moving beyond sponsorship

MOVING BEYOND SPONSORSHIPJOINT WORKING BETWEEN THE NHS AND PHARMACEUTICAL INDUSTRY

WelcomeThis toolkit has been jointly developed by the Department of Health and the Association of the British Pharmaceutical Industry to enable NHS organisations and the pharmaceutical industry to work together in the interests of patients.

The NHS faces many challenges. Economic pressures are unprecedented with a ceaseless drive for improved quality and productivity in the system.

NHS organisations are increasingly calling on external expertise to enable them to meet these challenges, recognising that joint working with partners who can supplement their own skills and resources can provide benefits that are not otherwise achievable. One such partner is the pharmaceutical industry, which, apart from supplying medicines that improve the quantity and quality of patients’ lives, can contribute skills and expertise arising from its particular

experience in business and financial management and its extensive knowledge of the therapy areas relevant to its medicines.

Provide Feedback

How to Use the Toolkit

Click here to enter site

This toolkit is designed to help the NHS meet the challenges of a rapidly evolving health service by providing practical advice and tools, based on best practice, so that joint working projects with the pharmaceutical industry can be set up rapidly and effectively, reducing duplication of effort, increasing efficiency, and minimising unnecessary workload and stress. It is unlikely you will need to use everything contained in the toolkit – how much you need will depend on the nature and complexity of your joint working project, and how experienced you are.

Items essential to any joint project are marked by red flags and included in a Quick Start Option.

The toolkit is underpinned by two important pieces of Guidance:

Best Practice Guidance for Joint Working between the NHS and the Pharmaceutical Industry issued by the Department of Health in February 2008

The ABPI Code of Practice for the Pharmaceutical Industry and Guidance Notes on Joint Working between Pharmaceutical Companies, the NHS and Others for the Benefit of Patients are designed to ensure a professional, responsible and ethical approach to the promotion of medicines in the UK to health professionals and appropriate administrative staff to ensure the appropriate use of medicines and support the provision of high quality care.

Gateway Ref: 14600

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082370�



http://www.abpi.org.uk/publications/pdfs/pmpca_code2006.pdf�


http://www.abpi.org.uk/publications/pdfs/ABPI_Code_Guidance_Notes.pdf�




This toolkit has been jointly developed by the Department of Health and the Association of the British Pharmaceutical Industry to enable NHS organisations and the pharmaceutical industry to work together in the interests of patients.

The NHS is in a challenging phase of reform. The White Paper, “Our health, our care, our say: a new direction for community services”, describes the strategic shift in services from secondary to primary care. The World Class Commissioning vision calls for “better health and well-being for all, better care for all, and better value for all.”

NHS organisations, and Practice-based Commissioners are increasingly calling on external expertise to enable them to meet these challenges, recognising that joint working with partners who can supplement their own skills and resources can provide benefits that are not otherwise achievable.

One such partner is the pharmaceutical industry, which, apart from supplying medicines that improve the quantity and quality of patients’ lives, can contribute skills and expertise arising from its particular experience in business and financial management and its extensive knowledge of the therapy areas relevant to its medicines.


Viewing: This toolkit has been developed in PDF format and is designed to be used on screen. Enter the seven main sections by clicking on the tabs down the left hand side of the screen; and use the tabs across the top of the text box to move between sub-sections.

To maximise the size of the toolkit, go to the “view” menu at the top of the screen and select the “full screen” option or press CTRL+0

Throughout the toolkit, templates are included to aid local implementation of joint working. These are optional and are available as editable files so that they can be adapted to meet local needs. However, when opened from within the toolkit they may indicate that they are Read-only files. To save an editable version to your PC do one of the following:

1. From the “File Download” box choose “Open.” If this opens as a read-only file choose “Save As” which will save the file as a “Copy of ABC.xxx” to the PC; or

2. When the “File Download” box appears choose “Save” instead of “Open” and an editable version is saved to the PC. Once the “Download Complete” box appears it can then be opened for editing

To access documents in this toolkit, you will need to have the following software installed:

Adobe Acrobat Reader MS Word MS Excel

Close

MOVING BEYOND SPONSORSHIPJOINT WORKING BETWEEN THE NHS AND PHARMACEUTICAL INDUSTRY


Click here to enter siteWelcome

Welcome and How to Use

Implementing

Setting up a Joint Project

Introduction

Good Practice Examples

Useful Contacts& Feedback

Acknowledgements

Quick Start Option

Getting Ready

Monitoring & Evaluation

Governance

Engaging Stakeholders

MOVING BEYOND SPONSORSHIP – JOINT WORKING TOOLKIT

Prepared by:

Endorsed by:


ReasonsDefinitions BenefitsSteps in a Joint Working

Project

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



What do we mean by Joint Working?

Joint working is a relatively new concept and differs from the traditional practice of sponsorship.

How does Joint Working differ from Sponsorship?

Joint working is distinctly different from sponsorship. In sponsorship arrangements pharmaceutical companies simply provide funds for a specific event or work programme.

In joint working, goals are agreed jointly by the NHS organisation and company, in the interest of patients, and shared throughout the project. A joint working agreement is drawn up and management arrangements conducted with participation from both parties in an open and transparent manner.

For many organisations, joint working will represent a new way of working. It requires a different mindset from sponsorship and a collaborative approach. Successful experiences (see Good Practice Examples) have shown that it can be of major benefit to patients, the NHS and pharmaceutical companies.

For a snapshot guide to differentiating Joint Working from other forms of NHS/Pharmaceutical Company Activity, click here.

Joint working describes situations where, for the benefit of patients, NHS and industry organisations pool skills, experience and/or resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery.

http://www.dh.gov.uk/en/prod_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117335.doc�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



ReasonsDefinitions BenefitsSteps in a Joint Working

Project


Why should the NHS and Pharmaceutical Industry work together?

The NHS and pharmaceutical industry share a common agenda to improve patient care outcomes through high quality and cost effective treatment and management.

In compiling this toolkit a joint meeting of NHS and industry managers agreed that:

Their common agenda is therefore to improve patient outcomes through working together to ensure that patients get optimal care, including appropriate use of cost-effective innovative medicines, with support to help them maximise the benefits of treatment. This can be achieved through services designed to ensure:

The NHS seeks to increase health through:

• improved patient experience• provision of effective packages of care• improved quality of care for patients• reductions in unnecessary consultations and hospital visits• effective self care, health promotion and disease prevention• optimising the cost effectiveness of services so as many patients as possible can benefit from them

The industry seeks to increase shareholder value through:

• researching and developing innovative medicines that meet clinical need• optimising the use of its medicines in appropriate patients• more proactive treatment and management of patients

Identification of appropriate patients Good self care and healthy living

Appropriate use of innovative medicines that are cost effective for the NHS

Optimal numbers of appropriate patients receiving treatment

A positive patient experience Measurable improvements in outcomes

Good professional and patient understanding of medicines and concordance with treatment

Page 1 of 2

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082840?IdcService=GET_FILE&dID=161026&Rendition=Web�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Reasons BenefitsSteps in a Joint Working

Project


Why should the NHS and Pharmaceutical Industry work together?

Examples of successful joint working have reaped real rewards for patients, the NHS and the industry (see Good Practice Examples) in terms of better quality and more productive services providing appropriate treatment.

The industry and NHS can bring skills and expertise to each other:

The role of commissioners has been described as “working collaboratively with partners ... stimulate innovation, efficiency and better service design, increasing the impact of the services they commission to optimise health gains and reductions in health inequalities.”

Good commissioning is seen as a key methodology to drive innovative and transformational change. Industry has many of the skillsrequired and can provide opportunities to the NHS to benefit from these.

Industry to NHS NHS to Industry

Project and change management Better NHS / customer understanding

Process re-engineering Information

Innovative solutions People

Communications, presentation and stakeholder management Contacts

Negotiation Funding

Education

Analysis and information management

IT

People

Funding

Page 2 of 2

Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project


Benefits of NHS and Pharmaceutical Industry Joint Working

Joint working does not just happen. It takes time and effort to get to a position where it has a chance of success.

But successful joint working projects (see Good Practice Examples) have delivered real benefits to patients, the NHS and industry.

TO PATIENTS

TO THE NHS

TO INDUSTRY

Care closer to homeFewer hospital admissionsMore equitable and consistent care and access to careBetter information on conditions and treatment optionsClearer pathway of careBetter experience of the system

Higher quality, more consistent care achieved more rapidlyServices configured around patients’ needsBetter health outcomesBetter use of resources More people treated appropriatelyLower costs of hospital admissionsMore creative approaches to problemsBetter cross-sectoral workingBetter skilled personnel

More people treated appropriately, including better use of medicinesBetter customer understandingImproved reputation

Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project


Steps in a Joint Working Project

To see more about each phaseClick on the relevant box


Setting Up

Implementing


Getting Ready

Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project






Setting Up

Implementing


Getting Ready


• Identify stakeholders• Who will make or break implementation?• Who should be involved?• Get senior level support and endorsement• How do you involve patients?• Manage stakeholders

Close

Go straight to this section

Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project





Setting Up

Implementing


Getting Ready

Getting Ready

Before entering into a joint working arrangement there are a number of things you need to have in place.

These include: • Agreeing joint principles• Developing a shared vision• Recognising the enablers and barriers to

joint working• Understanding cultural differences• Having in place appropriate organisational

policies

Close


Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project





Setting Up

Implementing


Getting Ready

Setting Up

• Identify the issues to be addressed and opportunities to address them

• Establish shared objectives – what’s in it for each party

• Agree outcomes, deliverables, milestones, who contributes what

• Draw up a programme of activities• Agree ongoing management

structures and governance arrangements

• Identify where resources are needed and where to get them

• Develop a business case

Close


Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project





Setting Up

Implementing


Getting Ready

Implementing

• Appoint joint leaders and a Joint Project Group

• Appoint a project manager• Implement the project plan working to pre-

agreed timetable and specific deliverables• Manage the budget

Close


Definitions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project




Setting Up

Implementing


Getting Ready



• Monitor and report progress against agreed deliverables and timescales

• Identify blocks and address them• Review the impact of the project• Is the project working in practice?• Is it worth sustaining?• Revise the working arrangements in

the light of experience• Build appropriate mechanisms to

ensure longer-term commitment• Build sustainability or agree an

appropriate conclusion• Record the lessons learned from the

experience

Close


Definitions

Preparedness EqIABuilding Trust

Cultural Issues

BarriersFacilitatorsPrinciples

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




This section gives some insights into overall principles, facilitators and barriers to joint working. Use it to examine some of the organisational, personal and attitudinal factors that will come into play when you are embarking on joint working projects.

Principles of Joint Working

Joint working requires energy and commitment. All joint working arrangements should be founded on some fundamental principles to hold them together, e.g. a commitment to improve the health of the local population. These should be agreed by all parties at the beginning of any arrangement and act as a touchstone when decisions have to be made or obstacles overcome.

Shared vision Each party must have a mutually shared vision of the aims and outcomes of any arrangement that underpins all aspects of working together. For example, reduced morbidity and mortality, a better patient experience, fewer unnecessary consultations and hospital visits.

Equity Recognition, backed by behaviour, that each party has a right to be at the table and their contributions valued (beyond their value in cash or public profile). Acknowledgement of the interdependent nature of the relationship between the parties.

Transparency Openness and honesty (a precondition to trust); access to and sharing of information.Benefits to patients, NHS and industry identified and shared.

Mutual benefit Each party should be entitled to benefit from the arrangement – ideally working to specific benefits for each party (e.g. meeting NHS targets, better identification of patients, optimal numbers of appropriate patients receiving treatment) as well as the common benefits to all.

Respect Respect for the other parties and for their ability to add value.


Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Enablers of Joint Working

The following factors have been identified as contributing to successful joint working. Run through them and check your own situation. Not all will be in place but awareness of what is and what isn’t will aid preparation and planning.

Adapted from Wildridge V et al. How to create successful partnerships – a review of the literature. Health Information and Libraries Journal, 21, pp 3-19

Environment / organisation Membership Process & Structure

Favourable political and social climate, e.g. willingness to work with the private sector / pharmaceutical industry

Favourable organisational culture, e.g. willingness to try new ideas

Collaborative group seen as a legitimate leader

Mutual respect, understanding and trust

Appropriate cross section of members, e.g. industry, primary care, secondary care, patients, community services

Members see collaboration as in their self-interest

Ability to compromise

Members share a stake

Multiple layers of participation

Flexibility and adaptability

Clear roles and responsibilities

Clear policy guidelines

Appropriate pace of development

Communication Purpose Resources

Open and frequent

Informal (as well as formal) relationships and communication links

Concrete, attainable goals and objectives

Shared vision

Unique purpose

Sufficient funds, staff, materials and time

Skilled leadership (both NHS and industry)


Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Barriers to Joint Working

Joint working cannot be successfully imposed – any arrangement where key players do not want to be there in the first place willface major difficulties. Being aware of potential barriers that may hinder your ability to work together will enable you to take measures to address them. Addressing them is important or you could end up in practice spending more time on the mechanisms of working together than on achieving outcomes.

Imbalance of “Power” Attitudinal Factors

Disproportionate benefits vs. disproportionate costs (e.g. one party does most of the work or contributes most of the resource but receives limited benefits)

Fundamental ideological differences

History of antagonism

Cultural clashes

Different perspectives on tackling joint issues

Stereotypical attitudes

Ambition or fear of raised personal profile

Territorial disputes about roles and remits

Claims to exclusive professional competence

Lack of trust

Resources Organisational Factors

Lack of appreciation of the work involved

Reluctance to fund all the costs

Defensiveness about resources

Work overload

Increased bureaucracy

Lack of role clarity and scope of responsibilities

Lack of clarity on lines of accountability

Differing governance arrangements

Commercial sensitivities

Competitive behaviour between companies


Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Cultural Issues between the NHS and Industry

The different cultures of the NHS and the pharmaceutical industry – and the public service versus commercial ethos – can lead todifferences in attitudes and behaviour. Some attitudes can be stereotypical, which can be unproductive and unhelpful in the joint working context.

Attitudes vary widely:

Source: Market Research: Long Term Leadership Strategy in Medicines (DH / ABPI)

Joint working will only work if there are shared goals and mutual respect based on recognition of each other’s differences.

NHS attitudes about the Industry Industry attitudes about the NHS

Negative PushyInsensitiveInflexibleAggressive marketingIrritatingUntrustworthy

ObstructiveOutdatedInaccessibleSuspicious / mistrustfulDisorganisedUncooperative

Positive InnovativeForward thinkingProactiveSupportiveInformativeOrganisedRespectful

InnovativeForward thinkingCommittedApproachableAware of NHS limitationsOrganisedRespectful



Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Building Trust

Trust is fundamental to any joint working relationship. Trust takes time to achieve (and very little time to break) so all parties have to work to build it. Here are some factors that help engender trust:

Process and organisation Behaviour

Developing a shared vision together

Transparent decision making (no corridor decisions)

Clear co-badging

Joint ownership of decisions and collective responsibility for direction, activities and outcomes

Recognition of the value of each party’s contribution (whether quantifiable or not)

Even-handedness in decision-making

Sticking to deadlines and actions

Sharing (rather than hoarding) knowledge

Demonstrable ability to be flexible and adaptable

Ability to compromise

Good personal relationships

Acknowledgement of cultural differences

Continuity / no surprises Outcomes

Not moving goalposts (e.g. pulling budgets, change of priorities)

Minimal personnel changes or at least good transition

Producing some quick wins

Successful outcomes


Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Organisational Preparedness

The NHS PerspectiveWhere NHS organisations are considering entering into a joint working arrangement it is better if this occurs within an existingpolicy framework, rather than policy and procedures having to be developed, in haste, to accommodate the desire for joint working.

NHS organisations should have in place a corporate policy, approved by the Board, which provides guidance to its staff on undertaking joint work with the pharmaceutical industry. Such a policy should be in line with the DH Guidance.

To access a template for an NHS policy on working with the pharmaceutical industry click here.

Professional organisations such as the General Medical Council, the Nursing and Midwifery Council and the Royal Pharmaceutical Society of Great Britain will normally have produced advice or guidance about working with the pharmaceutical industry, within which their members will be expected to operate. Healthcare professionals should make sure that they are familiar with the content of these as well as their organisational policies, and ensure that there is no conflict between them.

Changes to the New General Medical Services contract (nGMS) introduced in April 2006 include guidance designed to reduce excessive or inappropriate prescribing. See Annex 8 of the nGMS contract.

