Patient-initiated appointment systems: an alternative for hospital outpatient care?

Patient-initiated appointment systems: an alternative for hospital outpatient care?
PenARC Evidence Synthesis Team 23 April 2020

• Patient-initiated appointment systems (PIAS) enable patients to request a medical appointment when they feel it is needed and could reduce the number of those appointments allowing flexibility in the outpatient health care system. 
• A review of the evidence in 17 RCTs suggest that PIAS may have little or no effect on patient anxiety, depression and quality of life compared to consultant‐led appointment systems. Aspects of disease status, adverse events and patient satisfaction also appear to show little or no difference. There may also be little or no effect on service utilisation in terms of contact with health services but there is uncertainty about the impact on costs. Areas for further research include variations in the benefits and experiences of PIAS due to population characteristics and conditions.

The health commissioner perspective. 14 May 2020

Choose Wisely UK

Choosing Wisely UK

• Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses. It is encouraging patients to have informed discussions with their clinicians and shared decision making.

RCGP Person-Centred Care Toolkit

Person-Centred Care Toolkit
RCGP ongoing

• The Person-Centred Care Toolkit has been developed with NHS England to support GPs and primary care teams deliver person-centred care. The person-centred care approach gives people more choice and control in their lives by providing an approach that is appropriate to the individual's needs. 
• Includes The conversations, social prescribing, health literacy, shared decision making, health coaching, personal health budgets, the consultation. Also a short evidence listing to support PCP.

Universal Personalised Care: Implementing the Comprehensive Model

Universal Personalised Care: Implementing the Comprehensive Model
NHS England 31 January 2019

• This document sets out how the NHS Long Term Plan commitments for personalised care will be delivered. It establishes the Comprehensive Model for Personalised Care, comprising six, evidence-based standard components, and the detailed 21 actions to achieve its systematic implementation, right across the country. Implementation will be guided by delivery partnerships with local government, the voluntary and community sector and people with lived experience.
• The components are:

1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management
6. Personal health budgets and integrated personal budgets

Does hospital competition reduce rates of patient harm in the English NHS?

Does hospital competition reduce rates of patient harm in the English NHS?
Competition and Markets Authority 31 January 2019

• Previous hospital mergers have reduced the number of distinct organisations offering publicly funded and provided care in the NHS, reducing choice and between-hospital competition in some areas. 
• This paper tests the impact of variation in concentration on a new quality indicator: the prevalence of patient harm from falls, pressure ulcers, blood clots and urinary tract infections. Analysis finds a significant inverse relationship between concentration and quality. Specifically, estimates imply that a hypothetical merger to monopoly would, on average, be associated with a significant increase in harm rates. 
• In addition to the direct effect on patients’ well-being, even small gains to health from competition would likely give rise to large savings for the taxpayer because of reduced treatment costs.

Updates to NHS.uk website https://www.nhs.uk/

Update to NHS.uk website https://www.nhs.uk/
A new look NHS.uk website includes 

• Health A-Z (complete guide to conditions, symptoms and treatments), 
• Medicines A-Z (how your medicine works, how and when to take it, possible side effects), 
• Social care and support guide
• Behind the headlines (health headlines), 
• NHS App library 
• links to NHS services

NHS App

NHS App
NHS Digital, NHS England October 2018

• The NHS App provides a simple and secure way to access a range of healthcare services by smartphone or tablet. The NHS App will be rolled out gradually across England from December 2018 to patients aged 16 and over. 
• User testing is starting in October across Liverpool, Hastings, Bristol, Staffordshire and South Worcestershire.

Personal Social Services Adult Social Care Survey, England - 2017-18

Personal Social Services Adult Social Care Survey, England - 2017-18
NHS Digital 2 October 2018

• Findings from the annual Adult Social Care Survey 2017-18 (ASCS). 
• The survey seeks the opinions of service users aged 18 and over in receipt of long-term support services funded or managed by social services and is designed to help the adult social care sector understand more about how services are affecting lives to enable choice and for informing service development.

Coordinate My Care launches online patient portal

Coordinate My Care launches online patient portal
NHS Digital 9 February 2018

• Coordinate My Care (CMC) is an NHS clinical service that informs GPs, hospitals, ambulance crews, 111 providers, care homes, hospices and out of hours services about a patient’s wishes for urgent and end of life care.
• The new myCMC portal, which uses InterSystems’ unified health informatics platform HealthShare, allows patients to arrange their own urgent care plans online for the first time.

Collaborative action for person-centred coordinated care (P3C)

Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care
Health Research Policy and Systems 2017 15:98

• This paper presents an approach to the implementation of person-centred coordinated care (P3C) using collaborative action, the core aim of which is to accelerate the spread and adoption of P3C in UK primary care settings. 
• Includes analysis of early developments based in the South  West.

How can we all best use scientific evidence?

How can we all best use scientific evidence?
Academy of Medical Sciences June 2017

• A survey of British adults which indicated that only 37% of the public said they trusted evidence from medical research, compared to 65% who trusted the experiences of their friends and family. 
• The Academy of Medical Science has drawn up an action plan on how to make sure medical research is robust, relevant, trusted and that the evidence generated is useful and accessible to doctors and patients.

