1. Dr Anne Talbot GP & Urgent Care Clinical Lead, Bolton CCG Associate Medical Director, Service Transformation, Greater Manchester Supporting urgent care using clinical dashboards: transforming data into knowledge

2.  An overview of the Urgent Care Clinical Dashboard concept (including dashboard screenshots)  The local implementation approach  The project’s current position  Benefits  Success factors and key messages Presentation Overview

3.  The dashboard collates the previous day’s urgent care activity data and brings it all together in a user-friendly graphical display, integrated with GP practice data  GP practice staff may access the dashboard on their desktops via secure login. District nurses and active case managers can be given access for practices they work with  Clinicians can drill down to a more detailed patient-level view  Each dashboard is clinically-driven and locally led. Sites can use existing technology to build their dashboard, keeping costs down and increasing flexibility The Urgent Care Clinical Dashboard Concept

4. A&E Attendances PatientAttendance Date PatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 A&E Attendances PatientAttendance Date PatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 PatientK 03/09/2012 Admissions PatientAdmission Date PatientA 01/09/2012 PatientH04/09/2012 Admissions PatientAdmission Date PatientA 01/09/2012 PatientH04/09/2012 PatientK 08/09/2012 Discharges PatientDischarge Date PatientA 08/09/2012 PatientK 08/09/2012 Walk in Centre Patient Attendance Date PatientM01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Walk in Centre Patient Attendance Date PatientM01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 PatientK 08/09/2012 PatientK 03/09/2012 Out Of Hours Patient Contact Date PatientT01/09/2012 PatientY 01/09/2012 PatientJ02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Out Of Hours Patient Contact Date PatientT01/09/2012 PatientY 01/09/2012 PatientJ02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 PatientK 02/09/2012 Practice Disease Register Patient Register PatientTDiabetes PatientSCHD Practice Disease Register Patient Register PatientTDiabetes PatientSCHD PatientK COPD Before the Dashboard Information From Acute Trust Information From Practice Information received separately from multiple sources within different time frames – making identifying patterns difficult Integrating sources of information

5. PatientAttendance Date PatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 PatientAttendance Date PatientA 01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 PatientAdmission Date PatientA 01/09/2012 PatientH04/09/2012 PatientAdmission Date PatientA 01/09/2012 PatientH04/09/2012 PatientDischarge Date PatientA 08/09/2012 Patient Attendance Date PatientM01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Patient Attendance Date PatientM01/09/2012 PatientF 01/09/2012 PatientJ 02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Patient Contact Date PatientT01/09/2012 PatientY 01/09/2012 PatientJ02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Patient Contact Date PatientT01/09/2012 PatientY 01/09/2012 PatientJ02/09/2012 PatientM 03/09/2012 PatientJ 04/09/2012 Practice Disease Register Patient Register PatientTDiabetes PatientSCHD Practice Disease Register Patient Register PatientTDiabetes PatientSCHD PatientK Dashboard: Patient Drilldown - PatientK ServiceAttendance DateRegister? PatientK 08/09/2012 03/09/2012 02/09/2012 08/09/2012 03/09/2012 WiC OOH Discharge Admission A&E Admission A&E Discharge OOH WiC COPD Information From Acute Trust Information From Practice Integrating sources of information

6. The original Bolton dashboard

7. Devon dashboard

8. Cambridgeshire dashboard

9. Brighton & Hove dashboard

10. Brighton & Hove dashboard – risk

11. Brighton & Hove – drilldown

12. How Bolton use the dashboard  Individual patient level  Practice operational level - identifies issues of primary care access  Locality operational level - identifies poor patient pathways, areas of training need across professional groups  Locality strategic level - tool linked to strategic aims, objectives and plans; A&E frequent attender initiative, hospital readmission initiative, public media campaign

13. Dashboard-enabled change; practice level

14. Locality level; A&E attendances over time

15. Bolton CCG readmission initiative Practices were asked to use the Clinical Dashboard to identify all their discharges, contact these patients within 48 hours of discharge and follow up on any problems identified.  29.8% reduction in 24 hr readmissions  15.5% reduction in 48 hr readmissions  Positive patient feedback

16. Implementation approach Project scoping (4 weeks approx) Project delivery (10 weeks approx) Pilot go-live (4 weeks approx) Wider rollout and review (ongoing) Benefit and Change ManagementClinical Metrics and SafetyTechnicalInformation GovernanceProject ManagementEngagement and CommunicationTraining

17.  Structure provided to local teams through an implementation guide and toolkit available on NHS Networks. This provides templates, guides, standard metrics, data feed specifications to enable rapid progression.  Early checks to ensure that key elements for a successful implementation are addressed. These include:  clear clinical leadership and engagement with the GP community;  assessment of the technical landscape and approach for sourcing data and delivering the dashboard;  Information Governance approach;  and the creation of the clinical group to review and agree the metrics for inclusion on the dashboard Implementation approach

