map as a starting point

13. Map of Medicine – NHS Wirral E.andy.poole@wirral.nhs.uk T.0151 651 0011

14. Structure & Reporting Map of Medicine 18 Week Programme Board Professional Executive Committee Structure: Map of Medicine sits within the Health Systems Management Directorate, formerly Commissioning & Contracting Reporting: The project reports to the 18 Week Programme Board and PEC which in turn reports to the Board Localised pathways are signed off directly by PEC & provider organisation Wirral Board Programme Managers Quality Team Health Systems Management Directorate

15. NHS Wirral Population ~ 320,000 62 GP practices 1 Acute Trust