1. A managed care network for patients with neurological impairment Malcolm Macleod (Clinical Lead, Neurology) and Derek Blues (MCN Manager) NHS Forth Valley

2. Models of organisation …for a disease? –epilepsy, MND, MS … …for all neurological diseases? –so no discrimination on the grounds of prevalence …for all neurological impairments? –so no discrimination on the grounds of organicity – whats important are the symptoms not the cause

3. Diagnostic apartheid and QiS 5 important diseases –Epilepsy, PD, MS, MND, headache Either: –Other diseases (i.e. patients) not as much of a priority (care already considered adequate, patients not as deserving) –Other patients are as much of a priority, and due attention to generic standards will improve the quality of much of their care

4. Other patients are as much of a priority, and due attention to generic standards will improve the quality of much of their care Aspiration Inappropriate focus on disease specific standards will distract effort from other areas Some disease specific standards may have generic isoforms or homologues –Medicines reconciliation and timing

5. Opportunities in establishing an MCN Ensure an holistic approach to audit driven activities Sustaining existing MCN activities Broader platform for consultation Coherent input to planning and management Platform for research and audit Pooling and sharing of resources

6. Challenges in establishing an MCN Resources –Financial –Management and clinical energy Perceived reduction in services already covered by MCN Size of patient pools

7. MCN HEALTH LOCAL AUTHORITY PATIENT AND CARER VOLUNTARY SECTOR PRIVATE SECTOR What is an MCN?

8. Who is involved? Clinical Lead Protected Time Need not be the Recognised expert

9. Who is involved? MCN Manager Dedicated resource Support MCN project work MCN Support

12. What is an MCN? A sensible way of organising for effective team working The chance to use one voice to influence strategic direction The focal point for service development for a specific disease or for a particular area of care

13. Actions & outcomes Information resources for clinicians, patients and family members

14. Actions & outcomes Development towards an MDT clinic for small patient groups who dont have access to any dedicated service

15. Actions & outcomes Disease specific developments to meet gaps in the existing service

16. Actions & outcomes CREATE SESSION – 17 JUNE 2010 Who gets it? What conditions are we talking about? How many people ? Who is involved in providing the care? What else can we do? What is a Neurological condition? What effects do they have? Questions Opportunities for education

17. Actions & outcomes Interaction with patient groups and voluntary sector organisations

18. Contact details 01786 457256 derek.blues@nhs.net

19. Demands for data QiS Audit Other national audits –MS Register, SAIVMS, MND audit, BNSU audits 18 weeks RTT compliance Revalidation Service design Feasibility of research projects Long term conditions framework and avaiodance of admission Scottish Patient Safety Program

20. Types of audit data Quantitative or qualitative (numbers or words)? Interval or continuous? Sample or population? Internal or external?

21. A local solution to data management Principle: –a single patient data management system which will serve these multiple demands for data Desirable characteristics: –Simple to use –Avoids duplication of effort –Adaptable to local needs –Secure –Common data definitions –Data available to those who need it

23. Ward referral: delay to opinion Mean Wait> 24hrsTotal% breach April19.32450 May33.081747 June14.332114 July21.851436 August56.83560 September34.921217 October18.451338 November12.73933 319533

24. Delay until letter despatched n mean typing max typing mean checking max checking mean total max total Q113922.6353.01225.542 Q222511.11467.03518.0146 Q321916.5694.92721.473

25. Patients referred since 1 st April within 3 weeks of tripping 18 weeks CHIInvestigationDate requested xxxxxxxxxxNCS24/09/2010 xxxxxxxxxxMRI spinal cord29/09/2010 xxxxxxxxxxEMG29/09/2010 xxxxxxxxxxFSH genetics29/09/2010 xxxxxxxxxxMRI brain29/09/2010 xxxxxxxxxxeyewitness18/08/2010 xxxxxxxxxxMRI brain05/10/2010 xxxxxxxxxxAChR antibodies12/10/2010 xxxxxxxxxxEMG12/10/2010 xxxxxxxxxxMRI brain12/10/2010 xxxxxxxxxxCSF protein/ glucose/ cell count18/08/2010 xxxxxxxxxxCSF protein/ glucose/ cell count17/09/2010 xxxxxxxxxxECG20/08/2010 xxxxxxxxxxeyewitness account xxxxxxxxxxNCS20/08/2010 xxxxxxxxxxMRI spinal cord15/09/2010 xxxxxxxxxxroutine bloods15/09/2010 xxxxxxxxxxMRI brain13/10/2010 xxxxxxxxxxMRI brain29/09/2010 xxxxxxxxxxMRI brain12/10/2010 xxxxxxxxxxMRI spinal cord12/10/2010 xxxxxxxxxxNCS12/10/2010 xxxxxxxxxxct angiogram14/10/2010 xxxxxxxxxxMRI brain14/10/2010

26. Other uses Record assent to be contacted for audit, research Disease specific activity statistics Disease specific audit reporting (BSNU) Linkage to specialist nurse held data systems Patterns of requesting investigations