1. CVD Optimal Service Design Workshop Defining “what to change” using the NHS Right Care methodology
Part of the NEW Devon Way

2. Optimal Service Design Workshop Structure
Activity
timing
Introduction and Purpose of Today
15 mins
The purpose of today’s workshop
Why NEW Devon CCG has adopted NHS Right Care
How NEW Devon CCG uses NHS Right Care in QIPP planning
Gap Analysis
55 mins
Summary of deep dive findings
Review of deeper performance analysis
Best practice / optimal practice review
Q&A on deep dive findings
Adopt, Improve, Defend (AID)
65 mins
Work in groups to define:
Which best/optimal practice should be adopted
Which current practice should be improved
Which current practice can be defended
Feedback AID recommendations

3. Optimal Service Design Workshop Structure - continued
Activity
timing
Service Redesign
30 mins
Taking AID outputs, design the specification for the service
Action / strategy planning
15 mins
Produce action plan for new service specification and define strategic statements for longer term improvement
Workshop Feedback
5 mins
Feedback to make workshop a better learning experience
Questions
Final opportunity for questions

4. Optimal Service Design Workshop
Introduction &
Purpose
of Today

5. Optimal Service Design Workshop Purpose
To understand how NHS Right Care is used by for NEW Devon CCG
To understand the theory behind NHS Right Care
To understand the findings of the service deep dive and further analyse the topics selected for improvement
To design optimal service solutions to:
Resolve issues identified during the analysis
Set performance parameters for the new service design
Identify any strategic requirements
Reduce unnecessary variance in outcomes, quality & cost
To learn a standardised approach to evidence based change in NHS NEW Devon CCG

6. Systematic QIPP Development Adoption of NHS Right Care
NHS NEW Devon CCG must maintain a continuous list of improvement opportunities to ensure that QIPP requirements can be met each year
To do this we must adopt a standardised approach to QIPP development that will bring clarity and assurance to the QIPP proposals
NHS Right Care is designed for CCGs to tailor to their purposes using the overall methodology as a blueprint
NHS NEW Devon CCG will develop its use of the Right Care system in outline and refine it as the QIPP programmes develop, effectively testing it with delivery and improving as we go
5YFV “closing the gap” target for NEW Devon is to be upper quintile across the board, therefore all opportunities will be valued at a top 20% indicator
The deep dive has selected areas showing variation in the service that we need to change to meet peer performance and move towards national upper quintile
We are here to identify and agree changes to the service
to improve outcomes, cost and quality

7. Systematic QIPP Development NHS Right Care Overall Methodology
We are here
“What to change”

8. Systematic QIPP Development Phase 1 - Where to look
Where to look will happen once each year to produce a high level ranked list of opportunity to pursue
We do this using a series of nationally available indicative data comparing our performance against a selected peer group of health economies
The output of this phase is a scoped and ranked list of opportunity
Commissioning for Value
Atlas of Variance
Programme Budgeting
Local Interpretation
Benchmark, value, rank and prioritise themes using agreed national and local data.
Identify opportunity of top ranked themes.
Produce a scope per theme.
Present scope to steering
group for go/no go decision.
Themes ranked
With a scope
per theme

9. Systematic QIPP Development Phase 1 - Where to look (2015/16 data)
We have ranked all services by value (a combination of demand, outcomes, cost and performance)
For 2015/16 NHS Right Care shows a total value against peer of £116M and against the national upper quintile position of £268M
16 of the 22 categories have been selected for deep dive review in 4 waves in 15/16
These are not the QIPP targets but an indication of where our services are sub optimal compared with other health economies

10. Systematic QIPP Development Phase 2 part 1 - What to change
What to change starts with a deep dive exercise focusing on the selected theme
The deep dive pack is analysed (today’s exercise) and QIPP plans are defined with sufficient evidence to produce a project mandate.
The output of this phase is a project mandate
NHS Right Care deep dive is completed (4 weeks)
Detailed deep dive is analysed and prioritised and planned targets defined (3 days )
Implementation plans are drafted, business cases defined and project mandate produced (2 days)
Mandate assessed at steering group for go/no go decision
Note:
An example mandate is in your handouts

