NHS People Pulse

NHS People Pulse
NHS England

• The NHS People Pulse is a national online survey, developed for all NHS provider and commissioner organisations, to support local listening and engagement activities. Results will provide a regular national, regional and local view of employee experience and wellbeing.
• NHS People Pulse has been running since 1 July 2020 and was due to end on 31 January 2021 but has been extended for at least a further 12 months.

Involving NHS staff in research

Involving NHS staff in research
THIS Institute 7 February 2019

• This report explores why and how NHS staff (ie people directly and indirectly involved with delivery – everyone across clinical, managerial, administrative and support roles) contribute to research, the factors that enable engagement, the impact of engagement on research processes and outcomes, and the implications for future engagement efforts.

Approaches to improving staff engagement in the NHS - a quick guide

Approaches to improving staff engagement in the NHS - a quick guide
NHS Employers 22 January 2019

• A core set of approaches to staff engagement that have had positive impacts on organisations where they have been implemented effectively. The guide links to resources and case studies looking at how NHS organisations have put ideas into practice.

What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice?

What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review
BMC Medical Informatics and Decision Making, November 2018, 18:93

• Analysis of 69 studies concludes technological interventions must focus on providing decision support for clinical practice using recognised behaviour change techniques. Interventions must consider organisational context, clinical workload, and have clearly defined benefits for improving practice and patient outcomes.

Abstract:

Core Cities network - NHS Clinical Commissioners

The Core Cities Network
NHS Clinical Commissioners October 2018

• The Core Cities Network is a peer led network representing CCGs from the eight core cities in England outside London whose aim is to improve the health outcomes of populations that live in complex city environments.
• The Core Cities Network - Newcastle Gateshead CCG
• This case study explores the value of clinical engagement and collaboration as well as the challenges of and benefits from working across different geographies. 
• The Core Cities Network - Greater Nottingham Transformation Partnership 
• This case study looks at how commissioners and providers in Nottingham used the results of system-wide actuarial analysis to develop a framework that improves care, infrastructure and governance.

New care models: harnessing technology

New care models: harnessing technology
NHSCC, NHS Confederation, NHS Providers, LGA 11 September 2017

• An examination of how digital tools can help to deliver health and care services. 
• The report stresses the importance of involving stakeholders, both service users and clinicians, at all stages of introducing new digital technologies, and that local areas should "steal with pride" and make use of learning and evidence from other areas.
• Case studies from five vanguards - East and North Hertfordshire, Better Care Together Morecambe Bay, Better Together Mid Nottinghamshire, Salford Together and East Midlands Radiology Consortium.

Partnerships for improvement: ingredients for success

Partnerships for improvement: ingredients for success
Health Services Management Centre, University of Birmingham for Health Foundation, 6 September 2017

• This briefing summarises the main findings of a research report (see below) which looks at a range of current organisational partnerships, and draws tentative learning to help inform and guide both policymakers and providers.and what providers and policymakers can learn. 
• Most research has focused on the impact of structural mergers and acquisitions between health care providers. Studies show that realising financial or quality benefits from mergers of health care organisations is far from straightforward and often takes years to materialise. 
• Buddying schemes are popular across occupational sectors, but there is little academic research available on the effects or effectiveness of these more informal forms of partnership. The report examines five case studies to explore different forms of informal partnership and to understand the key ingredients for success for each.

Partnering for improvement: inter-organisational developments in the NHS

HSMC University of Birmingham September 2017

Reward in the NHS - the Total Reward Engagement Network

Reward in the NHS
NHS Employers 2 May 2017

• Themes, good practice, and innovation that have emerged from the Total Reward Engagement Network (TREN). Themes include:
• using reward to support organisational priorities
• benefits and rewards
• communicating reward
• the overall reward offer
• testing and evaluating reward.
• The network provides an opportunity for organisations from across the NHS to come together to share experiences and hear about what other organisations are doing in reward.