Next Steps on the Five Year Forward View - Accountable Care Systems

Next Steps on the Five Year Forward View - Accountable Care Systems
NHS England 31 march 2017

• "ACSs will be an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined up, better coordinated care."
• ACSs are STPs – or groups of organisations within an STP sub-area – that can:
• choose to take on clear collective responsibility for resources and population health to provide joined up, better coordinated care.
• together manage funding for their defined population,
• create an effective collective decision making and governance structure,
• operate on a horizontally integrated basis
• also operate as a vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,000-50,000 populations.
• deploy rigorous and validated population health management capabilities 
• establish clear mechanisms by which residents will still be able to exercise patient choice 
• In Q1 2017/18, NHS England and NHS Improvement will jointly run a light-touch process to encourage other STPs (or coherent parts of STPs) to come forward as potential ACSs and to confirm this list. Likely candidates include:
• Frimley Health
• Greater Manchester
• South Yorkshire & Bassetlaw
• Northumberland
• Nottinghamshire, with an early focus on Greater Nottingham and the southern part of the STP
• Blackpool & Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage.
• Dorset
• Luton, with Milton Keynes and Bedfordshire
• West Berkshire
• Some ACSs may lead to the establishment of an accountable care organisation (ACO) where the commissioners in that area have a contract with a single organisation for the great majority of health and care services and for population health in the area. 

Securing meaningful choice for patients: CCG planning and improvement guide

Securing meaningful choice for patients: CCG planning and improvement guide
NHS England, NHS Improvement, January 2017

• The guide draws together the minimum legal and contractual responsibilities CCGs need to meet, but will also enable CCGs to assess how well choice is working in the services they commission, for both physical and mental health, within their localities and decide where improvement is required.

The NHS Choice Framework

The NHS Choice Framework
Department of Health 29 April 2016

• This Guidance sets out patients’ rights to choice in healthcare, where to find information to help choose, and how to complain if choice isn’t offered.

Contents
1. My NHS care: what choices are available to me?
2. Choosing your GP and GP practice
3. Choosing where to go for your first appointment as an outpatient
4. Asking to change hospital if you have to wait longer than the maximum waiting times (18 weeks, 

or 2 weeks to see a specialist for cancer)
5. Choosing who carries out a specialist test
6. Choosing maternity services
7. Choosing services provided in the community
8. Choosing to take part in health research
9. Choosing to have a personal health budget
10. Choosing to access required treatment in another European Economic Area country
11. Where can I get more information to help me choose?
12. What should I do if I require a reasonable adjustment?
13. Contacting the organisations mentioned in this guide

Collaborative Healthcare: Supporting CCGs and HWBs

Collaborative Healthcare: Supporting CCGs and HWBs to support integrated personal commissioning and collaborative care
Inclusive Care, January 2016

• A guide and collection of case studies for CCGs and HWBs around the principles of collaborative care, individual choice and control and patient and public participation. 
• Includes
• 1. Experts by experience and self-advocacy. 
• 2. Self-Directed Support and personal (health) budgets. 
• 3. Capabilities (asset-based) approaches to health and care. 
• 4. Co-production and citizen-led commissioning. 
• 5. Community development and building social capital. 
• 6. Networked models of care.

Patient choice of hospital - location and quality

Location, quality and choice of hospital: Evidence from England 2002/3 - 2012/13
Centre Health Economics, University of York, January 2016

• Research using data from 2002/3 to 2012/13 on choice of hospital for elective hip replacement.
• Distance from the hospital is the most important single factor in the choice of hospital for elective care, and this is likely to especially so for hip replacement patients who may have mobility problems. However, patients are may also be influenced by quality and waiting time when choosing amongst hospitals.
• The analysis highlights changes over the period when constraints on choice of provider were relaxed (2006).

Jeremy Hunt HSJ Annual lecture 29 October 2015 - the elephant traps and patient power

Jeremy Hunt HSJ Annual lecture 29 October 2015

Full transcript here: http://www.hsj.co.uk/newsletter/news/hsj-annual-lecture-full-transcript/5091559.article
Video: http://www.hsj.co.uk/newsletter/home/video-health-secretary-announces-ofsted-style-ratings-for-ccgs/5091754.article

Highlights:

51% of patients seen by their GP were referred

Outpatient Appointment Referrals July 2015
NHS England, Monitor 16 September 2015

• In online interviews with 6,989 adults in England & Wales (June / July 2015) 5,347 patients had seen their GP in the past 12 months, of whom 2,729 (51%) had been referred for an outpatient appointment.
• Of those referred 65% had discussed with their GP  which hospital or clinic they  might go to for their first outpatient appointment.
• 64% of young people (18 - 25 year olds) were not offered a choice

Overview of waiting time and patient choice policies

NHS maximum waiting times and patient choice policies
House of Commons Library Briefing, 16 September 2015

• Maximum waiting times
• Patient rights to maximum waiting times
• Pledges on waiting times
• Mental health services
• GP appointments
• New cancer waiting time commitments
• Patient choice
• Shared decision making
• Choice of provider 
• Transferring to a different hospital
• Seeking a second opinion
• GP services
• Personal health budgets
• Mental health services
• Treatment in another European Economic Area country
• http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7171 

Impact of patient choice on levels of demand for elective care

New joints: private providers and rising demand in the English National Health Service
Institute for Fiscal Studies, IFS Working Paper W15/22, August 2015

• This paper investigates how changes in hospital choice sets affect levels of patient demand for elective hospital care. 
• We exploit a set of reforms in England that opened up the market for publicly-funded patients to private hospitals. Impacts on demand are estimated using variation in distance to these private hospitals, within regions where supply constraints are fixed. 
• We find that the reforms increased demand for publicly-funded procedures. For public hospitals, volumes remained unchanged but waiting times fell. Taken together, our results provide new insights into how individuals make choices about their care and the scope of competition between hospitals.