gray2011
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New challenges - new roles - new competencies Supporting primary care
commissioning. Anne Gray, Commissioning LibrarianNHS Milton KeynesUHMLG Conference, June 2011
June 2011 UHMLG Conference, Soton
MK Commissioning Librarian – a history
2004-09 Outreach Librarian MK Hospital Library – training primary care clinicians / literature searches little strategic impact ; improved knowledge not services
2007-10 Quality MK - Health Foundation programme Testing processes supporting whole system quality
improvement which is patient centred, clinical led and evidence based
Evidence support to service redesign teams, journal clubs in GP practices and primary care teams, alerting services
2009 PCT created Commissioning librarian post to inform commissioning (Cf Clinical Librarian)
2010 PCT reorganisation??
June 2011 UHMLG Conference, Soton
Commissioning Librarian Important to align service in line with
the current strategic objectives of the organisation - Financial balance (QIPP challenge) High quality health services Support transition (to Clinical
Commissioning Groups) Strategic objectives have changed
June 2011 UHMLG Conference, Soton
Commissioning Librarian Supporting pathway review and service
redesign Alerting services Searching for information
Retrieval, selection, appraisal, summarise Knowledge Zone:
www.qualitymk.nhs.uk Information skills training Links to NHS library networks
June 2011 UHMLG Conference, Soton
Day to day work
No physical library (SLA with local hospital) Open plan office with commissioners/managers Meetings!!
Member of strategic Programme Boards (Planned Care; Unplanned Care; Mental Health, Delivering Capabilities, Stroke network, Neurological Conditions LIT)
Understand the current issues Direct requests for evidence / examples etc Unsolicited reports Support the teams by highlighting relevant resources
as and when appropriate
June 2011 UHMLG Conference, Soton
Products
Web portal – Quality MK Knowledge & Learning Zones www.qualitymk.nhs.uk Hot topics, national alerting services, key
resources, GP Consortia development, public health intelligence, elearning,
Local alerting services Knowledge@lert for Commissioners Contribute to other alerts in organisation FYI highlighting particular resources to individuals
“unlock the door” Evidence search service – push and pull
June 2011 UHMLG Conference, Soton
Use of evidence in commissioning
“Using evidence is not an open and shut case. Producing evidence to aid commissioning is not enough”Ref: The need for clarity in evidence based commissioning.
HSJ 26 May 2011 p23-25 Academic research project - observations and
survey Identified two themes
Need different forms of evidence clinical and non-clinical Plurality rather than hierarchy of evidence Different types of evidence need to work together
Importance of timing Very much reflects experience in practice
June 2011 UHMLG Conference, Soton
Plurality of evidence
HSJ 26 May 2011 p23-25
June 2011 UHMLG Conference, Soton
Evidence used by commissioners Survey n=300Very/quite important
Local public health intelligence
Expert advice Examples of best
practice Local policies Guidelines Government pubs Benchmarking Cost effectiveness
Not important/did not use
General published literature
Professional association guidance
Management studies Academic research Management
consultantsHSJ 26 May 2011 p23-25
June 2011 UHMLG Conference, Soton
Evidence searches
Time intensive Understand the question Search Read / extract / appraise Summarise
Types of question How have others done it? Outcomes, KPIs, benchmarking Data/models to support development of
specifications
June 2011 UHMLG Conference, Soton
Evidence searches Current topics include
Impact on hospital use (re)admission, OPD, A&E, community care
Self management, decision aids Outcomes based contracting
Examples Has anyone charged for DNAs? Outcomes of MSK services service specifications eg Community cardiology,
MSK, Urgent Care Predictive modelling tools Return on Investment in telehealth/telecare GPs in A&E departments Why are our antenatal admissions so high? What self care tools will we need to support our new
MSK Clinical Assessment & Triage services?
June 2011 UHMLG Conference, Soton
Example: MSK CATS spec.
June 2011 UHMLG Conference, Soton
Search results included
•Anticipated case mix based on audit from existing service
•MSK self care resources
•MSK patient decision aids
ALSO
•Indication of impact on referral to acute care
•Contact info
June 2011 UHMLG Conference, Soton
Measuring impact
Difficult to quantify Literature search impact survey – small
pool of requestors But
Librarians are “pollinators” – Prof Paul Glazsiou
http://www.qualitymk.nhs.uk/default-ContentID-3011.htm
June 2011 UHMLG Conference, Soton
Nothing stands still
Evidence required by commissioners will not change, but the environment will Clinical Commissioning Groups (GP Consortia) NHS Commissioning Board – national and
regional PCT Clusters Public Health England NHS Evidence
Quality MK www.qualitymk.nhs.uk PCT website – future?