18. Typical urgent care metrics TitleDescription Urgent Contact numbers by service by time period Provides number of patient contacts at each of the various local, unscheduled care services yesterday, last 7 days and last 30 days Urgent Contact numbers time series (by service or aggregated) Provides number of patient contacts at each of the various local, unscheduled care services as a timeline over the last 30 days Urgent Contact numbers time series with comparison to previous year Provides a comparison of this year’s activity with the same period last year Urgent Contact numbers by time-bands Provides details of the spread of urgent care contacts during a 24hr period Urgent Contact numbers comparison between GP Practice and Peer Group Provides a comparison for each GP Practice of the urgent care activity for their patients compared to an agreed peer group’s activity (e.g. CCG or like Practices by Demographic) Urgent contact numbers grouped by number of contacts Provides a view of the numbers of patients with a given number of contacts in the given time period e.g. 10 patients with 3 contacts in last 7 days Patient list by highest urgent contacts Provides list of patients typically by NHS Number who have the most frequent contacts in the last 7 days. This is supported by a number of drill down views to enable clinicians to see patients’ details, the nature of urgent care contacts and supporting information like risk scores (from a risk stratification module) and disease register information.

19. KEY Sites with live dashboards Sites in implementation phase Further scheduled dashboard deployments NHS Stoke on Trent and NHS North Staffordshire NHS Devon NHS Torbay NHS Plymouth NHS Tees (NHS Hartlepool, NHS Middlesbrough, NHS Stockton-on- Tees, NHS Redcar & Cleveland ) NHS Gateshead NHS County Durham and Darlington NE Lincolnshire Care Trust Plus and partners NHS Calderdale NHS Northamptonshire NHS Leicester City, NHS Leicestershire County and Rutland NHS Cambridgeshire NHS Peterborough NHS Luton NHS North Essex NHS Suffolk NHS Oxfordshire NHS Southampton NHS Buckinghamshire Central London Healthcare Partnership NHS Bolton South Cheshire and Vale Royal GP Commissioning Consortia NHS Merseyside (NHS Liverpool, NHS Halton & St Helens, NHS Knowsley, NHS Sefton) NHS Manchester NHS Central Lancashire Lancaster Morecambe Carnforth & Garstang CCG NHS Oldham NHS Tameside & Glossop NHS Trafford NHS Brighton and Hove NHS East Sussex Downs and Weald Medlinc CCG/NHS Surrey Dashboard implementation sites

20.  32 sites now have a live Urgent Care Clinical Dashboard. The dashboard is available to over 1000 GP practices, and covers a patient population of around 6.3 million. This will increase to 2000+ practices and 13.5 million patients when sites currently implementing complete their rollout to GP practices  Early implementers are adding further content to their dashboards, e.g. risk scoring, additional data feeds (e.g. ambulance), a pseudonymised organisation-wide view, yearly activity comparisons  Refined implementation toolkit, templates, tools and guide available to all at our NHS Networks site: www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp- dashboard www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp- dashboard  Dashboard User Group established, run by sites for sites Current position: dashboard project

21. Emergent benefits at live dashboard sites Reduced A&E attendances Reduced/prevented Emergency/Non-Elective admissions Shorter stay for some patients in unscheduled care via earlier, supported discharge Reduced prescribing waste More timely information on attendances, admissions, & discharges, enabling more proactive care Enables quicker and improved support for hospitalised patients Increased awareness of data quality issues from unscheduled care settings Improved communication between clinicians from different teams/organisations Increased awareness of unscheduled care activity of patients resident in care homes and for patients with long-term conditions Increased visibility of: touch points within patient pathways inappropriate unscheduled care attendances during practice hours patients who will benefit from active case management primary care access issues (for GP practices) how they perform compared to peer practices/consortium average spend against budget at practice/locality level unscheduled care activity for commissioning support staff Increased identification of opportunities for patient education re: use of unscheduled care

22. Critical success factors

23. Lessons Learned/Key Messages  It’s never too early to engage with clinicians, data providers, or IG leads  Keep focusing on the benefits which the dashboard will deliver  Often, simplest is best  Use the resources and support available; someone has probably solved your problem already!  The dashboard is an enabler; it’s what you do with the information it provides that makes the difference

24. Any questions? clinical.dashboard@nhs.net www.networks.nhs.uk/nhs-networks/qipp- urgent-care-gp-dashboard QIPP Digital Technology: Working with national and local teams to exploit digital technology in order to accelerate delivery of their QIPP priorities http://www.networks.nhs.uk/nhs- networks/qipp-digital-technology-and-vision qippdt@nhs.net