Welcome to Wessex Strategic Clinical Networks Transformation Project Workshop 20/09/2018

Ensuring access to appropriate neurological expertise Dr Chris Kipps Wessex Strategic Clinical Network Mental Health, Dementia and Neurological Conditions

Aims of this workshop To understand why patient access to specialist neurological support needs improving? Neurological support services – what are they and where are they? What can be done to improve access to existing services? What else should be considered?

Why does patient access to specialist neurological support need improving? Rising unplanned and potentially avoidable neurological admissions Long waiting times for neurology referrals Fragmented care for patients with complex long term conditions Limited capacity of consultant neurologists and neurologically trained nurses Variable awareness and understanding of neurological conditions among non-specialist health and social care professionals leading to delays and inappropriate referrals

What can be done to improve access to existing services? Review and map neurological resources and services across Wessex Identify neurological performance indicators Target referrals that do not always require neurological assessment, e.g. headaches Specify safe, evidence-based pathways Establish an effective, affordable model for Advice and Guidance schemes Improve information signposting for patients

Neurological support services – what are they and where are they?

Neurological support services – what are they and where are they? Headache Pathway Advice and Guidance Risk Stratification

Regional variation in emergency admissions

Regional variation in emergency admissions

Regional variation in emergency admissions

At your fingertips… http://fingertips.phe.org.uk/profile-group/mental-health/profile/neurology/

Turning this into relevant outcomes

Headache Pathway Redesign Partnership project: West Hampshire CCG, HHFT, SCN funded by Wessex AHSN Project approach uses improvement science methodology Baseline surveys: diagnosis and management in Emergency Department and Primary Care Demand and capacity baselines for neurology outpatients Headache referral to discharge pathway mapping, and outcomes Managed headache pathway proposal designed stratifying risk for early access to neurological expertise or supported self- management in primary care Design concept for headache clinical decision support tool “HEADMAT” using digital innovation technology supported by potential pilot locality in West Hampshire

Headache Pathway Redesign Project Enablers Benefits Audit baselines pre- and post-implementation: -GP satisfaction -Current patient pathways and outcomes -Current referral rate   Design new headache diagnosis and management support tool (HEADMAT) Increased GP satisfaction Increased patient satisfaction Reduced outpatient referrals Improved quality of clinical assessment and accurate diagnosis of headache presentations Reduced patient waiting times and faster access for serious conditions More effective treatment

West Hampshire GP Headache Survey What GPs think of their knowledge and skills in diagnosing complex headaches

West Hampshire GP Headache Survey What GPs think of a decision support tool for diagnosing and managing headaches

West Hampshire GP Headache Survey What GPs say that they need “Better access to MRI head scan would be helpful – then I am more confident in managing unusual headaches” “I would like to be able to access CT scanning and then the referral rate would drop” “Telephone advice is hugely useful – current neurologists are much more approachable than those we have had in the past”

What else should be considered? Feedback and discussion Where do we look next to have the greatest impact on improving access to neurological support: Commissioning engagement Mapping neurological pathways and pathway re-design Advice and Guidance schemes Critical events and risk stratification of follow up Decision support tools in primary care Sharing innovation and best practice in other conditions

For more information Talk to us Get involved Complete a contact card Access our websites: http://www.wessexscn.nhs.uk/ http://www.wessexsenate.nhs.uk/ Email us at england.wessexscn@nhs.net

Variation in emergency admissions Source: Neurology Profiles, Public Health England, 2014

Variation in emergency admissions Source: Neurology Profiles, Public Health England, 2014

Variation in emergency admissions Source: Neurology Profiles, Public Health England, 2014