Page 1 of 2



http://www.gmc-uk.org/�

http://www.nmc-uk.org/�

http://www.rpsgb.org.uk/�


http://www.nhsemployers.org/SiteCollectionDocuments/Revisions_to_the_GMS_contract_-_full_CD_120209.pdf�

EqIA

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



PreparednessBuilding

TrustCultural Issues



Organisational Preparedness

The Pharmaceutical Industry PerspectiveFor joint working to be an effective means of improving the reputation and business performance of the company, ask the following questions:

Do you have corporate (i.e. Board level) support for the concept of joint working?

Do Board members understand the benefits, opportunities, challenges, commitments associated with joint working?

Is there a clear and well communicated organisational policy on joint working?

Do you have clear lines of accountability, roles and responsibilities for the successful development and implementation of joint working projects?

Are key individuals in the company involved directly and indirectly in joint working with the NHS aware of the Department of Health Guidance and the relevant parts of the ABPI Code of Practice and ABPI Guidance Notes on Joint Working?

Do individuals in your Code of Practice compliance team understand the concept of joint working, its aims and the practicalities of its implementation? Are they properly supportive?

Do you have individuals in the field who have the required competencies and time to develop and implement joint working projects?

Joint working is for the long term, requiring new ways of working and steep organisational learning – is your organisation fully committed to these challenges?

Page 2 of 2

For a checklist of your company’s preparedness for joint working, click here.

For ABPI approved competencies for company personnel undertaking joint working, click here (short version)

click here (long version)


http://www.abpi.org.uk/links/assoc/PMCPA/Code06use.pdf�




http://www.dh.gov.uk/en/prod_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117333.pdf�



Cultural Issues


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Equality Impact Assessment (EqIA)

The NHS Constitution says that the NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

Public bodies are subject to the public sector equality duties. All public bodies (like Primary Care Trusts (PCTs) and hospitals) that are subject to the duties are legally obliged to pay 'due regard' to the need to take action on race, disability and gender equality. In practice, this means that public bodies need to prioritise action to address the most significant areas of race, disability, gender inequality in their remit and focus their efforts where they can have most impact.

The Equality Act 2010 includes a new Public Sector Equality Duty. It is proposed that the duty will come into force in England from October 2010. The duty will cover all the protected grounds: age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief and sexual orientation.

Equality Impact Assessments (EqIAs) help public bodies demonstrate that they are meeting the public sector duties and taking steps to promote equality and reduce inequality as well as addressing disproportionate impacts of their activities (including their functions, policies and services) on:

Disabled peopleMen and women (including transgendered people)People from different racial or ethnic backgroundsPeople with different sexual orientationsPeople in different age groups People with different religions or beliefsPeople from different social and economic (‘socio-economic’) groups.

By undertaking EqIAs, public bodies can make an assessment, based on available evidence, of the likely impact of their activities on people in each of these groups. The assessment of impact should be used to inform decisions about the relevant activity. Timely and robust equality impact assessments can help to inform and strengthen the activity whilst it is being developed and while it is being carried out or implemented. Guidance on equality impact assessment is available from the Equality and Human Rights Commission and the Department of Health.

Guidance on how to carry out an EqIA and the templates you will need to complete can be found by clicking here.


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management

Planning the Project

Business Case & Resources

Laying Foundations

Identifying Opportunities

Identifying the Issue

This section provides information about the steps involved in setting up a joint working project. Use it as an aide memoire to make sure that you go through all the stages necessary.


It is vital to be clear on the issue that you are trying to solve. For example this could be:

Ask yourself if you or your organisation has the time, people or resources to solve the problem alone. If not, consider joint working with a partner organisation. Gather information on possible options and consult with stakeholders.


For the NHS For industry

High morbidity or mortality rates in your area

Long waiting times

Poor patient identification

Inadequate service provision to a particular patient group

Lack of skills, capacity or infrastructure

Lack of information to inform decision-making

Blockages in the system that prevent medicines reaching appropriate patients

Inappropriate treatment of a particular patient group

Lack of access to key decision makers

Poor patient identification

Inadequate service provision to a particular patient group

Long waiting times

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations





Identify opportunities for joint working with pharmaceutical companies or NHS organisations which have the skills and resources you think you need. Experience has shown that each can bring benefits to the other.

Consider whether the partner you are considering is an organisation or group of individuals with whom you can develop a workingrelationship:

If so, approach them, put proposals to them and motivate them to support you.

Ensure key stakeholders are comfortable with your decisions and decision-making processes.

Do they have the same ambition to benefit patients?

Would working together provide enough mutual benefit to sustain a working relationship?

Do they demonstrate behaviours that you are comfortable with, e.g. putting patients first, a preparedness to listen and engage in dialogue, ability to think and act flexibly to address particular issues or situations, lack of stereotypical attitudes to the NHS or industry, openness, a business-like attitude, a willingness to share knowledge and benefits, and work to a mutually agreed agenda?

Is their organisational culture sufficiently compatible with yours to meet your needs?

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations





Identify opportunities for joint working with pharmaceutical companies or NHS organisations which have the skills and resources you think you need. Experience has shown that each can bring benefits to the other.

Consider whether the partner you are considering is an organisation or group of individuals with whom you can develop a workingrelationship:

If so, approach them, put proposals to them and motivate them to support you.

Ensure key stakeholders are comfortable with your decisions and decision-making processes.

Do they have the same ambition to benefit patients?

Would working together provide enough mutual benefit to sustain a working relationship?

Do they demonstrate behaviours that you are comfortable with, e.g. putting patients first, a preparedness to listen and engage in dialogue, ability to think and act flexibly to address particular issues or situations, lack of stereotypical attitudes to the NHS or industry, openness, a business-like attitude, a willingness to share knowledge and benefits, and work to a mutually agreed agenda?

Is their organisational culture sufficiently compatible with yours to meet your needs?

Industry to NHS NHS to Industry

Project and change managementProcess re-engineeringInnovative solutionsCommunications, presentation and stakeholder managementNegotiationEducationAnalysis and information managementIT PeopleFunding

Better NHS/customer understandingInformationPeopleContactsFunding

Close

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Laying Foundations

Experience of successful (and unsuccessful) joint working demonstrates that it is absolutely vital to unequivocally establish upfront:

Remember:

Good communication is vital. It is easy for the organisations involved to interpret discussions and arrangements quite differently.

Communicate with key stakeholders about what you have agreed.

Shared goals

Principles under which you will work together.

The benefits to each party: start by considering the benefits to patients. Benefits will also include the commercial benefit that will accrue to the pharmaceutical company. If one or more parties is uncomfortable with the benefits that others will enjoy from the arrangement, it will be hard to make it work.

Who will contribute what to the arrangement.

Roles and responsibilities.

The ABPI Guidance Notes on Joint Working between Pharmaceutical Companies, the NHS and Others for the Benefit of Patientsare useful in outlining good practice in articulation and communication of joint working arrangements.



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Laying Foundations


Remember:




Shared Goals

Goal-setting is the intentional act of describing your aspirations and laying out a plan and timeline for achieving them. This process needs to be undertaken collaboratively by all parties. Try and follow SMART guidelines. Goals should be Specific, Measurable, Attainable, Realistic, and Time-based.

The acronym SMART has a number of slightly different variations, which can be used to provide a more comprehensive definition.

Close

S – specific, significant, stretching Well defined, e.g. reduction in unnecessary hospital consultations and hospital visits for X conditionClear to anyone that has a basic knowledge of the project

M – measurable, meaningful, motivational Know if the goal is attainable (e.g. % increase in patients identified for X condition) and how far away completion isKnow when it has been achieved

A – agreed upon, attainable, achievable, acceptable, action-orientated

Agreement with all stakeholders what the goals should be

R – realistic, relevant, reasonable,rewarding, results-orientated

Within the availability of resources, knowledge and time

T – time-based, timely, tangible, trackable Enough time to achieve the goal, e.g. an increase in appropriately treated patients after one yearNot too much time, which can affect project performance

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Laying Foundations


Remember:



Shared vision Each party must have a mutually shared vision of the aims and outcomes of any arrangement that underpins all aspects of working together.


Transparency Openness and honesty (a precondition to trust); access to and sharing of information.

Mutual benefit Each party should be entitled to benefit from the arrangement – ideally working to specific benefits for each party as well as the common benefits to all.

Respect Respect for the other parties and for their ability to add value. Close




Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Making the Case & Resourcing

A good business case will align the joint working initiative with patient benefit and the strategic objectives of all partners . The proposal should be succinct and well written, with discrete sections covering:

The level at which approval will be needed will depend on the nature, size and complexity of the initiative. Anything which has a financial implication for the NHS organisation will need to be discussed with the Director of Finance. However for a small scale, short duration project, where the resource contribution from the NHS is in the form of, for example, staff time, line managementapproval may be sufficient. A larger, more complex initiative will probably need senior management or Board level approval. If you are in any doubt about whether you have the authority to commit your organisation to participate in a joint working initiative discuss it with your manager.

For a pharmaceutical company, the case may best be put in the context of:

Depending on the nature, size and complexity of the project, there should be clear channels by which approval can be obtained –through a line manager, a Director or the Board as a whole.

Background and context Need for the initiative Description of the initiative

Aims, objectives and outcomes Contributions of each party Resourcing requirements and sources

Milestones and timelines Evaluation and audit Risks and benefits

Better use of NHS resources through improved service design and delivery to meet local patient needs

Faster NHS implementation of policy which may be relevant to your company’s business

Rapid and equitable patient access to appropriate treatment

Improved environmental intelligence

Better relationships with local decision-makers Improved company reputation

Page 1 of 2

Implementing


Introduction

Good PracticeExamples


Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations





No project will be successful if adequate resource is not allocated to it. Resources come in many forms:

Identify what you need and where it should come from. Be explicit about the amount and source of any financial support. Use your business case and remember to consult and get buy-in from stakeholders who could affect the final decision.

The level of structure and detail required will depend on the nature, scale and complexity of the project being undertaken. For a large-scale and/or complex project you will probably need to draw up an initial business case and then a more detailed planning document once initial approval to progress is given. For a simple project completion of a joint working framework document may be sufficient. Use what is most relevant to the joint work you are undertaking.

For a specimen template Business Case click here

For a specimen template Joint Working Framework document click here

People Expertise

Equipment Communication channels

Information technology Finance

Page 2 of 2



http://www.hsconsultants.co.uk/Joint Working Framework Template�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Planning

The better the planning at the beginning, the more effective the joint working will be and the better the chance of achieving the outcomes you want. First, it is important to set up a Joint Project Group that involves all parties to the arrangement and individuals who will play an active part.

Defining success criteria at this early stage is essential to future monitoring and evaluation. Success criteria will vary from project to project, but should be realistic and encompass:

It is important to recognise at the outset of a joint working initiative that things may not necessarily go according to plan. It is therefore important to make sure that a comprehensive risk assessment is undertaken, and that an explicit exit strategy is agreed at the start of any project to ensure that patient care is not compromised.

By the end of the planning stage, output and documentation will vary according to the nature, scale and complexity of the

project. For a range of specimen templates click on the links below.

For simple projects, the Joint Working Framework may be sufficient to outline the project, business case and implementation arrangements. Most projects are likely to require the Joint Working Framework and a Business Case.

For more complex projects, your organisation may require a Business Case, Joint Working Agreement (Single or Multi-company) and Project Initiation Document (PID). Use what is most useful to your organisation and situation to provide adequate governance without becoming bogged down in paperwork.

All projects should be accompanied by an Action Plan that sets out what should be done by whom and by when.

Patient (and ideally health) outcomes Outcomes relevant to the individual parties (e.g. service outcomes, commercial return)

Shared outcomes (e.g. more patients treated appropriately)

Markers of successful joint working – how the parties work together

If outcome measures will be unavailable in the short term it may be necessary to use input or process measures as interim surrogates for performance





http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_082862.doc�






Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Planning













Risk Assessment

At the outset of a joint working project, joint consideration should be given to what risks are involved to delivery of the project and what needs to be done to mitigate them.

Look at external dependencies – for example, people might not do things on time, may be of poor quality;

Examine the assumptions made in your planning - for example, availability of resources;

Look at each resource in the plan – will it be delivered? Are tools or technology unproven?

Include a Risk Assessment in the Project Initiation Document. Take appropriate actions to mitigate the risks identified. Make sure that any new or modified risks are shown in a Risks and Issues Log.

Close









http://www.hsconsultants.co.uk/Risk Assessment Template.doc�



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Planning













Exit Strategy

A robust exit strategy should be agreed at the outset to ensure that patient care is not compromised, and should involve all stakeholders.

Issues that may need to be addressed include: Mainstreaming the activities Intellectual property Residual funds Staff and/or staff contracts Availability and updating of information, tools, products, etc

after the end of the project Impact on patients

Close







Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Ongoing Management



Laying Foundations




Ongoing Management

As well as planning for the creation of the project it is important to establish as early as possible management structures andmechanisms that will oversee ongoing implementation.

These should include:

Best practice indicates that management should be overseen by the Joint Project Group, comprising key players from the partner organisations, and key individuals who will be directly involved in implementation. The Group should be co-chaired by leadersfrom the partner organisations and the Project Manager should act as Secretariat to the Group.

Avoid unduly complex structures and processes to manage the project. Excessive bureaucracy creates frustration and a sapping ofenthusiasm and commitment. If you feel the need to put such processes in place, this may indicate some defensiveness about aparty’s own interests or uncertainty about mutual trust. Focus on process and outcomes not structures and inputs.

Governance arrangements

Decision-making processes

Accountabilities

Roles and responsibilities

A detailed action plan

Communication channels – who should contact whom in the event of what

Which stakeholders should be informed of progress


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



People Issues

Meetings’ Management

BudgetingProject

ManagementJoint Project

GroupLeadership


This section covers the leadership, project management, budgetary, meetings management and people issues that you will need to consider when establishing a joint working project.

Leadership

Visible and strong leadership is a vital component of successful joint working. It helps:

Demonstrate a genuine commitment to the project Keep the focus on shared objectives and keep things on track Generate engagement, enthusiasm and confidence amongst those involved Engage, build confidence and reassure those who are affected Free up resources required to effectively implement the project Support problem-solving when required.

Leadership should be embodied by:

Leading individuals and bodies must be seen as legitimate and be given the authority to make decisions and effect change (this is often best gained through Board level endorsement).

Style of leadership is important – best described as ‘collaborative’ – an inclusive approach that engages those involved and values their individual and organisational input. Everyone should feel that they have an equal right to speak and to contribute to decisions.

Individuals – recognised jointly accountable leaders from the NHS organisation and pharmaceutical company who are of sufficient seniority and command respect

A recognised decision-making body, such as the Joint Project Group – co-chaired by the co-leaders

Visibility as well as effectiveness – demonstrating commitment to the joint working arrangement and the parties, and being prepared to promote the project to others

Industry Managers

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Role of the Joint Project Group

The Joint Project Group (sometimes referred to as the Project Board) provides overall direction and management of the project. It is accountable for the success of the project, and has responsibility and authority within the limits set by the organisations represented. This group should agree:

The Joint Project Group is the project’s “voice” to the outside world and is responsible for signing off all major plans (e.g. Project Initiation Document, project action plan), any communication materials, or other dissemination of information about the project. It should ensure that each party’s organisation is supportive of the project and able to manage the input that it will provide.

Specific Responsibilities

For a specimen template for the group’s Terms of Reference click here.

Approves all major plans and authorises any major deviation from plans

Signs off the completion of each stage and agrees the start of the next stage

Ensures required resources are committed

Arbitrates any conflict within the project

Negotiates a solution to any problems within the project, or between the project and external bodies (including the parties)

Approves the appointment and responsibilities of the Project Manager

Realistic outcomes and deliverables from the project Key factors that will identify success (or lack of it)

Who brings what to the table (and in the case of finance how much)

Stakeholders/stakeholder groups and how they should be involved or informed

Detailed roles and responsibilities

People Issues


BudgetingProject


GroupLeadership

Industry Managers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Pharmaceutical Company Managers

Joint working is a relatively new way of working for pharmaceutical companies as well as the NHS. The competencies required to work in this way are broader and deeper than many of the more traditional roles of managers interfacing directly with their customers.

The ABPI has developed a competency profile for industry managers undertaking joint working. It outlines the purpose, scope and accountabilities for the role, together with job outcomes. Skills, knowledge and behaviours/attributes are listed and described in full.

The aim of this profile is to ensure that managers from companies are fully equipped to support NHS customers in delivering successful joint working projects that deliver real benefits for patients, the NHS and companies in an open and transparent manner.

For the ABPI Competency Profile for Managers Undertaking Joint Working (short version), click here.

For the ABPI Competency Profile for Managers Undertaking Joint Working (long version), click here.

