1. Setting the Scene Dr Nick Kennedy
Healthcare Improvement Scotland (HIS) Clinical Advisor on HIV
Co-chair Scottish HIV Clinical Leads Network

2. Five key questions
Why are Boards being asked to develop HIV Integrated Care Pathways (ICPs)?
When do we have to do this by?
Can we get any support with this work?
What should the ICP include?
What is an ICP anyway?

3. A definition of an Integrated Care Pathway:
An ICP determines locally agreed multidisciplinary and multi-agency practice, based on guidelines and evidence where available for a specific patient/client group. It forms all or part of the clinical record, documents the care given, and facilitates the evaluation of outcomes for continuous quality improvement.
Sue Overill, Journal of Integrated Care (1998) 2, 93-98

4. Why develop HIV ICPs? Heathcare Improvement Scotland
Sexual Health and BBV Framework SG

5. 9.1
‘The NHS board can demonstrate .... the presence of an established HIV treatment and care network .....’
9.2
‘The NHS board has in place an integrated care pathway (ICP) for the management of HIV patients’

7. Oversight and support Scottish Government
Sexual Health and BBV Framework team
HIV Clinical Leads Network
HIV ICP Subgroup (now subsumed into main group)
Healthcare Improvement Scotland
Input and support from
Standards & Indicators Development Unit team
David Thomson, National ICP coordinator
NHS Boards
Local ICP coordinators/ leads
Local clinicians & multi-disciplinary teams
Scottish Pathway Association -

8. Questions/ issues National HIV ICP or local HIV ICPs?
Local, but with agreed
Core pathway
Essential components
Are Boards expected to ‘start from scratch’? No
Share learning (i.e. beg, borrow or steal...) from Boards who have advanced furthest
Formally link with other Boards if this suits
Does the final document have to resemble Tolstoy’s War and Peace?
When should Boards have their HIV ICPs in place by?
November 2013
What is the core pathway & the essential components?

9. HIV Integrated Care Pathway Flowchart
Positive HIV test (from any source)
Patient transfers care from another HIV unit
Discussion of initial result and confirmatory HIV test
This may take place at HIV clinic or other setting
See list of ‘essential ICP components for initial diagnosis or transfer of care’
Patient attends HIV clinic
Within 2 weeks of diagnosis (HIS and BHIVA Standards)
Contact, offer support and re-engage in services
3-month review
Annual review
Lost to follow up
Continued
follow-up
This will usually be at 3, 4 or 6-monthly intervals but will be dependent upon individual patient circumstances
FINAL DRAFT

10. List of Essential Components for an HIV ICP presentation to month 3