"Do no do" recommendations from Royal Colleges

Forty treatments that bring little or no benefit to patients
Academy of Medical Royal Colleges 24 October 2016

• The AoMRCs has compiled 40 recommendations from Royal Colleges of treatments that bring little or no benefit to patients. 
• This is core to their Choosing Wisely initiative which calls doctors and patients to have a fully informed conversation about the risks and benefits of treatments and procedures.
• The complete list of recommendations can be found on the Choose Wisely website here.
• See also AMRC launches Choosing Wisely programme

Clinical commissioning: GPs in charge?

Clinical commissioning: GPs in charge?
Kings Fund, Nuffield Trust 12 July 2016

• CCGs were set up to put GPs at the heart of NHS planning decisions. This report looks at their progress in implementing their clinically led model and what more needs to be done.
• This is the final report from a major project evaluating the progress made by six CCGs tracked since they were established in 2012

New Care Models and Staff Engagement: All Aboard

New Care Models and Staff Engagement: All Aboard
NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association 15 June 2016

• A guide to the work vanguards are doing to engage their staff in the design and delivery of new care models. 
• The publication contains four case studies which examine the ongoing work of NHS and local government organisations that are ensuring staff are at the heart of all decisions about new models of care in local areas. They are:
• All Together Better Dudley (multispecialty community provider)
• Barking and Dagenham, Havering and Redbridge System Resilience Group (urgent and emergency care)
• Better Care Together – Morecambe Bay Health Community (integrated primary and acute care system)
• East and North Hertfordshire Clinical Commissioning Group (enhanced health in care homes)The publication also identifies a number of key principles in order to help plan staff engagement when developing new models of care.

What makes a top clinical commissioning leader?

What Makes a Top Clinical Commissioning Leader?
NHS Clinical Commissioners, May 2016

• Through a series of interviews with both clinical and managerial CCG leaders this report highlights how both clinical and managerial leaders are integral to the success of a CCG. 
• It identifies qualities that make a top clinical commissioning leader including resilience, openness, emotional intelligence and being good communicators, with excellent listening skills and the ability to instill clarity of purpose.

How do you maximize clinical input into CCGs?

Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS
J Health Serv Res Policy May 5, 2016 1355819616648352

• Research from the University of Manchester.
• Objectives To explore the ‘added value’ that GPs bring to commissioning in the English NHS. Researchers f describe the experience of CCGs in the context of previous clinically led commissioning policy initiatives.
• Methods Realist evaluation. We identified the programme theories underlying the claims made about GP ‘added value’ in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice.
• Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the ‘added value’ that GPs bring to commissioning.
• Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.

Has clinical commissioning found its voice?

Has clinical commissioning found its voice? GP perspectives on their CCGs
Kings Fund 4 April 2016

• A slide set presenting the results of the fourth Kings Fund annual online survey of the views of GPs and practice managers' across six CCGs .
• The focus has been on CCGs’ relationship with their members – in particular:
• How involved are CCG members in the activities of the CCG, and what relationships are being built between them and CCG leaders? 
• How are CCGs discharging their responsibility to support quality improvement in general practice?

What happens when GPs engage in commissioning?

What happens when GPs engage in commissioning? Two decades of experience in the English NHS

J Health Serv Res Policy April 2016 vol. 21 no. 2 126-133

• Analysis of 218 published papers (published 1991 to 2010) by researchers from the Centre for Primary Care, University of Manchester concludes that there is limited evidence for a significant impact of clinical engagement on commissioning outcomes. While engagement of GP members of primary care commissioning organizations is an important determinant of progress, it generates significant transaction costs.       
• Research highlighted both 'virtuous cycles’ (experience of being able to make changes feeding back to encourage greater engagement) and ‘vicious cycles’ (failure to influence services generating disengagement).
• Engagement of the wider GP membership was an important determinant of success. Most impact was seen in GP prescribing and the establishment of services in general practices. There was little evidence of GPs engaging more widely with public health issues. Initial changes are likely to be small scale and to focus on services in primary care.

