1. Performance monitoring framework: worked example Rapid access chest pain service Gateshead Public Health Partnership

2. Worked example Rapid access chest pain clinic (RACPC) Gateshead service since 2001 Change to traditional outpatient appointment/ assessment process Consultant led service Clear pathway Distinct client group- those with new onset chest pain

3. The RACPC clinic is quicker and has fewer steps than traditional services for new onset chest pain Pathway duration

4. Where might we look for evidence for impact of RACPC? Safe services with good outcomes Differences in health experience minimised Longer lifeHealthier life Client experience & equitable use Better health from service contacts Equity audit Client surveys & waiting times Service monitoring/ review Fair access to appropriate services

5. Evidence RACPC Safe services with good outcomes Differences in health experience minimised Longer lifeHealthier life Client experience consistent? Prompt diagnosis and effective treatments initiated? Uptake matches prevalence? Client surveys & waiting times Proportion of positive diagnoses? Fair access to appropriate services Client outcome consistent?

6. Context Not all dimensions will be explored Some dimensions can be explored in more detail –In this service, there is regular monitoring of positive diagnoses, and what happens to the individuals concerned. Feedback from clients is also regularly sought. These are not presented in detail here, but should be summarised as part of any overview of a service. –The following slides look at fair access to services- whether those most likely to have coronary heart disease use the service as much as expected

8. Commentary on access graph This graph (which uses historical data) shows considerable variation in the referral to such services from different parts of Gateshead to the RACPC clinic Does this matter?

10. Commentary Whilst we cannot be certain, we would expect that more people from the less affluent parts of Gateshead to have higher levels of coronary heart disease, and therefore would need the service more than others In practice, for some parts of Gateshead, this does not appear to be the case. Those highlighted appear to have lower levels of referral than the mean. Since this analysis, the spread of referrals from GPs has been broadening

11. Using the performance monitoring framework Only one element has been elaborated for this example of using the framework It serves to illustrate that the framework can be applied to single services as much as to strategies an population initiatives