People Issues


BudgetingProject


GroupLeadership

Industry Managers



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project Management

Why You Need It

Good project management is absolutely vital to any joint working project, however large or small. Effective project managementenables:

Appointment of a dedicated project manager, or freeing up time for a member of the project team or member of staff, is a goodinvestment. Remember: industry generally has in-depth project management knowledge and skills – consider an industry member of the team or secondee. Be clear on what kind of person you want and what you want them to do.

Focus on the shared objectives (so that people don’t stray from these knowingly or unknowingly)

Momentum to be kept behind the project

Timelines and milestones being met

Clarity on what needs to be done and when with a focus on the right actions being taken by the right people at the right time

Good communication between all the players (formal through meetings and reports and informal through day-to-day liaison with those involved) and stakeholders

Good budget management

Effective problem solving, ideally anticipating issues before they become problems and ensuring these are addressed

The building of trust and confidence in and between all concerned

Page 1 of 3

People Issues


BudgetingProject


GroupLeadership

Industry Managers

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project Management

What is it?

Project management is essentially a set of methods for managing a one-off process or venture in order to achieve a specific, defined goal. Without using some project management technique there is a risk that those who commission a project, those who manage it and those who work on it will all have different ideas about how things should organised and completed.

There are a variety of project management methodologies. PRINCE2 is perhaps the best known (and is often used within the NHS) but others include PMP, MSP, MoR, Adaptive Project Framework and the Maturity Model. The level of complexity of the project will determine how structured the management of a project will need to be. The NHS Medicines Management Collaborative uses the PDSA method for introducing change, which on a smaller scale applies similar principles.

Successful project management depends on:• having a clear and agreed idea amongst the parties of what the finished project looks like• an organisational structure with sufficient skills and expertise• enough resources – time, money, facilities and people

There are three main project management roles: project manager, team member and sponsor (who provides the mandate for the project). In a small project, these roles can be performed by one person.

For more information about project management click here to see some additional reading.

Project complexity

Project Manager Project Team Sponsor

Simple Trusted individual with aptitude Team of willing and able personnel Work colleague

Standard Experienced individual with aptitude and proven project management ability

Trusted and experienced staff preferably with a track record of working well together

Line manager

Complex Formally trained project manager with appropriate experience

Experts with proven track record of delivery of similar projects to time

Senior or executive manager,or formal steering committee

Page 2 of 3

People Issues


BudgetingProject


GroupLeadership

Industry Managers

http://www.ogc.gov.uk/methods_prince_2__overview.asp�

http://www.pmi.org/�

http://www.ogc.gov.uk/guidance_managing_successful_programmes.asp�

http://www.ogc.gov.uk/guidance_management_of_risk_4441.asp�

http://www.npci.org.uk/medicines_management/skills/pdsa/library/5mg_pdsa.php�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project Management

What is it?

Project management is essentially a set of methods for managing a one-off process or venture in order to achieve a specific, defined goal. Without using some project management technique there is a risk that those who commission a project, those who manage it and those who work on it will all have different ideas about how things should organised and completed.

There are a variety of project management methodologies. PRINCE2 is perhaps the best known (and is often used within the NHS) but others include PMP, MSP, MoR, Adaptive Project Framework and the Maturity Model. The level of complexity of the project will determine how structured the management of a project will need to be. The NHS Medicines Management Collaborative uses the PDSA method for introducing change, which on a smaller scale applies similar principles.

Successful project management depends on:• having a clear and agreed idea amongst the parties of what the finished project looks like• an organisational structure with sufficient technical capability • enough resources – time, money, facilities and people

There are three main project management roles: project manager , team member and sponsor (who provides the mandate for the project). In a small project, these roles can be performed by one person.

For more information about project management click here to see some additional reading.

Project complexity

Project Manager Project team Sponsorship

Simple Trusted individual with aptitude Team of willing and able personnel Work colleague

Standard Experienced individual with aptitude and proven project management ability

Trusted and experienced staff preferably with a track record of working well together

Line manager

Complex Formally trained project manager with appropriate experience

Expert with proven track record of delivery of similar projects to time

Senior or executive manager,or formal steering committee

Additional ReadingOffice of Government Commerce, 2005. Managing Successful Projects with PRINCE2. Stationery Office Books(ISBN 0113309465)

Colin Bentley, 2005. Practical PRINCE2. Stationery Office Books(ISBN 0117035440)

Project Management Institute, 2004. A Guide to the Project Management Body of Knowledge. 3rd edition(ISBN 193069945X)

Crawford Kent, 2006. Project Management Maturity Model. Centre for Business Practice / Auerbach Publishers Inc.; 2nd edition(ISBN 0849379458)

Tim Saunders. How to manage projects effectively. Pharmaceutical Journal 2004: 272; 156 – 158 (available at PJ Online)

Close

Page 2 of 3

People Issues


BudgetingProject


GroupLeadership

Industry Managers

http://www.ogc.gov.uk/methods_prince_2__overview.asp�

http://www.pmi.org/�

http://www.ogc.gov.uk/guidance_managing_successful_programmes.asp�

http://www.ogc.gov.uk/guidance_management_of_risk_4441.asp�

http://www.npc.co.uk/mms/FiveMinGuides/library/5m_pdsa.htm�

http://www.pharmj.com/pdf/cpd/pj_20040207_projectmanagement.pdf�



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project Management

Project ManagerThe Project Manager has the authority to run the project on a day-to-day basis on behalf of the Joint Project Group, within constraints laid down by that group. The Project Manager’s prime responsibility is to ensure that the project produces the required products / outcomes, to the required standard of quality and within the specified constraints of time and cost. The Project Manager is also responsible for the project producing a result that is capable of achieving the goals and benefits defined in the business case.


For a specimen template job description for a Project Manager click here

Manage the production of the required products / outcomes

Facilitate and motivate the project team

Plan and monitor the project Produce the project contract

Prepare Project Plans in conjunction with the project team and agree them with the Joint Project Group

Manage business and project risks, including the development of contingency plans

Take responsibility for overall progress and use of resources, and initiate corrective action where necessary

Report to the Joint Project Group as necessary

Liaise with the Joint Project Group to assure overall direction

Prepare the Lessons Learned Report

Prepare any follow-on action recommendations required Identify and obtain any support and advice required for the management, planning and control of the project

Be responsible for project administration Liaise with any suppliers

Page 3 of 3

People Issues


BudgetingProject


GroupLeadership

Industry Managers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Budgeting

Transparent budget planning and monitoring of expenditure are essential elements of project governance and vital to ensure sustained mutual trust.

Key components in managing the budget are:

Realistic financial planning (fully explored and costed in the Business Case) Specificity on the sources of funding Transparent and regular monitoring of expenditure Clear reporting lines and channels Agreed mechanisms to address cost over-runs/under-spend Clear communication to project team members and financial stakeholders (e.g. Finance Directors)

The Joint Project Group (and joint team leaders) should be ultimately accountable for the budget. The Project Manager should be responsible for day-to-day monitoring and reporting.

Click here for a specimen template budget report

People Issues


BudgetingProject


GroupLeadership

Industry Managers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Regular meetings of the Joint Project Group will be necessary for effective planning and implementation – ensuring the right decisions are made up-front, keeping the project on track, and managing issues or unexpected developments. The intervals between meetings will vary from project to project, being more frequent in the early phases. As a rule of thumb, aim for monthly meetings at the beginning and quarterly when implementation is well underway.

Meetings are what you make them! They can be long, tedious and unproductive, or motivating and action-oriented.

Consider formats other than a traditional meeting with a formal agenda, e.g. events or workshops with break-out groups and discussions where issues can be explored in-depth. Ensure there is always an opportunity to increase the knowledge and understanding of the majority of the participants at each meeting to maintain interest and enthusiasm.

The Project Manager should be responsible for agenda planning, participant briefing (especially the Co-Chairs), reporting, communicating and ensuring actions are followed up.

Click here for tips on running a successful meeting and a checklist for managing the logistics of meetings

People Issues


BudgetingProject


GroupLeadership

Industry Managers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




People Issues

The cooperation and mindset of the people involved in joint working will make or break any joint working arrangement.

Choosing a Team – Joint Project Group

The Joint Project Group should be the accountable body for oversight and management of the project. It should be able to initiate and explore ideas as well as decisions and actions. It should comprise:

Each member should be able to make decisions for the people who sent them and be able to take forward initiatives between meetings. Members should be characterised by their:

Direct involvement in the joint working – try not to recruit people as a ‘token’ of their role in the organisation The skills they can bring to the table Attitude and mindset and ability to work in a team

The size of the team will be important – drawing a balance between inclusiveness and being unwieldy and ineffective. It may be useful to form time-limited sub-groups to take forward specific ideas and initiatives. The Joint Project Group should ensure that it has agreed Terms of Reference.

Click here for a specimen template for Terms of Reference

Co-chairs representing the NHS organisation and industry / company – in some cases, for example where there are multiple partners, an independent Chair may be appropriate

Key individuals who are directly involved in implementation – these will vary from project to project, but may include:

o Relevant health professionalso Medicines managemento Commissionerso Service Developmento NICE implementation leado Project manager

o Practice managero Company representative(s)o Company / NHS experts contributing particular skills

or expertise (e.g. IT)

Page 1 of 2

People Issues


BudgetingProject


GroupLeadership

Industry Managers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




People Issues

Attitudes and MindsetIn selecting your team, it is worth bearing in mind that the following describe characteristics of individuals who contribute tosuccessful joint working:

Time and WorkloadGiving people the time to make their contribution to joint working is essential. Avoid the temptation to expect this contribution to be made in someone’s ‘spare time’. This leads to stress, irritation, loss of commitment, and ultimately a breakdown in trust ascommitments are broken and action plans not implemented.

Roles and ResponsibilitiesEnsure that roles and responsibilities are clearly outlined and understood. This will avoid confusion and conflict, improve efficiency, prevent overlaps and stop things falling between the cracks.

Continuity of PersonnelOne major factor in slowing down or even halting joint projects is when personnel change. This is often, of course, inevitable, but steps should be taken to avoid situations where so much reliance is placed upon one individual to see the project through that it falls by the wayside when they leave. Commitment should be at a corporate as well as at a personal level with transition arrangements made when personnel change.

Open Flexible, adaptable and able to work with change

Able to listen Able to work across organisational boundaries

Action oriented Team player

Reliable – do what they say they will do Able to compromise

Committed to the project Open minded with lack of stereotypical attitudes and able to acknowledge cultural differences

Page 2 of 2

People Issues


BudgetingProject


GroupLeadership

Industry Managers

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



The Long TermWhy ? Evaluation Reviewing and Revising


Need for Monitoring and Evaluation

Regular monitoring and ongoing evaluation are essential in order to ensure that:

Effective monitoring and evaluation should comprise:

Click here for a specimen template for a Lessons Learned Log

Click here for a specimen template for a Lessons Learned Report

The joint working arrangement is meeting pre-defined aims and objectives

The joint working between the parties is operating effectively

Issues are identified as early as possible so that they can be addressed

All parties and participants have a clear view of the status of the project

Stakeholders are informed

Opportunities to publicise success are identified and communicated

Confidence is built in the whole process of joint working

Clearly pre-defined success criteria (see Planning)

Clear milestones and timelines (see Planning)

Clear arrangements to monitor and review how successfully the success criteria are being met

Clear arrangements to monitor how effectively the joint working between the parties is operating

Mechanisms to identify and communicate issues and successes

Clear arrangements to ensure that all parties have access to the monitoring information

A means to capture what has worked well or not (Lessons Learned Log and/or Lessons Learned Report)



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Evaluation

The methods used to evaluate the joint working project will vary according to its nature, scope and size. Even for the smallest of projects you should establish in the Planning phase how you will evaluate its outcomes and have jointly agreed success criteria. For a large-scale project, it may be appropriate to bring in a third party to conduct the evaluation, e.g. an academic body. For ideas on what you should consider when designing an evaluation click here.

Auditing Joint Working EffectivenessTo evaluate how well joint working between the parties has worked, answer the following questions:

Successful organisations learn from their experiences, and this applies to taking part in joint working initiatives as much as any other aspect of business. Learning will be more beneficial if it is preserved beyond the end of the project in the form of a report. So, as well as evaluating the outcome of the overall project, it is useful to assess how successful or unsuccessful the operation of the project has been so that lessons learned can be usefully applied to the design and running of other projects. Comments and observations about what is working well, what worked but could have been done better and what really hasn’t worked can be gathered over the course of the project in a Lessons Learned Log and used to compile a Lessons Learned Report at the end of the project. The purpose of this report is to answer the question “what should be done differently next time?”

Click here for a specimen template Lessons Learned Report

Has the shared vision agreed at the beginning been sustained? If not, has variance been addressed to mutual satisfaction?

Has the project achieved more through joint working than it would have done if parties had worked individually? Why?

Have all parties made their contributions according to the original agreement? If not, has variance been addressed to mutual satisfaction?

Has each party benefited from the joint working arrangement? How?

Have good relationships been maintained?

Has trust been generated and maintained?

Have differences been managed effectively?





Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Reviewing and Revising

Effective monitoring and evaluation should lead to a review of whether the project is working in practice and, if not, what needs to be done to keep it on track. Reviews should be done periodically, according to the needs of the project, but not so often that continuity is lost or things are not given enough chance to work. In reviewing the project, ask the following questions:

Make sure that learning is captured and that there are systems for continuous feedback, so that each organisation can use theexperience to contribute to its own organisational learning - often joint working initiatives can be atypical and outside the organisations’ core business, which makes this feedback particularly important.

Having answered the Reviewing questions, jointly decide on what needs to be done to revise the project to keep it on track to meet the shared vision and objectives. Revisions could be in the areas of:

Wherever possible, try not to revise the focus of the project such that the original objectives and shared vision are lost.

Take the opportunity to use this stage to recognise and address less tangible issues such as over- (or lack of) ambition, lack of commitment or structures and processes that may marginalise rather than involve parties.

Is the project meeting its objectives? If not, why not? Can the issues that have arisen be addressed and if so how?

What is the impact on the parties in the project? Is this impact positive or negative?

Is there enough resource?

Is it worth sustaining?

Working arrangements Resourcing Joint working agreement

Accountabilities Project focus

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Looking to the Long Term

Institutionalising

Once planning and implementation are underway, you have reviewed progress and revised arrangements with a view to continuing the project, it may be necessary to embed appropriate structures and mechanisms for the joint working arrangement to mature long term. This may take the form of continued regular meetings of the Joint Project Group or it may be necessary to put more formal arrangements in place, e.g. making the running of the organisation’s input the accountability of a particular department.Such arrangements should be mirrored by other parties.

Overall accountability should continue to reside with some form of joint decision-making body or process.

Sustaining or Terminating

Each joint working arrangement will have different end-points – some short term and others potentially infinite. The parties need to agree on whether to:

Sustain the project and if so how Agree an appropriate conclusion

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Stakeholder Engagement Patient Engagement Communications


EngagementKey principles of joint working are openness and transparency and a summary of arrangements should be made public.

Ensuring the commitment of those directly involved in the joint working is essential, but so is engaging people who are indirectly affected or who will be affected by the outcome in the future. Joint working can be viewed with scepticism, so building theconfidence of stakeholders, both internal and external, can prevent roadblocks and unnecessary misunderstandings.

Senior management support in the partner organisations is vital, should be achieved as early as possible and actively sustained to ensure adequate resourcing, effective addressing of issues, continuity and confidence in the project.

Divide your stakeholders into internal and external who:

Should be involved the project Are not directly involved but whose opinion could influence the outcome and who should be kept informed Will ultimately be directly affected by the outcome Whose opinions could facilitate or prevent success

Stakeholders groups could include:

Draw up a Stakeholder Map clearly identifying who they are and their importance. Prioritise them according to whether they

can ‘make or break’ the project.

Practices GPs, Practice Nurses, Practice Managers

PBC Groups PBC leads, Therapy Area Experts, Directors

PCO Managers Clinical Directors, Nurse Leads, Commissioners, Prescribing Advisers, PEC Members

Budget Holders Finance Directors, Company Marketing Managers

Clinicians Consultants and other relevant hospital specialists

Industry Company Decision Makers, Budget Holders, Management Board, NHS Liaison Manager, Local Representatives

Others Department of Health, Local Press, Local MP, ABPI


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Patient Engagement

In developing any system change, which a joint working project may involve, it is important to consider the impact on patients.

Depending on the nature of your joint working project, patients are likely to be one of your major stakeholders, and the importance of involving patients in service re-design should not be underestimated. Involving patients in discussions about service re-design allows them to contribute their unique perspective, as recipients of those services. It is important to explain the benefits of joint working to patients and patient groups, so that they do not misunderstand the motives behind such an arrangement.

