1. QIPP National Urgent Care Clinical Dashboard “From the outset it has been clear that the dashboard is a powerful tool to help clinicians understand the quality and effectiveness of their care, providing an invaluable tool to integrate and proactively manage care across our local health economy” Dr Anne Talbot, GP & Associate Medical Director, NHS Bolton

2. Provides “real-time” information from local Acute Trust on A&E attendances, admissions and discharges combined with “real-time” information from Out of Hours and the Walk in Centre to each GP Practice. Displayed in a graphical, user-friendly way to help Practices to more pro-actively manage and co-ordinate patient’s healthcare, especially for the most vulnerable patients and those with long-term conditions. Doesn’t contain any more information than the Practice already receives, but presents the information in a timely way, displaying all of information together to present a more complete picture. NHS Bolton Urgent Care Dashboard

3. A&E Attendances PatientAttendance Date PatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 A&E Attendances PatientAttendance Date PatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 PatientK 03/02/2009 Admissions PatientAdmission Date PatientA 01/02/2009 PatientH04/02/2009 Admissions PatientAdmission Date PatientA 01/02/2009 PatientH04/02/2009 PatientK 08/02/2009 Discharges PatientDischarge Date PatientA 08/02/2009 PatientK 08/02/2009 Walk in Centre Patient Attendance Date PatientM01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Walk in Centre Patient Attendance Date PatientM01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 PatientK 08/02/2009 PatientK 03/02/2009 Out Of Hours Patient Contact Date PatientT01/02/2009 PatientY 01/02/2009 PatientJ02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Out Of Hours Patient Contact Date PatientT01/02/2009 PatientY 01/02/2009 PatientJ02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 PatientK 02/02/2009 Practice Disease Register Patient Register PatientTDiabetes PatientSCHD Practice Disease Register Patient Register PatientTDiabetes PatientSCHD PatientK COPD Current Position Information From Acute Trust Information From Practice Information received separately from multiple sources within different time frames – making identifying patterns difficult Integration of information from multiple source systems

4. PatientAttendance Date PatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 PatientAttendance Date PatientA 01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 PatientAdmission Date PatientA 01/02/2009 PatientH04/02/2009 PatientAdmission Date PatientA 01/02/2009 PatientH04/02/2009 PatientDischarge Date PatientA 08/02/2009 Patient Attendance Date PatientM01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Patient Attendance Date PatientM01/02/2009 PatientF 01/02/2009 PatientJ 02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Patient Contact Date PatientT01/02/2009 PatientY 01/02/2009 PatientJ02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Patient Contact Date PatientT01/02/2009 PatientY 01/02/2009 PatientJ02/02/2009 PatientM 03/02/2009 PatientJ 04/02/2009 Practice Disease Register Patient Register PatientTDiabetes PatientSCHD Practice Disease Register Patient Register PatientTDiabetes PatientSCHD PatientK Clinical Dashboard: Patient Drilldown - PatientK ServiceAttendance DateRegister? PatientK 08/02/2009 03/02/2009 02/02/2009 08/02/2009 03/02/2009 WiC OOH Discharge Admission A&E Admission A&E Discharge OOH WiC COPD Information From Acute Trust Information From Practice Integration of information: simple working example

5. Dashboard interface Enables GPs, nurses and active case managers to monitor their own patients' recent attendances at A&E and out-of-hours services, and to highlight which of these patients are on disease registers.

6. 1 st stage patient level drill down GPs, nurses and active case managers are able to access individual patient information including the care setting the patient presented at, frequency of contact and whether the patients is on a disease registers. This information can highlight issues with the local delivery of care for specific types of disease management, providing pointers about where to focus local improvement efforts most effectively

7. 2 nd stage patient level drill down Enables GPs, nurses and active case managers to see a more granular level of patient information including the symptoms the patient presented with and the outcomes. Such information can greatly assist pro-active clinical intervention for patients with multiple presentations to unscheduled care settings. In particular, this level of information can help GPs and other healthcare staff to identify those patients in need of detailed Primary Care assessments, to then review existing management plans, and to establish new levels of care or assistance where this is needed.

8. Identifying patients regularly accessing unscheduled care services This report shows urgent contacts, sorted in order by highest number of contacts. This enables practices to identify and focus on those patients that are regularly accessing unscheduled services.

9. Quality Benefits Improved awareness about practice patients attending unscheduled care services, enabled GPs and Practice Healthcare staff to proactively and better manage vulnerable patients and those ‘just below the clinical radar’ The dashboard was used as an enabler and integrated alongside related initiatives to better channelling patient pathways and improving patient experience Efficiency Benefits Within the first pilot practices in Bolton, one practice reduced their A&E attendance by 16.8%, compared to an increase of 3.85% in their peer practices. A second practice reduced their non-elective admissions in targeted areas of asthma, COPD, diabetes, falls and heart failure by 20.69%. Use of the dashboard combined with wider ‘joined-up’ initiatives and excellent clinical engagement across the PCT helped led to significant reductions in A&E attendances and non-elective admissions. Benefits and levels of use

10. The Urgent Care Dashboard is now part of the QIPP Urgent Care workstream led by Sir John Oldham. QIPP National Urgent Care Clinical Dashboard High level aim - to make the Urgent Care Clinical dashboard (based on the NHS Bolton dashboard) available to all PCTs /GP Consortia across England over the next 2 years, starting with 12 locally led pioneer sites.

11. NHS Stoke on Trent and NHS North Staffordshire NHS Devon NHS Tees NE Lincolnshire Care Trust Plus / NHS North Lincolnshire / North Lincolnshire & Goole Hospitals NHS Foundation Trust NHS Northamptonshire NHS Cambridgeshire NHS Oxfordshire Central London Healthcare Pathfinder GP Consortium Newham Health Partnership / Newham Commissioning Group South Cheshire and Vale Royal GP Commissioning Consortiums NHS Central Lancashire NHS Brighton and Hove QIPP Urgent Care dashboard - Pioneer Sites

12. Wider objectives Inform the strategy and approach to the wider ‘local’ take-up of the Urgent Care dashboard Development of Local SHA/PCT Cluster/GP Consortia capability to become self-sufficient in supporting local deployment To create a toolkit to support wider take-up of the Urgent Care dashboard including Standards, Logical architecture, data feeds library, detailed design documentation, project management artifacts and updates to metrics repository QIPP National Urgent Care Clinical Dashboard

13. Further information & contact Resources NHS Networks - http://www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp- dashboard Further information Background Information http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/Medicaldirectorsbulletin/D H_122289http://www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp- dashboard http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/Medicaldirectorsbulletin/D H_122289 DH QIPP http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm NHS Institute for Innovation and Improvement http://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html http://www.institute.nhs.uk/cost_and_quality/qipp/cost_and_quality_homepage.html NHS Evidence http://www.evidence.nhs.uk/qualityandproductivity http://www.evidence.nhs.uk/qualityandproductivity Details relating to National Pilot (including case studies and toolkit) http://www.cfh.nhs.uk/clindash http://www.cfh.nhs.uk/clindash Contacts T eam Mailbox – clinical.dashboard@nhs.net