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How clinicians can lead service redesign

Posted on 10 October 2012 by Mike Henley  6 comments

The reconfiguration debate is often about large-scale plans that involve closures of departments or entire hospitals. What you hear about less are the smaller scale service changes driven by those of us that work in the NHS.

Take chronic disease for example. A consequence of people living longer is that they are more likely to have to live with one or many chronic conditions. The burden of chronic disease casts a shadow on patients’ lives and places a huge pressure on NHS budgets.

I’m a urologist involved in a project that aims to improve services by embedding them in the community and using intelligent information technology.

We have calculated that, for prostate cancer patients, you can improve the service and save roughly £500,000 per 700,000 patient catchment area, per year.

We have developed software that pulls together the basic data about a patient’s care from various IT systems. A nurse, armed with this information, will then have a consultation with the patient. By asking questions about symptoms or problems the patient may be experiencing, the system can be used to identify whether they need specialist advice or can safely continue in nurse-led care.

The software takes 26 different situations into account before providing a management plan. It can safely provide care based on national guidance for all men with stable prostate cancer.

This leaves GPs, specialist oncology nurses and consultants free to concentrate on more complex cases. It also allows patients to be seen by a nurse close to home rather than having to travel to their nearest hospital. A nurse can be trained to use the software in a single day. Compare this to the current situation where it takes between one and two years to train and assess a specialist nurse as safe.

One of the amazing facts to come out of this work is that the doctors showed an error rate of about 10%, the computer rather irritatingly had an error rate in testing of zero.

I am not suggesting computers are infallible but reducing mistakes is a great outcome.

The system can also, if desired, produce a referral letter in the patient’s native tongue. Not many medical staff can do that in real time. It will then email the letter directly to the patient’s GP. No notes are needed, no typing up or letters to be posted.

My example of service redesign is small but it illustrates the improvements that can be achieved when clinicians work together to bring about change that raises the standards of care. Reconfiguration doesn’t have to be something that is done to you — clinicians can take the lead. By getting involved we can help ensure that financial pressures are not the only factor that drives change.

Mike Henley is a Derby consultant urological surgeon and a member of the BMA Consultants Committee

Posted in:  Reconfiguration

Tags:  Reconfiguration NHS reform

Comments

  • Sara hedderwick

    16 October 2012

    This is why engaging clinicians rather than antagonising them is so much more cost effective. It's the small changes in practice, reproduced elsewhere which make the patient experience so much better. "Give us the tools and we will finish the job".

  • Prof Chris Booth, Urologist

    22 October 2012

    Of course doctors should be leading on service redesign! Who else has the necessary expertise? The best redesigns are lead through collaboration between clinical leaders and patients supported by whole team review and feedback.
    Check out "Shifting Care Closer to Home" , "World Class Commissioning" and the "Action On" programmes for numerous examples.

  • Robert Varnam, GP

    23 October 2012

    Thank you for this encouraging report. I believe doctors have an ethical duty to improve the systems by which our patients are treated. Also, to continue finding those situations where we can simultaneously improve quality, safety, patient experience and cost - they're legion. By sharing - and adopting - great practice like this, we can keep the NHS free for future generations.

  • Natasha Jones, consultant in Sport and Exercise Medicine, Oxford

    23 October 2012

    As a new consultant in a new specialty, service redesign is part of the job description. Our team of clinicians have recently led the redesign of primary care exercise interventions locally, developing an innovative service using a novel computer application. Our strength in this service is the partnership we have formed with the third sector. I have found commissioners open to new ideas, particularly if they can see improvements in patient care, attention to quality and robust evaluation. Our challenge is to keep energy levels high in difficult financial times.

  • Mitch Blair Prof of Paediatrics

    23 October 2012

    Great example of training to task as advocated by Nigel Edwards ex Ceo nhs. See his book Turning the World upside down. Really important book about what we can all learn from developing world with limited resources. Sound familiar?!

  • Hamish Laing, Director of clinical strategy and plastic surgeon

    23 October 2012

    All clinicians have a responsibility to help shape services that give the best outcomes and experience for patients: at a time of reducing funding our role becomese even more important.
    Patients and the public (and politicians) look to doctors for reassurance that changes are really about improving care, so it is critical that we get behind good evidence-based changes and help make thema reality. Fortunately better and safer care is usually cheaper for the NHS too.

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