Ways of securing patients’ experience include:

A number of publications and useful resources on patient and public involvement can be found from the following:

CHAIN (Contact, Help, Advice and Information Networks)NHS Networks LINks Exchange The Patient and Public Involvement Specialist Collection

Patient stories of their experience

Mapping the key pathways of a service with patients and staff working together

Filming a patient’s experience of a service

http://chain.ulcc.ac.uk/chain/index.html�

http://www.networks.nhs.uk/�

http://www.lx.nhs.uk/�



http://www.library.nhs.uk/ppi�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Communications

The way you communicate with your stakeholders will depend on who and where they are and how important they are.

Agree a Communications Plan, which draws a balance between the increased effectiveness of some methods against the time

and resource taken to undertake them. For example, whilst one-to-one briefings are likely to have the most impact, they are themost time and manpower intensive, whereas distribution of written materials is less expensive but may have less impact.

Communications Materials

It may be appropriate to develop specific materials to use in stakeholder communication, e.g.:

Presentations Background/information sheets Information leaflets Patient information Press releases

Face-to-face briefings: ‘one-to-one’ briefings of individuals who have a particular interest or influence

Presentations: to groups of individuals, e.g. general practice and secondary care teams

Written information: for circulation and distribution to interested groups or individuals including patients and patient groups

Press releases: for coverage in local newspapers


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



Framework Guidance Ongoing Arrangements


This section looks at the initial and ongoing governance arrangements which should be put in place to support a joint working project. It also covers the national guidance available to support such arrangements.

Need for a Robust Governance Framework

When entering into a joint working initiative NHS organisations and staff need to ensure that they are working within a governance framework which is robust. All relationships must be handled in an open and transparent manner, which comply with the requirements of guidance issued by the Department of Health. Healthcare professionals have a responsibility to comply with their own codes of conduct at all times.

The pharmaceutical industry must comply with the requirements of the ABPI Code of Practice for the Pharmaceutical Industry . The ABPI Guidance Notes on Joint Working between Pharmaceutical Companies and the NHS and Others for the Benefit of Patients provide a useful guide to arrangements specific to joint working.

The partners should maintain a register of joint working initiatives which record those proposals which are submitted and approved, or not approved, including the reason for non-approval. This register should be open for inspection by the public. Meetings connected with the development or delivery of a joint working initiative should be formally minuted and recorded.

Click here to access a specimen template for a register of submitted proposals

Conflict of Interest Individuals involved in the development or consideration of any proposal must declare any potential conflict of interest they or their immediate family may have at the beginning of the process. Examples could include:

Shareholding or directorships in companies Research or educational grants Consultancy work Speaking at industry sponsored events







Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





DH and ABPI GuidanceBest Practice Guidance for Joint Working between the NHS and the Pharmaceutical Industry was published by the Department of Health in February 2008. This states that ‘NHS organisations and staff are encouraged to consider opportunities for joint working with the pharmaceutical industry, where the benefits that this could bring to patient care and the difference it can make to their health and well-being are clearly advantageous’.

The guidance is intended to assist NHS staff to build effective and appropriate working relationships with key partners in the pharmaceutical industry, as a realistic option for the delivery of high-quality healthcare. It emphasises the need for joint working to be for the benefit of patients, and that it should be conducted in an open and transparent manner. The guidance sets out the core values and additional principles which should apply to joint working arrangements, and highlights the responsibilities of NHSemployers and staff. It also contains a useful list of other underpinning and extant NHS guidance.

The ABPI Code of Practice has been in operation since 1958. One of the aims of the Code is to ensure that the promotion of medicines to health professionals and to appropriate administrative staff is carried out within a robust framework to ensure theappropriate use of medicines and support high quality patient care. As well as covering printed materials, it controls samples,meetings, promotional aids and the provision of medical and educational goods and services. The Code also sets standards relating to the provision of information to patients and the public about prescription only medicines, and relationships with patient groups.

The Code states that no gift, benefit in kind or pecuniary advantage shall be offered or given to members of the health professions or administrative staff as an inducement to prescribe, supply, administer, recommend, buy or sell any medicine. Medical and educational goods and services which enhance patient care, or benefit the NHS and maintain patient care, can be provided, butmust not bear the name of any medicine. Activities or materials associated with promotion of medicines must never bring discredit on, or reduce confidence in, the industry. Information provided must be accurate, balanced, fair, objective and unambiguous, andcapable of substantiation. Companies must operate to high standards.

The clauses in the 2008 Code of Practice (and supplementary information) of particular relevance to joint working are clauses 18, 19, 9.1 and 9.2. In addition, the ABPI issued in 2009 Guidance Notes on Joint Working between Pharmaceutical Companies and the NHS and Others for the Benefit of Patients.

The Prescription Medicines Code of Practice Authority (PMCPA) was established by the Association of the British Pharmaceutical Industry (ABPI) on 1 January, 1993 to operate the Code of Practice for the Pharmaceutical Industry at arm's length from the ABPIitself. A leaflet on the role of the PMCPA, the complaints procedure and the charges associated with complaints has also been published. Reports on cases considered are published at www.pmcpa.org.uk.





http://www.abpi.org.uk/links/assoc/pmcpa.asp�

http://www.abpi.org.uk/links/assoc/PMCPA/Leafletauthority06.pdf�

http://www.pmcpa.org.uk/�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Ongoing Governance Arrangements

For joint working to be successful some simple ground rules need to be openly acknowledged:

When entering into any joint working arrangement organisations need to carefully consider issues such as:

Make sure that you have in place a mechanism to record risks and issues which affect the project as they arise.

Click here to access a template Risks and Issues Log.

The ABPI Guidance Notes on Joint Working between Pharmaceutical Companies and the NHS and Others for the Benefit of Patients may provide helpful information.

You need to seek legal advice on any aspect that you are uncertain about.

Trust Mutual benefit

Added value Reliability

Consistency Integrity

The costs and benefits of any joint working arrangements for all parties concerned or affected by the project

The impact on purchasing decisions – which should not be influenced by any joint working agreement

Handling of patient specific information and confidentiality issues

Security standards applying to information, and limits to be placed on the use of information

Whether income-generation principles need to be considered

Where employment or secondment of staff are involved relevant employment regulations, exit arrangements and plans for future funding should be addressed in consultation with the Human Resources Department

The need for indemnity insurance cover Ownership of intellectual property rights covering products from a joint working arrangement



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Quick Start Option

If you are experienced in joint working, this section of the toolkit provides you with access straight to the key tools and resources that you might need to implement a joint working project, without needing to work through the whole toolkit.

If you have some experience but would like to find out more, you can take a mini-tour of the toolkit.

Go Straight to Tools and Resources

View the Whole Toolkit

Take a Mini Tour

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance

EngagingStakeholders


Quick Start OptionThe size and complexity of your project will dictate how rigorously structured you need to make the management of your project.


Joint Working FrameworkAction Plan

Risks and Issues LogLessons Learned ReportDesigning an Evaluation

Joint Project Group Terms of ReferenceProject Manager Job Description

Running Successful MeetingsBudget Report

Go to this

section

Go to this

section

Go to this

section

Go to this

section

Register of ProposalsNHS Joint Working Policy

ABPI Code of PracticeABPI Guidance Notes on Joint Working between Pharmaceutical Companies, the NHS

and Others for the Benefit of Patients Articulation of the Benefits of NHS/Pharmaceutical Industry Joint Working

Snapshot Guide to differentiating Joint Working from Other NHS/Industry ActivityCompany Organisational Preparedness

Competencies for Company Personnel (Short Version / Long Version)

Stakeholder MapCommunications Plan

Go to this

section

Business CaseProject Initiation Document

Joint Working Agreement (Single Company)Joint Working Agreement (Multi Company)

Risk AssessmentAction Plan

Risks and Issues LogLessons Learned Log

Lessons Learned ReportDesigning an Evaluation

Setting Up


Implementing

Getting Ready


Simple Project Large / Complex Project






































http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_082841.xls�




Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




What do we mean by Joint Working?

Joint working is a relatively new concept and differs from the traditional practice of sponsorship.

How does Joint Working differ from Sponsorship?

Joint working is distinctly different from sponsorship. In sponsorship arrangements pharmaceutical companies simply provide funds for a specific event or work programme.

In joint working, goals are agreed jointly by the NHS organisation and company, in the interest of patients, and shared throughout the project. A joint working agreements is drawn up and management arrangements conducted with participation from both parties in an open and transparent manner.

For many organisations, joint working will represent a new way of working. It requires a different mindset from sponsorship and a collaborative approach. Successful experiences (see Good Practice Examples) have shown that it can be of major benefit to patients, the NHS and pharmaceutical companies.

For a snapshot guide to differentiating Joint Working from other forms of NHS/Pharmaceutical Company Activity , click here.

Page 1 of 18

Exit Quick Start Mini Tour

Joint working describes situations where, for the benefit of patients, NHS and industry organisations pool skills, experience and/or resources for the joint development and implementation of patient centred projects and share a commitment to successful delivery.


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance







Setting Up

Implementing


Getting Ready

Page 2 of 18


Implementing


Introduction


Useful Contacts & Feedback

Acknowledgements

Quick Start Option

Getting Ready


Governance








Setting Up

Implementing


Getting Ready


• Identify stakeholders• Who will make or break implementation?• Who should be involved?• Get senior level support and endorsement• How do you involve patients?• Manage stakeholders

Close


Page 2 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance







Setting Up

Implementing


Getting Ready

Getting Ready

Before entering into a joint working arrangement there are a number of things you need to have in place.

These include: • Agreeing joint principles• Developing a shared vision• Recognising the enablers and barriers to

joint working• Understanding cultural differences• Having in place appropriate organisational

policies

Close


Page 2 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance







Setting Up

Implementing


Getting Ready

Setting Up

• Identify the issues to be addressed and opportunities to address them

• Establish shared objectives – what’s in it for each party

• Agree outcomes, deliverables, milestones, who contributes what

• Draw up a programme of activities• Agree ongoing management

structures and governance arrangements

• Identify where resources are needed and where to get them

• Develop a business case

Close


Page 2 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance







Setting Up

Implementing


Getting Ready

Implementing

• Appoint joint leaders and a Joint Project Group

• Appoint a project manager• Implement the project plan working to pre-

agreed timetable and specific deliverables• Manage the budget

Close


Page 2 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance






Setting Up

Implementing


Getting Ready



• Monitor and report progress against agreed deliverables and timescales

• Identify blocks and address them• Review the impact of the project• Is the project working in practice?• Is it worth sustaining?• Revise the working arrangements in

the light of experience• Build appropriate mechanisms to

ensure longer-term commitment• Build sustainability or agree an

appropriate conclusion• Record the lessons learned from the

experience

Close


Page 2 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Laying Foundations


Remember:



Shared goals

Principles under which you will work together.

The benefits to each party: start by considering the benefits to patients. Benefits will also include the commercial benefit that will accrue to the pharmaceutical company. If one or more parties is uncomfortable with the benefits that others will enjoy from the arrangement, it will be hard to make it work.

Who will contribute what to the arrangement.

Roles and responsibilities.

Page 3 of 18





Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Laying Foundations


Remember:



Page 3 of 18



Shared Goals

Goal-setting is the intentional act of describing your aspirations and laying out a plan and timeline for achieving them. This process needs to be undertaken collaboratively by all parties. Try and follow SMART guidelines. Goals should be Specific, Measurable, Attainable, Realistic, and Time-based.

The acronym SMART has a number of slightly different variations, which can be used to provide a more comprehensive definition.

Close

S – specific, significant, stretching Well defined, e.g. reduction in unnecessary hospital consultations and hospital visits for X conditionClear to anyone that has a basic knowledge of the project

M – measurable, meaningful, motivational Know if the goal is attainable (e.g. % increase in patients identified for X condition) and how far away completion isKnow when it has been achieved

A – agreed upon, attainable, achievable, acceptable, action-orientated

Agreement with all stakeholders what the goals should be

R – realistic, relevant, reasonable,rewarding, results-orientated

Within the availability of resources, knowledge and time

T – time-based, timely, tangible, trackable Enough time to achieve the goal, e.g. an increase in appropriately treated patients after one yearNot too much time, which can affect project performance


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Laying Foundations


Remember:



Close

Page 3 of 18


Shared vision Each party must have a mutually shared vision of the aims and outcomes of any arrangement that underpins all aspects of working together.


Transparency Openness and honesty (a precondition to trust); access to and sharing of information.

Mutual benefit Each party should be entitled to benefit from the arrangement – ideally working to specific benefits for each party as well as the common benefits to all.

Respect Respect for the other parties and for their ability to add value.


Close



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





A good business case will align the joint working initiative with patient benefit and the strategic objectives of all partners . The proposal should be succinct and well written, with discrete sections covering:

The level at which approval will be needed will depend on the nature, size and complexity of the initiative. Anything which has a financial implication for an NHS organisation will need to be discussed with the Director of Finance. However for a small scale, short duration project, where the resource contribution from the NHS is in the form of, for example, staff time, line management approval may be sufficient. A larger, more complex initiative will probably need senior management or Board level approval. If you are in any doubt about whether you have the authority to commit your organisation to participate in a joint working initiative discuss it with your manager.

For a pharmaceutical company, the case may best be put in the context of:

Depending on the nature, size and complexity of the project, there should be clear channels by which approval can be obtained –through a line manager, a Director or the Board as a whole.

Background and context Need for the initiative Description of the initiative

Aims, objectives and outcomes Contributions of each party Resourcing requirements and sources

Milestones and timelines Evaluation and audit Risks and benefits

Better use of NHS resources through improved service design and delivery to meet local patient needs

Faster NHS implementation of policy which may be relevant to your company’s business

Rapid and equitable patient access to appropriate treatment

Improved environmental intelligence

Better relationships with local decision-makers Improved company reputation

Page 4 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





No project will be successful if adequate resource is not allocated to it. Resources come in many forms:

Identify what you need and where it should come from. Be explicit about the amount and source of any financial support. Use your business case and remember to consult and get buy-in from stakeholders who could affect the final decision.

The level of structure and detail required will depend on the nature, scale and complexity of the project being undertaken. For a large-scale and/or complex project you will probably need to draw up an initial business case and then a more detailed planning document once initial approval to progress is given. For a simple project completion of a joint working framework document may be sufficient. Use what is most relevant to the joint work you are undertaking.

For a specimen template Business Case click here

For a specimen template Joint Working Framework document click here

People Expertise

Equipment Communication channels

Information technology Finance

Page 5 of 18






Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Planning









Page 6 of 18
















Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Planning









Page 6 of 18






Risk Assessment

At the outset of a joint working project, joint consideration should be given to what risks are involved to delivery of the project and what needs to be done to mitigate them.

Look at external dependencies – for example, people might not do things on time, may be of poor quality;

Examine the assumptions made in your planning - for example, availability of resources;

Look at each resource in the plan – will it be delivered? Are tools or technology unproven?

Include a Risk Assessment in the Project Initiation Document. Take appropriate actions to mitigate the risks identified. Make sure that any new or modified risks are shown in a Risks and Issues Log.

Close









http://www.hsconsultants.co.uk/Risk Assessment Template.doc�



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Planning









Page 6 of 18






Exit Strategy

A robust exit strategy should be agreed at the outset to ensure that patient care is not compromised, and should involve all stakeholders.

Issues that may need to be addressed include: Mainstreaming the activities Intellectual property Residual funds Staff and/or staff contracts Availability and updating of information, tools, products etc

after the end of the project Impact on patients

Close







Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Ongoing Management

As well as planning for the creation of the project it is important to establish as early as possible management structures andmechanisms that will oversee ongoing implementation.

These should include:

Best practice indicates that management should be overseen by the Joint Project Group, comprising key players from the partner organisations, and key individuals who will be directly involved in implementation. The Group should be co-chaired by leadersfrom the partner organisations and the Project Manager should act as Secretariat to the Group.

Avoid unduly complex structures and processes to manage the project. Excessive bureaucracy creates frustration and a sapping ofenthusiasm and commitment. If you feel the need to put such processes in place, this may indicate some defensiveness about aparty’s own interests or uncertainty about mutual trust. Focus on process and outcomes not structures and inputs.

Governance arrangements

Decision-making processes

Accountabilities

Roles and responsibilities

A detailed action plan

Communication channels – who should contact whom in the event of what

Which stakeholders should be informed of progress

Page 7 of 18



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Leadership

Visible and strong leadership is a vital component of successful joint working. It helps:

Demonstrate a genuine commitment to the project Keep the focus on shared objectives and keep things on track Generate engagement, enthusiasm and confidence amongst those involved Engage, build confidence and reassure those who are affected Free up resources required to effectively implement the project Support problem-solving when required.