 

Exploring the GP ‘added value’ in commissioning

Exploring the GP ‘added value’ in commissioning: What works, in what circumstances, and how?
PRUComm 13 October 2015

• An exploration of the potential added value that clinicians, specifically GPs, bring to the commissioning process through interviews and observations of commissioners at work.
• Four programme theories were identified that were most frequently claimed by both GPs and managers around frontline knowledge about patient experience and services, clinician to clinician conversations and GP-manager symbiosis.
• While GPs can and do ‘add value’ to the commissioning process, there was evidence of duplication of effort, wasted opportunities and failure to make best use of GPs time and talents.
• The report includes actionable messages for GPs, CCGs and policy makers, 

RCP vision for structural reform of the NHS

Putting the pieces together: removing the barriers to excellent patient care
Royal College of Physicians,  17 September 2015

• The RCP outlines many of the structural and systematic challenges faced by patients whilst presenting a vision of how to reform and improve the systems and structures that underpin the NHS.
• The RCP believes that a sustainable, joined-up and person-centred health and care system is necessary to achieve the best health and healthcare for everyone. To translate this vision into reality they have outlined a number of principles which should form the foundations for the service planning, commissioning, contracting and payment mechanisms that underpin the way care is provided. These include:
• Empowering commissioners to collaborate 
• Valuing quality of care above competition 
• Valuing clinical engagement and joined up leadership
• Not making short-term plans for long term problems 
• Building better payment systems
• Fostering a sustainable workforce
• Promoting innovation
• The report includes examples of commissioners, service planners and clinicians building strong, collaborative relationships to improve patient care.
• In a second report - "How physicians can influence the commissioning system: a guide to getting involved" the RCP provide a practical guide designed to help make sense of the different ways that physicians can influence the planning and commissioning of patient care. 

GP engagement in commissioning

What happens when GPs engage in commissioning? Two decades of experience in the English NHS.

J Health Serv Res Policy. 2015 Jul 8.

• A review of the evidence on commissioning schemes involving clinicians in the NHS (1991- 2010), found that the extent of clinical engagement varies between the various schemes. Schemes allowing clinicians to act autonomously were more likely to generate significant engagement, with 'virtuous cycles' (experience of being able to make changes feeding back to encourage greater engagement) and 'vicious cycles' (failure to influence services generating disengagement) observed. 
• Engagement of the wider GP membership was an important determinant of success. 
• Most impact was seen in GP prescribing and the establishment of services in general practices. 
• There was little evidence of GPs engaging more widely with public health issues.

AMRC launches Choosing Wisely programme

Choosing Wisely in the UK: the Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine
BMJ 2015;350:h2308 (12 May 2015)

• The Academy of Medical Royal Colleges is launching a Choosing Wisely programme along the lines of the US initiative to get doctors to stop using interventions with no benefit.
• To ensure the development of a Choosing Wisely culture in clinical practice, the academy suggests:
• Doctors should provide patients with resources that increase their understanding about potential harms of interventions and help them accept that doing nothing can often be the best approach
• Patients should be encouraged to ask questions such as, “Do I really need this test or procedure? What are the risks? Are there simpler safer options? What happens if I do nothing?”
• Medical schools should ensure that students develop a good understanding of risk alongside critical evaluation of the literature and transparent communication. Students should be taught about overuse of tests and interventions. Organisations responsible for postgraduate and continuing medical education should ensure that practising doctors receive the same education
• Commissioners should consider a different payment incentive for doctors and hospitals.


• An American study published in BMJ has demonstrated only modest success so far. See BMJ 2015;351:h5437 (Available through NHS Open Athens)
• Follow "Choose Wisely" research on PubMed.

How do we change professional practice?

Tailored interventions to address determinants of practice.
Cochrane Database of Systematic Reviews 2015, Issue 4. Art. No.: CD005470.

• This updated review of tailored interventions to change professional practice (ie those which take into account factors explaining current professional practice, including reasons for resisting change) identified 32 studies, of which 17 were based in primary care.
• Approaches include audit and feedback, education, patient care plans.
• Analysis showed that while these interventions can change professional practice, they are not always effective and, when they are, the effect is small to moderate. There is no evidence about the cost-effectiveness of tailored interventions compared to other interventions.
• See the studies included here.