fls case study: service improvement with additional funding - dr zoe paskins
TRANSCRIPT
Fracture Liaison Service Case Study: Service improvement with additional
fundingThe Haywood Hospital
Zoe Paskins @zpaskinsSenior Lecturer and Honorary Consultant Rheumatologist
Haywood Rheumatology Centre, Stoke on Trent Keele University
Overview: a story of 2 parts
• Service expansion: our ‘journey’
• Other service improvement initiatives
Stoke-on Trent
Our FLS: Nurse-led one-stop clinicCatchment (acute Trust) 500,000
Fracture Liaison Service first commissioned by SoT PCT 2009
Physical presence in fracture clinic to identify patients – mornings only
One stop clinic for DXA, assessment, lifestyle
advice, bloodsTreatment
recommendations to GP
£
Letter to GP recommending referral
in to clinic
££ Rheumatology tariff, WL
Bad for
• Patients
• GPs
• Commissioners
Lessons learnt:Number 1
Be prepared with all the arguments for commissioners – ‘moral’ and financial
2012-3
Fracture liaison Service first commissioned by SoT PCT
2009
2012/13Business case first submitted
to NS PCT
2013-4Fracture liaison
Service first commissioned by
SoT 2009
2012/131st Business case
submitted to NS PCT
1st Business case approved in principle …
Commissioners left2013/14
June 2014Clinical Lead of service changed
2014
Fracture liaison Service first
commissioned by SoT
2009
2012/13Business case first submitted to NS
PCT
Business case approved in
principle Commissioners left
2013/14
June 2014Clinical Lead of service changed
Peer review of osteoporosis
serviceOct 2014
NOS involvement
Peer reviewCommissioning workshop Face to face - help sort prioritiesBy e-mail - draft documents – service spec,
business case v 2.0, cost analysis
Lessons learnt:Number 2
Attendance at these meetings is really important!
NOS involvement
Peer reviewCommissioning workshop Face to face - help sort prioritiesBy e-mail - draft documents – service spec,
business case v 2.0, cost analysisMeeting with commissioners - moral support
Fracture liaison Service first
commissioned by SoT 2009
2012/13Business case
first submitted to NS PCT
Business case approved in
principle Commissioners
left2013/14
June 2014Clinical Lead of service changed
Peer review of osteoporosis
serviceOct 2014
Jan 2015Business case
re-visited
Verbal agreement to commission
Jan 2015
Fracture liaison Service first
commissioned by SoT 2009
2012/13Business case first submitted
to NS PCT
Business case approved in
principle Commissioners
left2013/14
June 2014Clinical Lead of
service changed
Peer review of osteoporosis
serviceOct 2014
Jan 2015Business case
re-visited
Verbal agreement to commission
Jan 2015
No contractJuly 2015
• No written confirmation of approval received (or money, or contract) despite chasing ++
• We started tentatively to clear waiting list (overtime)
• New staff posts not approved without contracts• Morale of existing staff suffering
• Then.. An email about something else, to someone else
(part of) my reply
“……………….This is also particularly embarrassing given that the National osteoporosis Society have highlighted our FLS unit in a recent high profile journal article and cited the case of Stoke as a commissioning success. They are in constant contact with me about the progress on this venture and I should not like to have to tell them that the CCG are only prepared to fund a partial service.”
Lessons learnt:Numbers 3,4 & 5
Follow up all meetings with something in writing
Keep staff informed all the way
Using clout of NOS?
June 2014Clinical Lead of
service changed
Peer review of osteoporosis
serviceOct 2014
Jan 2015Business case
re-visited
Verbal agreement to commission
Jan 2015
No contractJuly 2015
August September
2015 – commissioned
Peer review of osteoporosis
serviceOct 2014
Jan 2015Business case
re-visited
Verbal agreement to commission
Jan 2015
No contractJuly 2015
August September 2015 – commissioned
Our next mission: South
Staffs 2017
Email to someone else, about something else… June 2015
“We therefore request that you provide a response outlining how you will deliver the FLS within the identified cost envelope including a trajectory for the management of the backlog as unfortunately there will be no additional money to fund this.”
End of part 1!
Other service developments: peer review driven
“Opportunity to refine the FLS-DXA-OP clinic pathway cutting out the GP step”
Solution: LMC not CCG!
“Review roles – including .. job plan review, line management”
One of the solutions:
“There is little evidence of integrated and seamless care across secondary, community and primary care”.
Solutions?
• 72 responses!
• >10 GPs gave emails for future contact
• Lots of helpful suggestions Reduced length of report Changed policy on blood results
Service away (half) day• The task:How do we demonstrate our excellence?What are our key outcomes?How can we deliver better value/ be more efficient?How do we deal with increasing referral rates?How can we be more patient centred?
• (Some) actions/outcomes: Evaluation of our helpline
Patient feedback on all elements of service
Changed follow up policy for DXA
Invite patients to our service meetings/ future away days
Summary
• Importance of maintaining follow up with commissioners after initial agreements
• The value of NOS peer review
• But.. You don’t need a peer review to improve your service!