Leadership should be embodied by:

Leading individuals and bodies must be seen as legitimate and be given the authority to make decisions and effect change (this is often best gained through Board level endorsement).

Style of leadership is important – best described as ‘collaborative’ – an inclusive approach that engages those involved and values their individual and organisational input. Everyone should feel that they have an equal right to speak and to contribute to decisions.

Individuals – recognised jointly accountable leaders from the NHS organisation and pharmaceutical company who are of sufficient seniority and command respect

A recognised decision-making body, such as the Joint Project Group – co-chaired by the co-leaders

Visibility as well as effectiveness – demonstrating commitment to the joint working arrangement and the parties, and being prepared to promote the project to others

Page 8 of 18


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Role of the Joint Project Group

The Joint Project Group (sometimes referred to as the Project Board) provides overall direction and management of the project. It is accountable for the success of the project, and has responsibility and authority within the limits set by the organisations represented. This group should agree:

The Joint Project Group is the project’s “voice” to the outside world and is responsible for signing off all major plans (e.g. Project Initiation Document, project action plan), any communication materials, or other dissemination of information about the project. It should ensure that each party’s organisation is supportive of the project and able to manage the input that it will provide.


For a specimen template for the group’s Terms of Reference click here.

Approves all major plans and authorises any major deviation from plans

Signs off the completion of each stage and agrees the start of the next stage

Ensures required resources are committed

Arbitrates any conflict within the project

Negotiates a solution to any problems within the project, or between the project and external bodies (including the parties)

Approves the appointment and responsibilities of the Project Manager

Page 9 of 18


Realistic outcomes and deliverables from the project Key factors that will identify success (or lack of it)

Who brings what to the table (and in the case of finance how much)

Stakeholders/stakeholder groups and how they should be involved or informed

Detailed roles and responsibilities


Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance



MOVING BEYOND SPONSORSHIP – JOINT WORKING TOOLKITExit Quick Start Mini Tour

Pharmaceutical Company Managers

Joint working is a relatively new way of working for pharmaceutical companies as well as the NHS. The competencies required to work in this way are broader and deeper than many of the more traditional roles of managers interfacing directly with their customers.

The ABPI has developed a competency profile for industry managers undertaking joint working. It outlines the purpose, scope and accountabilities for the role, together with job outcomes. Skills, knowledge and behaviours/attributes are listed and described in full.

The aim of this profile is to ensure that managers from companies are fully equipped to support NHS customers in delivering successful joint working projects that deliver real benefits for patients, the NHS and companies in an open and transparent manner.

For the ABPI Competency Profile for Managers Undertaking Joint Working (short version) , click here.

For the ABPI Competency Profile for Managers Undertaking Joint Working (long version) , click here.

Page 10 of 18



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Project Management

Project ManagerThe Project Manager has the authority to run the project on a day-to-day basis on behalf of the Joint Project Group, within constraints laid down by that group. The Project Manager’s prime responsibility is to ensure that the project produces the required products / outcomes, to the required standard of quality and within the specified constraints of time and cost. The Project Manager is also responsible for the project producing a result that is capable of achieving the goals and benefits defined in the business case.


For a specimen template job description for a Project Manager click here

Manage the production of the required products / outcomes

Facilitate and motivate the project team

Plan and monitor the project Produce the project contract

Prepare Project Plans in conjunction with the project team and agree them with the Joint Project Group

Manage business and project risks, including the development of contingency plans

Take responsibility for overall progress and use of resources, and initiate corrective action where necessary

Report to the Joint Project Group as necessary

Liaise with the Joint Project Group to assure overall direction

Prepare the Lessons Learned Report

Prepare any follow-on action recommendations required Identify and obtain any support and advice required for the management, planning and control of the project

Be responsible for project administration Liaise with any suppliers

Page 11 of 18



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Budgeting

Transparent budget planning and monitoring of expenditure are essential elements of project governance and vital to ensure sustained mutual trust.

Key components in managing the budget are:

Realistic financial planning (fully explored and costed in the Business Case) Specificity on the sources of funding Transparent and regular monitoring of expenditure Clear reporting lines and channels Agreed mechanisms to address cost over-runs/under-spend Clear communication to project team members and financial stakeholders (e.g. Finance Directors)

The Joint Project Group (and joint team leaders) should be ultimately accountable for the budget. The Project Manager should be responsible for day-to-day monitoring and reporting.

Click here for a specimen template budget report

Page 12 of 18



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Need for Monitoring and Evaluation

Regular monitoring and ongoing evaluation are essential in order to ensure that:

Effective monitoring and evaluation should comprise:

Click here for a specimen template for a Lessons Learned Log

The joint working arrangement is meeting pre-defined aims and objectives

The joint working between the parties is operating effectively

Issues are identified as early as possible so that they can be addressed

All parties and participants have a clear view of the status of the project

Stakeholders are informed

Opportunities to publicise success are identified and communicated

Confidence is built in the whole process of joint working

Clearly pre-defined success criteria (see Planning)

Clear milestones and timelines (see Planning)

Clear arrangements to monitor and review how successfully the success criteria are being met

Clear arrangements to monitor how effectively the joint working between the parties is operating

Mechanisms to identify and communicate issues and successes

Clear arrangements to ensure that all parties have access to the monitoring information

A means to capture what has worked well or not (Lessons Learned Log)

Page 13 of 18


http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_082841.xls�

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Evaluation

The methods used to evaluate the joint working project will vary according to its nature, scope and size. Even for the smallest of projects you should establish in the Planning phase how you will evaluate its outcomes and have jointly agreed success criteria. For a large-scale project, it may be appropriate to bring in a third party to conduct the evaluation, e.g. an academic body. For ideas on what you should consider when designing an evaluation click here.

Auditing Joint Working EffectivenessTo evaluate how well joint working between the parties has worked, answer the following questions:

Successful organisations learn from their experiences, and this applies to taking part in joint working initiatives as much as any other aspect of business. Learning will be more beneficial if it is preserved beyond the end of the project in the form of a report. So, as well as evaluating the outcome of the overall project, it is useful to assess how successful or unsuccessful the operation of the project has been so that lessons learned can be usefully applied to the design and running of other projects. Comments and observations about what is working well, what worked but could have been done better and what really hasn’t worked can be gathered over the course of the project in a Lessons Learned Log and used to compile a Lessons Learned Report at the end of the project. The purpose of this report is to answer the question “what should be done differently next time?”

Click here for a specimen template Lessons Learned Report

Has the shared vision agreed at the beginning been sustained? If not, has variance been addressed to mutual satisfaction?

Has the project achieved more through joint working than it would have done if parties had worked individually? Why?

Have all parties made their contributions according to the original agreement? If not, has variance been addressed to mutual satisfaction?

Has each party benefited from the joint working arrangement? How?

Have good relationships been maintained?

Has trust been generated and maintained?

Have differences been managed effectively?

Page 14 of 18





Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Ongoing Governance Arrangements

For joint working to be successful some simple ground rules need to be openly acknowledged:

When entering into any joint working arrangement organisations need to carefully consider issues such as:

Make sure that you have in place a mechanism to record risks and issues which affect the project as they arise.

Click here to access a template Risks and Issues Log.

The ABPI Guidance Notes on Joint Working between Pharmaceutical Companies and the NHS and Others for the Benefit of Patients may provide helpful information.

You need to seek legal advice on any aspect you are uncertain about.

Trust Mutual benefit

Added value Reliability

Consistency Integrity

The costs and benefits of any joint working agreementfor all concerned, including patients

The impact on purchasing decisions – which should not be influenced by any joint working agreement

Handling of patient specific information and confidentiality issues

Security standards applying to information, and limits to be placed on the use of information

Whether income-generation principles need to be considered

Where employment or secondment of staff are involved relevant employment regulations, exit arrangements and plans for future funding should be addressed in consultation with the Human Resources Department

The need for indemnity insurance cover Ownership of intellectual property rights covering products from a joint working arrangement


Page 15 of 18



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Useful Contacts


The Association of theBritish Pharmaceutical Industry12 Whitehall London SW1A 2DY

Tel: 0870 890 4333Fax: 020 7747 1414

www.abpi.org.uk

Pharmaceutical Company personnel with responsibility for Joint Working

For a contact name within a Pharmaceutical Company contact Carol Blount on 020 7930 3477

ABPI NHS Partnership Projects

Regional FacilitatorsJan BalmerEast MidlandsTel: 07734 [email protected]

Carol Blount, Head of Commercial Affairs

Adam AllerhandNorth WestTel: 07718 535 [email protected]

Tel: 020 7930 3477

Helen MorrisonSouth WestTel: 07852 [email protected]

[email protected]

Pamela San JuanTel: 07894 [email protected]

The National Prescribing CentreGround Floor, Building 2000, Vortex Court, Enterprise Way, Wavertree Technology Park, LiverpoolL13 1FB

See website for telephone numbers

www.npc.co.uk

Prescription Medicines Code of Practice Authority12 Whitehall,London SW1A 2DY

Tel: 020 7747 8880Fax: 020 7747 [email protected]

www.pmcpa.org.uk

Page 16 of 18

http://www.abpi.org.uk/�



mailto:[email protected]�






http://www.npc.co.uk/�




Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Useful Contacts


Please Provide Feedback

In order to make sure that the Toolkit a useful resource we need to understand whether you found it easy to use, and whether the content is helpful to you in developing joint working. Please spare a few minutes to complete a short feedback form, to helpus continue to develop and improve the Toolkit.

General Medical CouncilRegent’s Place350 Euston RoadLondon NW1 3JN

Tel: 0161 923 6602 www.gmc-uk.org

Royal Pharmaceutical Society of Great Britain1 Lambeth High StreetLondon SE1 7JN

Tel: 020 7735 9141 www.rpsgb.org.uk

Nursing and Midwifery Council23 Portland PlaceLondonW1B 1PZ

Tel: 020 7637 7181Fax: 020 7436 2924

www.nmc-uk.org

If you have accessed the Toolkit before

and are returning to use it again click hereIf this is the first time you have

accessed the Toolkit click here

Page 17 of 18






Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Acknowledgements

This toolkit was commissioned by the Ministerial Industry Strategy Group, whose members comprise Ministers from the Department of Health, Treasury and Business Enterprise and Regulatory Reform and senior executives from the pharmaceutical industry, as part of the Long Term Leadership Strategy in Medicines (LTLS). The aim of the LTLS is to secure the provision of safe and effective medicines for patients, maintain and strengthen the UK pharmaceutical industry within Europe, and to advance healthcare innovation within the NHS.

The toolkit was developed by a Working Group comprising representatives of Ashton Leigh and Wigan PCT, East Lincolnshire PCT,the National Cancer Action Team, the National Prescribing Centre, GlaxoSmithKline, Lilly UK, UCB Pharmaceuticals, Roche Products, Takeda, the ABPI and the Medicines Pharmacy and Industry Group at the Department of Health. We would like to acknowledge andthank them for their input.

We would also like to thank the POIP, NHS East of England, NHS Mid Essex, NHS Nottingham City, Nottingham City University Hospitals Trust, Weston PBC Cluster, Newcastle West PBC Group, NHS Enfield, Enfield/Edmonton PBC, City and Hackney Teaching PCT, Trafford PCT, Bradford & Airedale PCT, Newcastle upon Tyne Hospitals NHS Foundation Trust, Wakefield Integrated Substance Misuse Service, Somerset PCT, StHealth PBC Consortium, North West London Cardiac Network, Northwick Park Hospital, Birmingham East and North PCT, NHS South West, Haringey Teaching PCT, Kent and Medway NHS and Social Care Partnership Trust, North Hampshire Hospital NHS Trust, Huddersfield & Calderdale NHS Trust, Kirklees PCT, London Renal Modernisation Team, Nottingham City PCT, the Manadon Commissioning Group, Pfizer Ltd., Pfizer Health Solutions, Boehringer Ingelheim, Abbott Laboratories Ltd, Servier Laboratories, Napp Pharmaceuticals, sanofi-aventis, and Schering-Plough for providing copies of policies, tools and good practice examples which have been used in the development of the toolkit.

Liability: Information provided on this toolkit has been provided in good faith and the Department of Health/National Health Service and the ABPI uses reasonable care to ensure the information is up to date. However, the Department of Health/National Health Service and the ABPI make no representations or warranties as to the accuracy, completeness or currency of such information. The Department of Health/National Health Service and the ABPI disclaim any obligation to update the information and advice featuring on this toolkit There are hypertext and other links in this toolkit which, if used, will involve you entering another website which is not controlled by the Department of Health/National Health Service and the ABPI. The Department of Health/National Health Service and the ABPI accept no responsibility or liability in respect of your access to, or use of, any website which is not under their direct control or in respect of any materials posted on such a website. Access to the toolkit is at your own risk. The Department of Health/National Health Service and the ABPI shall not be liable for any damage to the hardware or software installed on the computer you use to access this toolkit as a result of your access to, or use of, this toolkit or your downloading of any resource from the website.

Page 18 of 18


More >>Trafford

LTC TrainingLincolnshire

COPDABPIPOIP - CCTPOIP –C-PORT

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Pharmaceutical Oncology Initiative Partnership (Pharmaceutical Oncology Initiative, National Cancer Action Team, NHS Improvement) Chemotherapy Planning Online Resource Tool (C-PORT)

C-PORT is a web-based simulator which enables cancer hospitals to effectively plan capacity and improve access to cancer medicines for patients. Initiated in 2005, it has been implemented in most Cancer Networks and over 100 hospitals, with the support of a team of NHS and industry facilitators. In March 2009, over 2,800 simulations had been run through the system. In 2004, a review of use of cancer treatments approved by NICE by the National Cancer Director revealed wide variation between Cancer Networks in England which could not be explained. One major constraint identified was service capacity. Inputs such as drug regimens, patient flows, resource levels and ways of working all influence the performance of a unit. By using advanced techniques to recreate real-life events, C-PORT enables Trust chemotherapy units to review resources, model the impact of changes in resource utilisation and understand the consequences of investment decisions and choices. The POIP was led by a working group (now superseded by the C-PORT Steering Group and C-PORT User Group) with representatives from all parties. There are several examples of improvements to service capacity using C-PORT that have demonstrated real benefits to local chemotherapy units and access to cancer medicines for patients. C-PORT has won numerous awards for innovation and joint working.

Further information: Jane Whittome, Associate Director, National Cancer Action Team, [email protected] Palmer, National Lead Facilitator, C-PORT [email protected]

The POI member companies that have supported C-PORT are Amgen, AstraZeneca, GlaxoSmithKline, Lilly, Merck Serono, Novartis, Ortho Biotech, Pfizer, Roche, sanofi-aventis, Schering-Plough and Wyeth



More >>Trafford


COPDABPIPOIP -CCTPOIP –C-PORT

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Pharmaceutical Oncology Initiative Partnership (Pharmaceutical Oncology Initiative, National Cancer Action Team, National Cancer Intelligence Network)Cancer Commissioning Toolkit

The POIP was created to identify and implement projects of mutual interest that would ultimately benefit cancer patients by improving access to and uptake of cancer medicines. The Cancer Commissioning Toolkit (CCT) was developed in response to the Cancer Reform Strategy and the need for information on cancer services by commissioners and providers to improve the whole commissioning process and ensure that ultimately patients have access to the most appropriate cancer services including medicines.

The CCT is a web-based tool which supports commissioners and cancer service providers to understand and apply data to help service planning and delivery. It is a one stop solution for cancer commissioning information, bringing together data in a format that is easy to access and review and which was previously only available in diverse locations. It also enables data to be compared across PCTs, Networks and SHAs in standard reporting formats that can be downloaded for consideration at local level.

The POIP was led by a working group (now superseded by the CCT Steering Group and CCT User Group) with representatives from all parties. All parties have contributed resources in terms of finance and manpower over several years. The POIP continues to provide technical and logistical support (such as technical development, data updates and training). The outcome is a product which was unlikely to have been achieved by any party alone. Feedback is collected via the User Group and user surveys and has been excellent. The CCT will continue to be developed to provide the data required for future commissioning.

Further information: Di Riley, Associate Director, Clinical Outcomes Programme, National Cancer Intelligence Network at [email protected].


More >>Trafford



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Association of the British Pharmaceutical Industry ‘NHS Partnerships’ Project

Successful joint working projects exist all over the country, but not all NHS organisations are willing to consider working with industry. In order to create opportunities for companies and the NHS to work together on projects that benefit patients, the ABPI has established a collective industry presence on the ground to enable dialogue with PCTs who traditionally have been unwilling to work with pharmaceutical companies.