11. Systematic QIPP Development Phase 2 part 2 – What to change – today’s workshop
Once the mandate is approved we can undertake deeper analysis of the selected QIPP projects
This deeper analysis culminates in an optimal service design workshop including providers, patients and CCG members
The output of this phase is a project initiation document including the new service design, strategy and implementation plans
Assess gaps to best in class
Clinically led pathway redesign
Strategy for theme
Complete Strategy to action plans, full business case, & full PID
Test against gold target and initial objective
Full PID assessed at steering group for go/no go decision

12. Systematic QIPP Development Phase 3 - How to Change
Once the PID is approved we can start to implement the planned changes
Implementation will follow the NHS NEW Devon CCG turnaround methodology and will seek to deliver benefits as fast as possible
Projects will be delivered and sustained under the Turnaround governance structure

13. Optimal Service Design Workshop Systematic QIPP Development
Questions?

14. Optimal Service Design Workshop Gap Analysis
Deep Dive
Summary

15. Optimal Service Design Workshop Gap Analysis
Performance
Analysis Review

16. Optimal Service Design Workshop Gap Analysis
Best / Optimal
Practice Review

17. Optimal Service Design Workshop Gap Analysis
Questions?

18. Optimal Service Design Workshop
Adopt, Improve or Defend

19. Optimal Service Design Workshop Adopt, Improve, Defend
What:
Identify the key elements of the service that are sub-optimal
Determine if there is better practice for the element
Elect to adopt better practice, improve current practice or defend current practice
How:
Map the backbone of the service in patient flow order
Under each mapped step record the performance of the step
Identify better practice for the suboptimal steps and put it under each step
Elect to Adopt, Improve or Defend for that element
Patient managed in primary care
Patient managed in primary care then referred on
Patient seen at outpatients but discharged at first appointment
Patient receives follow up appointment
Patient admitted
Pathway Backbone
38% more than average in primary care
72% patients referred on from primary service
29% more than average discharged at first appointment
23% more than average follow up appointments
4.8% more patients admitted than average
Pathway Performance
NICE guidance on primary care management
Gloucester model for primary care management
Oxford model for O/P triage
NICE guidance on patient initiated follow up
Royal College recommendation on decision to admit
Better practice
Defend
Adopt
Improve
Adopt
Adopt
AID

20. Optimal Service Design Workshop Service Redesign
What:
Having elected an AID category for each step of the service define what the step will look like and how it will perform
Specify reasons with evidence for any defend decisions
How:
Map the backbone of the new service
Under each mapped step record the expected performance
Record key changes to current step to achieve the new one - “must” statements
If necessary add a strategic statement for the step
Patient still managed in primary care
Patients requiring acute service identified early
Patient triage completed by DRSS for GPwSI service
Patient initiated follow up iaw NICE guidance
Conservative treatment offered iaw guidance
New Backbone
38% more than average managed in primary care
50% reduction of patients managed in two settings
40% reduction in discharge at first appointment
25% reduction in follow up appointments
4% reduction in admissions
Expected Performance
Currently best use of interface service in UK
- Change spec for primary service
- GP funding for back referrals
Setup GPwSI service
Adopt Oxford triage protocol
- Standard letter to patient
- Reappointment “hot line”
Conservative treatment made available
Key Changes /
Defend evidence
To increase primary care management
To use patient decision aids
To reduce surgical intervention
Strategic statements

21. Optimal Service Design Workshop Action Planning
What:
Determine actions to make the key changes happen
Align the actions with the project timescale:
Implementation = making the change
Delivery = measuring the benefit
How:
Complete a post it for each action as shown
Put the post it on the timeline where the task starts
Add new planning categories as they emerge
For quick wins: date is ASAP; position on the timeline is not relevant
Action: stop all physio referrals to outpatients
Outcome: 2,300 unnecessary outpatient referrals stopped, 500 back referrals to GPs started
Date (from –to): ASAP
Owner: F Bloggs, commissioning lead
Implementation
Delivery
Planning Category
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Strategy
Commissioning policy
Pathway changes
Quick wins

22. Optimal Service Design Workshop
Workshop feedback

23. Optimal Service Design Workshop Next Steps
In the next two weeks, the CCG project team will:
Complete a project plan and business case for the proposed changes (PID)
Complete any further analysis required to support the business case
Identify and inform stakeholders of the planned changes
Submit to the CCG turnaround steering group for formal acceptance as a QIPP scheme

24. Optimal Service Design Workshop
Thank You