1. Summary of Learning Richard Thomson On behalf of MAGIC Cardiff and Newcastle

2. Key learning: Summary SDM is so much more than tools; more to do with skills and new ways of consulting (aided by decision support) Complex PDAs have a role, but also need simpler in-consultation support (Option Grids/Brief Decision Aids). Need to embed within clinical pathways (or adapt) and show value to clinicians Need for wider PPI at all levels

3. Key learning: Summary Important emerging role of patient activation (provided service is ready to respond) Measurement of patient experience hard at local level, but local measures likely to be of value if they stimulate change and inform clinical practice (e.g. DQM) Link to QI/service improvement – local context

4. Wider policy and systems issues SDM needs to be incentivised within the system (e.g. key metrics/performance management; national/ professional body support; commissioner buy in; board buy in) Tensions exist –Rapid progress through cancer care pathways –QOF ( e.g. for hypertension treatment targets) –Tendering processes within the English market –Criterion based models of referral management and NICE guidance may create tensions with SDM

5. Wider policy and systems issues Need for national coordination around education and training Coordination nationally between patient experience/SDM and LTC/SSM Access to resources at the time needed – e.g. within info systems Use of routine data for monitoring and QI Research needed (e.g. NIHR) to develop valid and reliable measurement of SDM