Dedicated industry regional coordinators have been recruited to approach these PCTs and to discuss potential joint working projects. They then identify companies with relevant interests and expertise and facilitate dialogue between them and PCT managers with a view to developing and implementing measurable joint projects of value to patients.

Since March 2006, 33 PCTs have met with the regional coordinators, and 32 have agreed in principle to consider joint working. Nine projects are already underway in areas including COPD, cardiovascular disease, medicines concordance and wastage, health care acquired infections and more.

For further details contact Carol Blount, Head of Commercial Affairs([email protected])


More >>Trafford



Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





East Lincolnshire PCT Chronic Obstructive Pulmonary Disease Programme in collaboration with GlaxoSmithKline, Boehringer Ingelheim and Pfizer

East Lincolnshire PCT developed a locally enhanced service, three-phase programme to target suspected COPD. Phase 1 identified patients and screened them for COPD within spirometry clinics; phase 2 involved training clinicians to manage these patients; and in phase 3 specific COPD clinics within the practices were set up. Patients were identified for referral to secondary care for specialised treatments, such as pulmonary rehabilitation, long term oxygen assessment and lung volume reduction surgery. Additional support was provided by an educational pathway available to all clinicians in primary care.

The programme recorded a 23% fall in admission rates in COPD (neighbouring PCTs' reductions were in single figures). Over a five-month period, 78 out of 215 case-managed patients had acute episodes that were successfully managed at home. Only one resulted in hospital admission. All 37 practices in the PCT area signed up for the enhanced service.

Funding was shared between the PCT and the three companies. Industry was also able to provide essential project management support and communications and marketing expertise.

The project won the Health Service Journal’s Chronic Disease Management Award and overall Secretary of State’s Healthcare Management Award in 2005.

For further details contact Judith Smith, Respiratory Nurse Consultant ([email protected]), Noel O’Kelly, GPwSI ([email protected]), Marian Tadman ([email protected]), Michael Edwards, Account Manager ([email protected]) or Nicole Bacon, Healthcare Development Manager ([email protected]).








More >>Trafford

LTC TrainingLincolnshireABPIPOIP - CCTPOIP – C-PORT

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Trafford PCT, ABPI, BMS, GSK, AstraZeneca, MSD, Solvay, sanofi-aventis, Takeda, Boehringer IngelheimTrafford Education and Training Partnership

Trafford PCT wants to increase the uptake of education by multi-disciplinary staff in GP surgeries. Attendance at educational meetings has traditionally been very poor and the PCT is working with a number of pharmaceutical companies to put together a series of bespoke training and development programmes to address this issue. Three events have taken place: on COPD and vascular disease in 2008 and diabetes in 2009, with a further three planned.

A Joint Project Group was created for the project. Companies have provided disease area expertise and innovative ideas, together with project management, facilitation, networking, and communication support. The PCT contributed planning and administration, expertise in medicines management and training, and Mastercallcover.

All events have been very successful with over 110 delegates attending each, including between 49 and 71 GPs, and feedback has been excellent. Training events from Trafford PCT are now seen as some of the most effective in the North West. For the companies, relationships with the PCT have been improved and the joint working concept has been tested and succeeded. It is hoped that further opportunities for joint working will arise from the experience.

Further information: Janet O’Mahony, Training and Development Manager, Trafford PCT at [email protected] or Pamela San Juan, ABPI Outreach Facilitator at [email protected].



More >>NHS SW Allergy

Somerset MedCheck

<< MoreMid Essex

Pain

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





NHS Mid Essex, Mid Essex Hospitals Trust, and Napp Pharmaceuticals LimitedImproving Primary Care Capacity in Chronic Pain Management

Access to pain management services in Mid Essex is currently via hospital based Consultant clinics and Consultant outreach clinics within four GP Practices across Mid Essex for chronic pain patients. Of the 30,306 patients referred in 2007, 75% went to secondary care. In conjunction with Napp Pharmaceuticals, a group consisting of commissioners, managers, consultants, GPs, pharmacists and physiotherapists was established to develop a pain management service to reduce the number of secondary care appointments and consultant-to-consultant referrals, meet the 18-week target and improve local access.

A modular pain service development tool (Comm-ITTM ) was designed by Napp to help PCTs with capacity plans, service specifications and the business case. As a result patients have improved services closer to home, equal standards of care, helping to improve quality of life, while better management supports more appropriate prescribing. Pain Consultants have provided clinical and service knowledge, and the PCT has driven the project forward and managed stakeholder communication. The objective is to improve local pain management services. It is hoped that this will provide benefit to patients and encourage prescribing appropriate to patients needs and consistent standards of care.

The business case is now approved and funding has been made available. Following the outcome of the pilot, a tender may be issued to potential providers.

Further information: Lynne Smith, Mid Essex PCT at [email protected] or Paul Walshaw, NappPharmaceuticals Limited at [email protected]

SW Medicines Shortages



More >><< MoreSomerset

MedCheckMid Essex Pain

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Somerset PCT and 11 Pharmaceutical Companies (AstraZeneca, BMS, GSK, Janssen-Cilag, MSD, Norgine, Recordati, Roche, sanofi-aventis, Solvay, Wyeth)MedCheckA group of pharmaceutical companies worked with the Head of Medicines Management in Somerset PCT to develop and deliver a medicines review service for elderly patients discharged from community hospital taking numerous medicines for multiple conditions.

The aims of the project were to improve patient care by examining the process of medicines management post discharge, with a view to reducing medicines waste and readmissions caused by medicines-related complications. It was also hoped to identify weaknesses in the system, develop solutions, and demonstrate the need for an intermediate care pharmacist. Good practice would address ‘medicines reconciliation’ in anticipation of guidelines from NICE and the NPSA. For industry, the aim was improved use of medicines and experience of working in this way with the PCT.

Initially small-scale, a pilot to evaluate the need for an intermediate care pharmacist involved 30 patients in two community hospitals in Somerset, with 23 home visits completed. A Joint Project Group supported funding of the pharmacist, with the PCT providing pharmacy skills and the companies providing project management.

The project was evaluated by questionnaire completed by the pharmacist after each home visit. Questions were designed to gauge the level of patient understanding of how to take, store and dispose of their medicines, and whether the medicines they were taking matched the discharge letter. It confirmed that the majority of patients were taking multiple medicines and had difficulties, and that management in the home is complex. MedCheck has resulted in a number of recommendations to the PCT on future commissioning, the need to improve communication systems, policies and procedures, and the wider use of medication reminder charts. The PCT has become a pilot for the Care Quality Commission inspection looking at post-discharge.

Further information: Shaun Green, Associate Director Head of Medicines Management, NHS Somerset at [email protected] or Helen Morrison, ABPI Regional Coordinator, at [email protected].

NHS SW Allergy





Somerset MedCheck

<< More Mid Essex Pain

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





South West Medicines Safety PartnershipMedicines Shortages Project

NHS South West, ABPI (represented by Chugai Pharma UK Ltd, Wyeth, Solvay Healthcare and Cambridge Laboratories), British Association of Pharmaceutical Wholesalers (represented by AAH Pharmaceuticals Ltd), British Generic Manufacturers Association (represented by Actavis and Sandoz Ltd

The South West Medicines Safety Partnership is an innovative collaboration between the South West Strategic Health Authority, NHS South West and the Association of the British Pharmaceutical Industry (ABPI) aimed at reducing avoidable harm to patients. The pooling of resources, skills and expertise has allowed three multi-disciplinary teams to develop practical solutions to high priority issues, one of which is the shortage of medicines, which can lead to suboptimal patient care and an increase in risk to patients by causing unpredictable changes to routine clinical practice.

This project set out to create a better understanding of the issues involved and improve existing methods of communication between the NHS and Pharmaceutical Industry in order to tackle this subject at a local level. Joint working, including communication with the Department of Health and PaSA, has resulted in the development of an electronic system to gather and disseminate information across the South West with the aim of minimising risk to patients associated with lack of supply. The system is co-ordinated by the regional procurement pharmacist via a password-protected website, which provides trusts with early notification and guidance, including advice on alternative therapeutic strategies, risk assessment, use of robust communication plans and the potential to manage stock across the region during a shortage to minimise risk.

Further information: Steve Brown, Medicines Adviser, NHS South West , at [email protected] or Helen Morrison, ABPI Regional Coordinator, at [email protected]






Somerset MedCheck

<< More Mid Essex Pain

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





South West Medicines Safety PartnershipAllergy Project

NHS South West , ABPI, AstraZeneca UK, Merck Sharp & Dohme Ltd, Pfizer Ltd, Schering-Plough

The South West Medicines Safety Partnership is an innovative collaboration between the South West Strategic Health Authority, NHS South West and the ABPI, aimed at reducing avoidable harm to patients from medicines. The pooling of resources, skills and expertise has allowed three multi-disciplinary teams to develop practical solutions to high priority issues, one of which is medicines allergy.

The NHS/Industry project team organised a patient focus group to gain insight into what patients understand of medicines allergy and to establish how information on the subject could be improved. The outcome led to the development of a “Medicines Allergy Matters Campaign” which aims to empower patients and raise awareness amongst healthcare professionals of the importance of accurately documenting medicines allergy on clinical systems, as highlighted in the Patient Safety Observatory Report, Safety in Doses1. The group has also made recommendations to the Clinical Applications and Patient Safety Project (part of the Common User Interface Programme under Connecting for Health).The project has been published in the Pharmaceutical Journal and shared with the National Patient Safety Agency.

Further information: Jill Loader, Associate Director of Medicines Management, NHS South West, at [email protected] or Helen Morrison, ABPI Outreach Facilitator at [email protected]

1The fourth Patient Safety Observatory report – Safety in doses: medication safety incidents in the NHS, National Patient Safety Agency, 2007



<< More More >>Nottingham

INFORCENottingham

Happy HeartsSW Medicines Reconciliation

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





South West Medicines Safety Partnership Medicines Reconciliation ProjectNHS South West, ABPI, Recordati Pharmaceuticals, GSK, Daiichi-Sankyo, sanofi-aventis

ABPI and NHS South West have formed the South West Medicines Safety Partnership to reduce harm to patients caused by medicines and demonstrate the benefits of joint working. The pooling of resources, skills and expertise has allowed three multi-disciplinary teams to develop practical solutions to high priority issues, one of which is implementation of the NICE/NPSA Guidance Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. The focus has been on mental health trusts and community hospitals where lack of access to pharmacists presents particular challenges.

The aims of the project are to design and test a form for incorporation into the admissions process, develop and test an e-learning package to train staff and assess their competence in reconciling medicines and taking medicines histories, and develop materials to promote the concept of consistent medicines reconciliation for patient safety.

Under a joint steering group, NHS and industry skills have been combined to produce the outputs, with a grant from the SHA and sales and marketing expertise from the companies. The form to document medicines reconciliation has been successfully incorporated into the admissions processes of pilot sites where no documentation had previously been in place. The e-learning package has been identified by senior Trust Pharmacy Managers and PCT Heads of Medicines Management as a need that will help embed the practice of medicines reconciliation into all organisations.

Further information: Jill Loader, Associate Director of Medicines Management, NHS South West at [email protected] and Karen Traves, Business Manager, GSK at [email protected].

East of England COPD




Happy Hearts

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Nottingham City PCT and the ABPI NHS Partnerships ProgrammeHappy Hearts ProjectNottingham City is the 13th most deprived local authority area in the country and its population suffers from an associated high incidence of Coronary Vascular Disease (CVD), with mortality rates significantly higher than the national average and a 10-year gap in life expectancy between the most and least deprived areas. Working in collaboration with six pharmaceutical companies under the ABPI NHS Partnership Projects Programme, the parties developed and implemented a primary care based CVD risk identification and management programme. Targeted at 13 GP practices in Nottingham City’s most deprived areas, the “Happy Hearts” project aimed to reduce levels of CVD risk and associated premature mortality through primary care identification and management of an estimated 2500 people thought to have more than a 20% risk of developing diabetes, heart disease and stroke.

Equally funded by the PCT and the companies, the project employed and trained 13 Clinical Healthcare Assistants (CHCAs) who, using specially developed software to interrogate GP clinical systems, identified patients who were or were potentially at risk of developing CVD. They were invited to have a consultation with the CHCA, who carried out relevant clinical tests and offered lifestyle advice and support. Patients were signposted to relevant services such as smoking cessation clinics and where appropriate were offered medical intervention. The project engaged with over 2,000 of the 2,500 patients estimated to be at risk of developing CVD and of those identified 1,352 patients (66%) had a risk level of >20% and were given support to manage and reduce that risk, including appropriate medication.

The NHS and industry partners worked together via a joint project board, with equal input to all decisions regarding design, implementation and evaluation of the project, which has provided the PCT with a wealth of learning and experience that has informed the development of the PCT’s city wide vascular checks programme as part of the national Health Check initiative. A detailed evaluation report of the project, results and methodology can be found at www.nottinghamcity.nhs.uk/happyhearts

Further information: Dr Jeanelle de Gruchy, Deputy Director of Public Health NHS Nottingham City, at [email protected] or Jan Balmer Project Manager [email protected] Companies involved Novartis, Solvay Healthcare, Schering Plough, Merck Serono , MSD


Nottingham INFORCE

SW Medicines Reconciliation

http://www.nottinghamcity.nhs.uk/happyhearts�




INFORCE

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





NHS Nottingham City, Nottingham University Hospitals Trust, ABPI, AstraZeneca, Boehringer-Ingelheim, GSK, Nycomed, PfizerINFORCE – Reducing COPD ExacerbationsPrevalence of COPD in Nottingham City is higher than the national average and there are around 140 COPD related deaths (40% of which are in people under 75) and up to 1000 admissions to Nottingham’s hospitals annually for people with a primary diagnosis of COPD. There is also significant variation in life expectancy for COPD patients based on where they live.

NHS Nottingham City, Nottingham University Hospitals Trust and five pharmaceutical companies designed and implemented a programme to improve COPD management across primary and secondary care, reduce the number of avoidable hospital admissions, and improve patient outcomes. A clinical audit and treatment review of all Nottingham City patients admitted to Nottingham University Hospitals NHS Trust with an exacerbation of their COPD was carried out and analysis of the data enabled identification of whether care prior to admission had been managed according to the NICE clinical guideline. It also enabled identification of areas of potential improvement in local care pathways and treatment guidelines. Service changes now include: development and implementation of a personalised self management plan for all patients with COPD; treatment reviews of all patients with COPD who have had one or more exacerbations in the previous 12 months to ensure they are being managed in line with NICE guidelines using four respiratory nurse specialists seconded to the programme from company partners; development and implementation of a bespoke COPD clinical management template for GP clinical systems; primary care professional training and education.A telephone outreach service to provide patients with self care advice and personalised support. The project has been built into the business plans of three PBC clusters which are providing additional funding to continue specialist respiratory nurses working with practices. A programme of training and education for HCPs is in development and a re-audit of admissions will be carried out during the winter of 2010.

Further information: Shirley Smith, Assistant Director Commissioning Long Term Conditions and Community Services at [email protected] or Jan Balmer Project Manager [email protected]; see also INFORCE website at www.nottinghamcity.nhs.uk/inforce


Nottingham Happy Hearts




http://www.nottinghamcity.nhs.uk/inforce�

<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





NHS East of England and GSKImproving Delivery of Pulmonary Rehabilitation to Patients in the East of England

The NICE clinical guideline published in 2004 for the care of people with COPD highlighted the importance of pulmonary rehabilitation in improving patients’ quality of life, function and exercise capacity, and reducing dyspnoea and the length of hospital stays. In 2008/9, the estimated number of people across East of England (EoE) receiving pulmonary rehabilitation was 3,227; expected levels based on NICE benchmarks move this figure to 12,896. The SHA has an objective to provide pulmonary rehabilitation to all eligible individuals as defined by NICE by end 2010/11.

A specialist Project Manager from GSK has been seconded to work with Service Development and Long Term Conditions staff at EoE to raise awareness of the NICE standards, examine commissioning challenges, and develop bespoke support packages designed to meet individual PCTs’ needs, using material from within the SHA and examples of best practice beyond. Outputs include a generic service specification and service development booklet. Working in alignment with the National Centre of Social Marketing, a social marketing project is about to be undertaken, the first of its kind in pulmonaryrehabilitation. The GSK Project Manager will also provide support for PCTs in preparing for and implementing the National Strategy for COPD.

