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

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

3. 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?

4. 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

5. 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

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

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

8. Regional variation in emergency admissions

9. Regional variation in emergency admissions

10. Regional variation in emergency admissions

11. At your fingertips…

12. Turning this into relevant outcomes

13. 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

14. 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

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

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

18. 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”

19. 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

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

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

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