The EoE Service Development Manager provided knowledge on relevant health and social care policies, galvanised a network of PCT commissioning leads, and provided overall guidance and support. The GSK secondee brought project management and marketing expertise, a thorough business planning approach, a suite of support tools and resources and a high level of energy and ‘can do’ approach to driving the project forward. Outcomes are being evaluated and the secondment has been extended from six months to one year.

Further information: Heather Ballard, Service Development Manager, NHS East of England at [email protected] Michelle Murray, National Account Excellence Manager, GSK at [email protected].

Nottingham INFORCE

Nottingham Happy Hearts





Bradford & Airedale Angina

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Bradford and Airedale PCT and Servier LaboratoriesOptimal Management of Patients with Stable Angina

Bradford and Airedale PCT has a large South Asian population and it is known that people of South Asian origin have a higher incidence of coronary heart disease (CHD) than those of other ethnic backgrounds. The PCT has approximately 2,900 newly-diagnosed cases of angina each year. Consensus is emerging that invasive and expensive revascularisation has limited benefit in some patients with stable angina, who can be more optimally managed with medicines.

The PCT is working with Servier Laboratories to pilot CHD clinics, utilising the skills of Primary Care Clinical Pharmacists and Practice Nurses, concentrating on managing patients with stable angina who have been identified by the Cardiology Department of Bradford Royal Infirmary. Following a defined care pathway and treatment algorithm, weekly clinics in three sites will offer education, risk factor management, treatment with medicines, and onward referral where appropriate. The aims of the project are to better manage stable angina and its risk factors in primary care, optimise the use of medicines, reduce unplanned admissions, improve patient outcomes and experience, and ultimately reduce mortality. Servier Laboratories facilitated meetings and communication between key players across primary and secondary care, undertook project management, meetings organisation and support for writing a business case, whilst the PCT and Bradford Royal Infirmary provided clinical expertise, Clinical Pharmacist training and supervision, the treatment algorithm and clinical governance.

Challenging targets have been set for the project, including reductions in follow-up appointments for stable angina by 50%; in elective percutaneous coronary intervention (PCI) in stable angina patients by 15%; in complications associated with PCI by 15%; in unnecessary hospital admissions and costs associated with trim point thresholds for length of stay of >3 days on HRG E15 by 15%; and in HAIs. Review templates will be used to monitor outcomes.

Further information: Dr Chris Morley, Bradford Hospitals Cardiology Department at [email protected] or ZafShah, Servier Laboratories at [email protected]

Newcastle Spirometry

Wakefield WISMS<< More More >>

Enfield Diabetes



Wakefield WISMS

Bradford & Airedale Angina<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Commissioning for OutcomesWakefield Integrated Substance Misuse Service, Schering-Plough and Healthskills Ltd.The Wakefield Integrated Substance Misuse Service (WISMS) comprises a range of services for treating and caring for people with alcohol and drug problems. Use of Class A drugs alone generates over £15 billion economic and societal costs each year; substance misuse disproportionately affects vulnerable groups and individuals and leads to chronic health problems. Tackling it is a government priority. Currently success is largely measured by the user completing a 12-week treatment programme, with no measurements to assess how the patient has progressed thereafter.

This project aimed to create a new set of markers that accurately measure the real life outcomes of services for people who are opioid dependent, capturing outcomes that meet health policy targets and where possible societal benefits, thereby improving commissioning and delivering a more individual service. A robust balanced scorecard, supported by commissioners and providers, has been developed enabling the service to demonstrate its impact on service users, the local health economy and the wider community. Currently the partners are working to bring together over 12 clinical and non-clinical systems to capture performance against the measures in the scorecard. WISMS has also been chosen as one of 16 Integrated Care Pilots, securing funding from the DH.

All partners contributed human resources and finance, with WISMS providing clinical leadership and drive, Healthskills acting as organisational coach and facilitator, and Schering-Plough further facilitation, project management and business rigour. A Steering Group provided direction and four task groups developed each quadrant of the balanced scorecard.

For WISMS, the project has enabled them to become an exemplar Substance Misuse Service. For Schering-Plough, a cutting edge set of outcome measures has been created to enable the true value of treatment to be measured.

Further information: Dr Linda Harris, WISMS Clinical Director on [email protected] or Simon Nicholson, Head of Partnership Development, Schering-Plough on [email protected].


Enfield Diabetes


<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Peripatetic Spirometry Service Pilot Royal Victoria Infirmary, Newcastle West PBC, Pfizer

Early identification and improved diagnosis and management of COPD result in earlier treatment; increased lung function; decreased exacerbations and hospitalisations; and improved long-term outcomes for patients. In Newcastle-upon-Tyne PCT the QoF-identified vs. predicted prevalence rate suggested a COPD detection rate of 37%, and COPD emergency admissions were identified as the primary opportunity for productivity improvement (potential £1.2million in 2006/07). A previous local study had identified low quality of spirometry and interpretation across Newcastle PCT.

Dr Graham Burns (a respiratory consultant from Newcastle upon Tyne Hospitals NHS Foundation Trust) and Pfizer set up a pilot peripatetic primary care spirometry service to deliver high quality, cost efficient spirometry and interpretation for screening and review of COPD. The aims were to: improve detection and management of COPD; assess the value of the service and whether GPs would commission it; and identify the proportion of cases for which a change in management was recommended to comply with the local COPD guidelines. Pfizer provided data, project management and organisational support, market research expertise, and a grant, with Newcastle West PBC and the RVI providing clinical expertise.

A highly skilled lung function technician ran spirometry clinics for screening and review of COPD in six GP practices. The spirometry report was analysed by Dr Burns and a patient report issued to the GP, practice nurse and patient. The spirometry reports, together with feedback from GP, practice nurse and patient questionnaires, were used to evaluate project outcomes. In over 90% of 119 patients, a change was recommended to diagnosis or management to comply with the local COPD guidelines. Based on the results of the pilot and patient feedback, local GPs voted to commission this service for the whole of Newcastle-upon-Tyne PCT. The service also aligns with the DH Closer to Home agenda and improved patient access and convenience.

Further information: Dr Graham Burns, Newcastle upon Tyne Hospitals NHS Foundation Trust at [email protected] or Andrew Riley, Pfizer at [email protected]


Wakefield WISMS

Enfield Diabetes




Enfield Diabetes<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Improving Links with the Muslim Population of Enfield during RamadanNHS Enfield, Enfield/Edmonton PBC, Enfield Mosque, sanofi-aventis

People who follow Islam comprise 10% of Enfield’s population and many of these culturally diverse groups have a high incidence of diabetes. Fasting during Ramadan means that people consume no food or drink between dawn and sunset. Ramadan now falls within the summer months, so can involve fasting for up to 15 hours over 29 or 30 days. This can lead to erratic blood sugar levels with associated health risks for those with diabetes.

Project objectives were to raise awareness of diabetes management during Ramadan amongst Bangladeshi people living in Enfield PCT, by demonstrating that the PCT can provide support and education to reduce risks during fasting; build sustainable relationships between the Bangladeshi population and the diabetes team; and extend the work with other groups who follow Islam.

The project group included representatives of the PCT and PBC, Enfield Mosque and sanofi-aventis. Information materials were sourced by NHS diabetes specialists and the project advertised via the PCT website. The mosque representative secured an event venue and advised on appropriate etiquette. A local GP provided interpretation and leadership to mosque attendees on understanding the healthcare risks associated with uncontrolled blood sugar levels. Sanofi-aventis provided project management and funding support.

Project evaluation was conducted by survey. Two mosque events were held and found successful from both the PCT and public perspectives; attendees stated they would encourage family and friends to have diabetes check-ups during Ramadan. The partners forged relationships that will act as building blocks for action in subsequent years. The model was presented at a Diabetes UK meeting, and used by Haringey PCT to present to the Board on diabetes service redesign.

Further information: NHS Enfield: Kit McAuley [email protected] or Daksha Entwisle, sanofi-aventis at [email protected]


Wakefield WISMS






City & Hackney Diabetes<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





City & Hackney Diabetes Enhanced ServiceCity and Hackney Teaching PCT, sanofi-aventis

Diabetes is one of City and Hackney PCT’s top 10 outcome targets. Service capacity to deliver high quality diabetes care is stretched and there is a need for care to be delivered as close as possible to patients’ homes.

A project was set up to deliver a diabetes enhanced service, commissioned via PBC and delivered by community pharmacists: screening and MUR; full clinical and medication review, weight management, insulin titration; and insulin initiation, pharmacist prescribing, structured education. It included 43 community pharmacies covering a population of 250,000 which included 14,500 diagnosed type II and an estimated 5,000 undiagnosed diabetes patients.

The joint project group included all partners. The project was inspired by one of the National Clinical Directors for Pharmacy; the PCT provided leadership, funding and communication with local stakeholders; sanofi-aventis funded initial project management and then provided ongoing project management, time and expertise, which was central to driving the project and reduced the drain on PCT resources. One-year data is being analysed, including measurement of the number of new patients identified, analysis of MUR and MUR+ forms, and audit. The project has helped the PCT meet targets, and address lack of provision and variability in care, whilst utilising an under-used resource. Joint working has reduced the drain on PCT finance and time and increased organisational expertise. Sanofi-aventis can introduce this model into other areas with endorsement from a National Clinical Director.

Further information: Jonathan Mason, National Clinical Director for Pharmacy, Department of Health and Head of Medicines Management at [email protected] or Mike Pleasance, sanofi-aventis at [email protected]

StHealth PBC COPD

Weston PBC COPD

NW London ACS




StHealth PBC COPD

Weston PBCCOPD<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





A locally enhanced COPD service Weston PBC Cluster, Weston Super Mare; Pfizer

North Somerset PCT identified a need to significantly reduce increasing COPD emergency admissions. To address this and improve identification and management of moderate and severe COPD patients within the primary care setting, Weston PBC cluster and Pfizer worked together to develop and implement a locally enhanced service (LES) across 11 practices.

The aims were to improve the patient experience and outcomes by providing care closer to home; reduce emergency hospital admissions; improve implementation of NICE guidelines; improve uptake of community based services such as pulmonary rehabilitation; and reduce secondary care referrals; thereby helping the PBC deliver value for money.

The first step was a baseline audit of all practices to identify people attending frequently or with severe COPD and assess the quality of data collection. Each practice identified a ‘COPD champion’ and a training event was held for all ‘champions’ to raise awareness and implementation of NICE and local guidelines and to improve the knowledge of pathways to community based services. Each ‘champion’ then arranged meetings with all practice-based clinicians managing COPD patients so they could pass on learnings. Each practice was given the objective to develop an action plan for improving COPD care.

Hospital activity reduced by 1% across the PBC cluster compared to 0.6% for the other PBC clusters within the PCT. Five practices had reductions in hospital activity of >10% alongside audited reductions in emergency admissions.The PBC cluster COPD lead helped drive the project and utilise relationships with key PCT players. Pfizer brought project management capabilities and networking and problem-solving expertise, which helped move the project forward and raise the profile of the company as a valued partner.

Further information: Dr John Heather, COPD & Diabetes Lead Weston PBC Cluster, at [email protected] Debra Montague, Pfizer, at [email protected]

City & Hackney Diabetes

NW London ACS

StHealth PBCCOPD<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Improving Quality and Productivity in the Management of COPDStHealth PBC Consortium and GlaxoSmithKline

StHealth is the largest PBC group in NHS Halton and St Helens serving a population of about 137,000 over 24 practices. COPD prevalence in NHS Halton and St Helens is high and some 4,000 patients are undiagnosed. The cost of COPD admissions is around £1m and the emergency admission rate is 55% higher than the 2008 national average. In April 2009, only 32% of patients were recorded as receiving NICE standard care.

StHealth embarked on a two-year project meeting QIPP requirements: quality enhancement by delivering better outcomes and more equitable care according to NICE standards; innovation through better management in the community; prevention through a COPD6 screening programme; and productivity by reducing inappropriate referrals and unplanned admissions and optimising the patient pathway.

A business case developed and signed by the partners set out aims, objectives and pooling of resources, skills and expertise. Funding was split 52:48% between StHealth and GSK. A patient pathway, treatment protocol and primary care nurse training programme were developed. Use of GSK’s POINTS patient audit software enabled effective prioritisation of patients and measurement of change towards NICE standards. Investment was made in Vitalograph COPD6 FEV1 monitors to improve early diagnosis, and the patient experience was measured.

Patients receiving NICE standard care have increased from 32% to 85%, variability in review standards has reduced by 73%, and very high satisfaction levels have been reported by patients. COPD emergency admissions reduced by 6% in nine months and 171 patients have been identified for proactive management through screening. Use of appropriate respiratory medicines has increased by 10% (including GSK medicines) and relationships between GSK and NHS staff have improved markedly.

Further information: Dr Karen Beeby, GP & Chair, StHealth PBC Consortium at [email protected]; or Stephen Baker, HES & POINTS Manager, GSK at [email protected]

NW London ACS

Weston PBC COPD




NW LondonACS More >><< More

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Improving Implementation of NICE Guidance on ClopidogrelNorth West London Cardiac Network, Northwick Park Hospital, sanofi-aventisThe Primary Care Sub-group of the North West London Cardiac Network produced local guidance on clopidogrel(Plavix®) prescribing for acute coronary syndrome (non ST elevation myocardial infarction - NSTEMI) in line with NICE guidance, which recommended its use in combination with aspirin for up to 12 months. The guidance had been distributed to all GPs in North West London (spanning 8 PCTs) and to secondary and tertiary centres. The Network wanted to understand the degree of compliance with the guidance and approached sanofi-aventis (S-A) to work together on an audit. It also wanted to identify areas where clopidogrel was being inappropriately prescribed.

The audit questionnaire was developed by Northwick Park Hospital and the Network circulated it via the Primary Care Sub-group and analysed the results. S-A provided project management and linkages between the Network Director and local Service Improvement Managers.

The audit indicated that awareness of the local guidance was low and that compliance was poor. Only 49% of GPs felt that they had been provided with a clear indication of why clopidogrel had been initiated and only 30% felt they knew the correct duration of treatment. Direct measures were taken by the Network in collaboration with local stakeholders to improve discharge information and the visibility of the guidance on local IT systems. A re-audit took place throughout 2009.

The audit and measures taken have improved consistency of prescribing and better knowledge amongst clinical staff across the Network. Patients have benefited from better prescribing practice, and S-A from appropriate prescribing of one of its most important medicines. Communication between local stakeholders improved markedly because of the involvement of S-A.

Further information: Maria O’Brien Hillingdon Community Health at Maria.O’[email protected]; Dr NavtejChahal Northwick Park Hospital at [email protected]; Mike Turner, sanofi-aventis at [email protected].

StHealth PBC COPD

Weston PBC COPD






Birmingham North & East<< More More >>

Kent & Medway SMI

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Birmingham East and North PCT, NHS Direct and Pfizer UK Health Solutions Chronic Conditions Management Project

This collaboration between a PCT, NHS Direct and Pfizer involves telephone care in the management of patients with chronic conditions. The project is a commercial arrangement between the three partners, underpinned by a contractual framework.

NHS Direct and Pfizer provide a telephone-based care management service for people with long-term medical conditions, in response to policy in this area. NHS Direct provides the telephone-based care management centre, and the Pfizer managers bring a rigour in project and programme management, and measuring outcomes.

The initial one-year project in a deprived area provides telephone care managers, who rather than persuading patients to change their lifestyle, work to create an environment where the patients begin to understand their condition and start to develop their own personal goals. The initial project has recently been extended and now covers 3,500 patients with chronic diseases, including coronary heart disease, diabetes and heart failure, and is about to extend to include COPD.

Evidence is building that the project is working, as people who originally had poor health metrics are now showing BMI, blood pressure and cholesterol levels that are more acceptable. There is also evidence that unplanned use of healthcare services is reducing.

For further details contact Andrew Donald, Director of Redesign and Commissioning [email protected] John Procter, Head of UK Pfizer Health Solution [email protected].

LondonRenal Disease

North Hants Hosp Chemotherapy



Kent & Medway SMI<< More More >>


Implementing


Introduction


Acknowledgements

Quick Start Option

Getting Ready


Governance





Kent and Medway NHS and Social Care Partnership Trust and Lilly UK:Provision of a Well Being Support Service to patients with Severe Mental Illness (SMI)

People with SMI are three times more likely to die prematurely than those without: suicide is a factor but death can also occur because of respiratory problems, cardiovascular disease, diabetes, and poor lifestyle. A two year pilot undertaken by Lilly UK, Inventive Solutions and seven mental health trusts showed that of the 966 outpatients with SMI, significant improvements were observed in levels of physical activity ( p < 0.0001), smoking ( p < 0.05) and diet ( p < 0.0001). There were no changes in mean BMI although 42% lost weight over 2 years. Self-esteem improved significantly. Low self-esteem decreased from 43% at baseline to 15% at 2 years ( p < 0.0001). The completion rate at 2 years was 80%.

Kent & Medway decided to roll out the programme to deliver physical health checks to people with SMI in their area following the publication of two documents: "From Values to Action: The Chief Nursing Officer’s review of mental health nursing" and "Choosing Health: Supporting the physical health needs of people with severe mental illness -commissioning framework". The latter document refers to the Lilly programme and how the NHS can access support from Lilly.

102 nurses and occupational therapists have been trained in Kent and Medway to date in General health (blood pressure, pulse, blood glucose and lipid and cholesterol levels); Lifestyle (including smoking, diet, physical activity levels, alcohol and the use of illicit substances) ; Medication side effect management.

By the end of October 2007, 480 patients had attended with health outcomes being measured via a web-based audit tool. Lilly UK provided the training (via Inventive Solutions), project management and facilitation of the project, whilst the Trust provided professional input and clinical governance.

Further information: Donna Eldridge, Assistant Director of Nursing, Kent & Medway NHS & Social Care Partnership Trust at [email protected] or Rob Holmes, Lilly UK [email protected]

LondonRenal Disease

Birmingham North & East




North Hants Hosp Chemotherapy<< More More >>

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





North Hampshire Hospital NHS Trust and Lilly UKMaximising Chemotherapy Capacity

A project to look at ways of enhancing capacity and efficiency of the hospital’s chemotherapy unit by reducing waiting times and improving utilization over a five-day week. The project phases were:

Define the problems and issues facing the unit and agree required improvements Measure the nurses’ work load and understand how their time was being utilised Analyse the results to know where to look for improvement Improve working practices through identifying and prioritising realistic solutions Control the changes and evaluate the solutions to ensure they delivered the expected outcomes.

Lilly UK provided project management and two staff with expertise in the Lean 6 Sigma (DMAIC) process. Staff from the Trust brought knowledge of the problems and working practices.

Increased capacity for patients has been created, with increased nurse time for patients and less staff overtime. Administrative processes have been changed, including a streamlined booking process and a chemotherapy documentation pathway. The process highlighted the need for an emergency bed for unplanned patients and developed capacity for a further Health Care Assistant.

For further information contact Shelagh Goddard, Lead Cancer Nurse, Basingstoke and North Hampshire NHS Foundation Trust [email protected] or Rob Holmes, Lilly UK [email protected]

Kent & Medway SMI

London Renal Disease

Birmingham North & East



LondonRenal Disease<< More

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Reaching Renal Standards: Development and Implementation of Performance Improvement Templates for Parts 1 and 2 of the Renal NSFLondon Renal Modernisation Team and Roche Products Ltd

A project to translate the qualitative standards of the Renal National Service Framework into quantitative measures and develop an Improvement Template which could be used to identify current service standards, prioritise service improvements across primary and secondary care and track progress year on year.

The LRMT and Roche worked together via a multi-disciplinary working group to develop the Improvement Template. This was launched to all renal units and PCTs in London and an audit for Part 1 of the Renal NSF has been conducted. The top 10 improvement measures required to implement Part 2 of the NSF have been identified. In time, data from each London renal centre and PCT will be regularly collected to inform Units’ and PCTs’ Improvement Plans. In addition this will enable comparisons across London for learning through identification and dissemination of good practice, and inform a formal, commissioner-led service improvement plan for the region. The Improvement Template is now the definitive set of measures for the next three years in London.

The project was jointly funded by LRMT and Roche. Roche also provided project management and facilitation, expertise in organisational change and performance management in the form of 20 days’ input from a company expert. LRMT provided leadership of the working group, supported project management and coordination, and ensured participation of renal experts, including Nephrologists, Renal Specialist Nurses, GPs, Business Unit Managers, Commissioners, and Renal Modernisation and Palliative Care Leads. They also provided administrative support.

For further information contact Robert Creighton, Chief Executive Ealing PCT and Chair of the London Renal Modernisation Team [email protected] or Claire Housden, Roche Products Ltd [email protected]

Kent & Medway SMI


Birmingham North & East More >>



<< MoreManadon

COPD

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Manadon Commissioning Group and GlaxoSmithKlinePlanning for Better COPD Care

A project to improve care for patients with COPD through a personalised and localised service and reduce the number of emergency hospital admissions, founded on a detailed business case.

The four practices in the Commissioning Group had recognised that improved COPD care was a local need, with pressures on secondary care from emergency admissions, the need to implement NICE guidance, and opportunities to provide better links between primary care and existing services such as pulmonary rehabilitation and secondary care nurse support. The Group wanted to develop a responsive ‘tiered’ COPD service through development of individual patient care plans (shared with the local out-of-hours provider), better patient education and regular monitoring of disease progression. To do this they needed to build additional skills and competence in COPD management, including additional specialist nursing, and accrue savings from reduced hospital admissions to reinvest in better management of long term conditions.

The Group worked with GSK to design the service and develop a robust business case. GSK provided project management and in-house expertise from an Integrated Healthcare Manager, Respiratory Care Associate, and its Marketing and Health Outcomes Departments. It also funded project group meetings. The practices provided manager, GP and nurse time to develop the service, premises, and links to the out of hours service. A specialist nurse was co-funded in equal parts by both parties.

Outcomes were measured using Dr Foster data and patient and clinician satisfaction questionnaires devised by GSK. In spite of an increase in list size and a merger with another surgery, in year 1, absolute numbers of hospital admissions remained relatively stable. The Group aims to extend the project throughout Plymouth.

For further information contact Craig Smith-Avery ([email protected]) or John Perry ([email protected])

Kirklees Arthritis

Ashton, Leigh & Wigan

Haringey L’TermConditions





<< MoreKirkleesArthritis

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Huddersfield & Calderdale NHS Trust, Kirklees PCT and Abbott Laboratories LtdRheumatoid Arthritis Integrated Care Pathway

A project to provide comprehensive annual interdisciplinary clinical assessments for patients with Rheumatoid Arthritis through an Integrated Care Pathway (ICP) to:

Enhance care records and communication across primary and secondary care; Help develop satellite tertiary care clinics in primary care and transfer day cases into primary care; Support primary care professionals to become integral to clinical assessments and care plan formulation

through learning opportunities for both primary care professionals and patients.

Through working together on service redesign, the project is seeking to address a disjointed rheumatology service with ad hoc Physiotherapy, Podiatry and Occupational Therapy input, which is leading to communication difficulties and clinical governance and patient safety implications. There is also a need for a formal patient education programme.

The Trust has obtained funding for the project as an ISIP trial site together with clinical expertise and leadership. Kirklees PCT has provided support through organisation of meetings, gaining approval from its Board, and supporting the drive for change through Practice Based Commissioning.

Abbott UK has supplied strategic planning expertise and support by facilitating a Clinician Engagement meeting and a strategic business management training course for the stakeholder group. It has also provided working examples, shared best practice from around the country and provided an ICP template.

Outcomes will be measured by comparison of costs and benefits of the service before and after redesign, together with patient and GP surveys and measurement of the numbers of patients available for treatment with a biologic medicine.

For further information contact Alison Bragg, Kirklees PCT; Simon Holmes, Huddersfield Trust or Roshani Perera, Abbott UK, [email protected]

ManadonCOPD




<< MoreHaringey

L’Term Conditions

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Haringey Teaching PCT and Pfizer Ltd

An innovative, long term conditions pilot programme was launched in 2004 to provide person-centred, telephone-based support for 600 patients with diabetes, heart failure and coronary heart disease by supporting them to take a more informed and active role in their healthcare.

A team of dedicated care managers, all of whom were qualified nurses, provided assessment, care planning, regular coaching and support for patients based on their individual needs, signposting them to other services as appropriate. They used decision support software to facilitate proactive communication with patients, and which also provided and recorded information for ongoing care management. This software was developed by Pfizer Health Solutions Inc., customised to local guidelines and care pathways and approved by the Clinical Reference Group described below. The expectation of the programme was that, through regular communication, patients would become more successful in managing their condition and improve their clinical outcomes and quality of life, while reducing the demands on local health services.

This programme was equally funded by the Department of Health through NatPaCT’s transformational change programme and Pfizer Ltd. Implementation was managed by a Project Board and Project Team comprising representatives from Haringey Teaching PCT, the two local acute trusts, Pfizer Health Solutions Inc. and Pfizer Ltd. There was extensive consultation and involvement from representatives covering most aspects of patient care in Haringey and an independent Clinical Reference Group of local clinicians was also set up to agree and approve all clinical and patient materials in the programme.

The programme was conducted as a randomised controlled trial, with the evaluation overseen by an Evaluation Steering Committee, which included an independent external evaluator and independent statistician. The results are expected to be published.

For further details contact Sarah Barron, Head of Contractor Performance ([email protected]) or John Procter, Head of UK Pfizer Health Solution [email protected].

Kirklees Arthritis

ManadonCOPD




<< MoreKirklees Arthritis

ManadonCOPD

Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance





Ashton Leigh and Wigan PCT ‘Find and Treat’ Strategy

ALW PCT has a population with one of the lowest life expectancies in England and a high prevalence of Coronary Heart Disease and diabetes. It saw valuable potential to work with industry to find a large cohort of people with these diseases and treat them. It also saw industry as a valuable contributor to its ‘Learning Network’ which aims to deliver high quality continuing professional development to the PCT’s clinical and managerial staff.

The find and treat strategy involves the PCT working with pharmaceutical companies. A project manager, seconded from industry, has been appointed and is jointly funded by the PCT and ABPI to support the learning network. The pharmaceutical companies are sharing their expertise to support the PCT in the delivery of this innovative project,which aims to decrease morbidity and mortality and increase life expectancy for the people of Wigan.

A joint PCT/ABPI Project Board, which reports to both the PCT’s Professional Executive Committee and ABPI’s NHS Task Force, has been set up to oversee development of the Find and Treat Programme and Learning Network Curriculum and overall governance of the working relationship between the PCT and industry.

For further details contact Umesh Patel, Head of Medicines Management ([email protected]) or Martin Anderson, Project Director ([email protected])





Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Useful Contacts Page 1 of 2

The Association of theBritish Pharmaceutical Industry12 Whitehall London SW1A 2DY

Tel: 0870 890 4333Fax: 020 7747 1414

www.abpi.org.uk

Pharmaceutical Company personnel with responsibility for Joint Working

For a contact name within a Pharmaceutical Company contact Carol Blount on 020 7930 3477

ABPI NHS Partnership Projects

Regional FacilitatorsJan BalmerEast MidlandsTel: 07734 [email protected]

Carol Blount, Head of Commercial Affairs

Adam AllerhandNorth WestTel: 07718 535 [email protected]

Tel: 020 7930 3477

Helen MorrisonSouth WestTel: 07852 [email protected]

[email protected]

Pamela San JuanTel: 07894 [email protected]

The National Prescribing CentreGround Floor, Building 2000, Vortex Court, Enterprise Way, Wavertree Technology Park, LiverpoolL13 1FB

See website for telephone numbers

www.npc.co.uk

Prescription Medicines Code of Practice Authority12 Whitehall,London SW1A 2DY

Tel: 020 7747 8880Fax: 020 7747 [email protected]

www.pmcpa.org.uk














Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Useful Contacts

General Medical CouncilRegent’s Place350 Euston RoadLondon NW1 3JN

Tel: 0161 923 6602 www.gmc-uk.org

Royal Pharmaceutical Society of Great Britain1 Lambeth High StreetLondon SE1 7JN

Tel: 020 7735 9141 www.rpsgb.org.uk

Nursing and Midwifery Council23 Portland PlaceLondonW1B 1PZ

Tel: 020 7637 7181Fax: 020 7436 2924

www.nmc-uk.org

Please Provide Feedback

In order to make sure that the Toolkit a useful resource we need to understand whether you found it easy to use, and whether the content is helpful to you in developing joint working. Please spare a few minutes to complete a short feedback form, to helpus continue to develop and improve the Toolkit.

If you have accessed the Toolkit before

and are returning to use it again click hereIf this is the first time you have

accessed the Toolkit click here

Page 2 of 2






Implementing


Introduction



Acknowledgements

Quick Start Option

Getting Ready


Governance




Acknowledgements

This toolkit was commissioned by the Ministerial Industry Strategy Group, whose members comprise Ministers from the Department of Health, Treasury and Business Enterprise and Regulatory Reform and senior executives from the pharmaceutical industry, as part of the Long Term Leadership Strategy in Medicines (LTLS). The aim of the LTLS is to secure the provision of safe and effective medicines for patients, maintain and strengthen the UK pharmaceutical industry within Europe, and to advance healthcare innovation within the NHS.

The toolkit has been developed by a Working Group comprising representatives of Ashton Leigh and Wigan PCT, East LincolnshirePCT, the National Cancer Action Team, the National Prescribing Centre, GlaxoSmithKline, Lilly UK, UCB Pharmaceuticals, Roche Products, Takeda, the ABPI and the Medicines Pharmacy and Industry Group at the Department of Health. We would like to acknowledge and thank them for their input.

We would also like to thank the POIP, NHS East of England, NHS Mid Essex, NHS Nottingham City, Nottingham City University Hospitals Trust, Weston PBC Cluster, Newcastle West PBC Group, NHS Enfield, Enfield/Edmonton PBC, City and Hackney Teaching PCT, Trafford PCT, Bradford & Airedale PCT, Newcastle upon Tyne Hospitals NHS Foundation Trust, Wakefield Integrated Substance Misuse Service, Somerset PCT, StHealth PBC Consortium, North West London Cardiac Network, Northwick Park Hospital, Birmingham East and North PCT, NHS South West, Haringey Teaching PCT, Kent and Medway NHS and Social Care Partnership Trust, North Hampshire Hospital NHS Trust, Huddersfield & Calderdale NHS Trust, Kirklees PCT, London Renal Modernisation Team, Nottingham City PCT, the Manadon Commissioning Group, Pfizer Ltd., Pfizer Health Solutions, Boehringer Ingelheim, Abbott Laboratories Ltd, Servier Laboratories, Napp Pharmaceuticals, sanofi-aventis, and Schering-Plough for providing copies of policies, tools and good practice examples which have been used in the development of the toolkit.

Liability: Information provided on this toolkit has been provided in good faith and the Department of Health/National Health Service and the ABPI uses reasonable care to ensure the information is up to date. However, the Department of Health/National Health Service and the ABPI make no representations or warranties as to the accuracy, completeness or currency of such information. The Department of Health/National Health Service and the ABPI disclaim any obligation to update the information and advice featuring on this toolkit There are hypertext and other links in this toolkit which, if used, will involve you entering another website which is not controlled by the Department of Health/National Health Service and the ABPI. The Department of Health/National Health Service and the ABPI accept no responsibility or liability in respect of your access to, or use of, any website which is not under their direct control or in respect of any materials posted on such a website. Access to the toolkit is at your own risk. The Department of Health/National Health Service and the ABPI shall not be liable for any damage to the hardware or software installed on the computer you use to access this toolkit as a result of your access to, or use of, this toolkit or your downloading of any resource from the website.

DH INFORMATION READER BOX

Policy EstatesHR / Workforce CommissioningManagement IM & T Policy

Planning / FinanceClinical Social Care / Partnership Working

Document Purpose

Gateway ReferenceTitle

Author

Publication DateTarget Audience

Circulation List

Description

Cross Ref

Superseded Docs

Action Required

TimingContact Details

80 London Road

Revised toolkit designed to help aid NHS and Industry implement best practice for joint working. This toolkit is a result of a recommendation in the report "MISG LTLS Guidance on Joint Working in the Pharmaceutical Industry" published in Feb 2008

N/A

DH/NHS/ABPI

27 Aug 2010PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Foundation Trust CEs , Medical Directors, Directors of PH, Directors of Nursing, PCT Chairs, NHS Trust Board Chairs, Special HA CEs, Directors of HR, Directors of Finance, Allied Health Professionals, Communications Leads

GPs, Pharmaceutical Companies, Thrid Sector Organisations, Patient Group

Best practice guidance for joint working between the NHS and the pharmaceutical industryMoving Beyond Sponsorship - Joint Working Between the NHS and Pharmaceutical Industry

N/A

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082840

14600

Best Practice Guidance

For Recipient's Use

(Revised) Moving Beyond Sponsorship - Joint Working Between the NHS and Pharmaceutical Industry

London, SE1 6LH(020) 7972 2708

Naima KhondkarPharmaceutical Industry Policy, Industry Sponsorship4th Floor, Area A, Skipton House