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Annual Report 2009/10
Involving clinicians in shaping health services
Professional Executive Committee (PEC)
Our Professional Executive Committee (PEC) is a small group of experienced Sheffield doctors, a nurse, and a pharmacist, who help to lead improvements in health services in the city. The group see and treat patients every week as well as play a major part in ensuring their colleagues and patients views lead NHS Sheffield to developing quality, safe and innovative health services.
PEC overview of the year
This has been another busy year for the PEC, with a wide variety of activity taking place. Working in partnership has been a key theme, as we have developed our relationships with colleagues in secondary care, Practice Based Commissioning consortia and the Local Authority. Another thread which has run through the year has been the need to tackle problems on a system wide basis.
Developing clinical professionals as leaders
Our increasing emphasis on quality in health services has highlighted the need for strong clinical leadership. We arranged leadership development for primary care professionals by commissioning Keele University to run a foundation level programme. This covered a wide range of subjects in two full days, including how to motivate others, managing change and leading for improvement. The teaching drew on extensive research, including recent work carried out in the UK public sector looking at what makes an effective leader. Thirty people took part in the two day course, which was very well evaluated.
Some of the people who took part in this programme are now leading city wide work (for example on back pain) and have been involved in tackling a number of strategic issues – as you’ll read about below.
Co-ordinating city wide working
There are a number of clinical and service issues which NHS Sheffield cannot tackle alone. For example, Sheffield has a higher number of older people who require an emergency admission to hospital than other similar cities, and once admitted, patients tend to stay longer. We have been working with partners from across health and social care to design services which help older people maintain their health and independence for longer, and services which can support them to get back home quickly if they do need a stay in hospital. Several of the people who took part in the Keele leadership scheme have been working to find solutions to these problems – for example, developing “anticipatory care” which identifies older people who have emerging health issues and then puts proactive care in place. This helps patients avoid emergency or crisis situations.
The PEC is well placed to support city wide, system reform work just like this because of the relationships we have and the influence we are able to bring to decision making. We set up two “clinical summits” in September and December 2009 to bring together senior clinical leaders to discuss and agree on priorities for quality improvement and tackling inefficiency, and have used the remainder of the year to progress these with colleagues. One practical improvement which came from this was the development of a standardised approach to GP referrals, so that an agreed set of information is now included in those referrals. This helps to ensure that all referrals are appropriate. This work has been taken forward by the Practice Based Commissioners, with PEC support.
Better Outcomes for Patients: The second year of our improvement programme
This two year programme was led and sponsored by the PEC. It started in April 2008, with the aim of creating practical improvements which patients and carers would be able to notice, and to address problems in pathways which were a source of frustration for patients, carers and clinicians alike.
The project has forged new relationships and dialogue between professionals from different backgrounds and parts of the system, and has given a stronger voice to patients and carers.
Over 130 clinicians, voluntary sector, patient and carer representatives were involved in recommending 50 improvements across ten conditions (this work was carried out in 2008-09). Over the last year we have been working hard with our partners to deliver the improvements. We haven’t been able to implement all 50 ideas, but have completed delivery on 27, and work remains under way on around 15. In some cases, we have adapted the original idea and gone beyond it. Here are some of the improvements we have achieved:
- Research project on promotion of oral health and improved nutrition for older people; this directly influenced investment in new dentistry services in Darnall
- Publicity campaign on early signs of bowel cancer and importance of taking up screening
- Piloting new techniques in voice therapy for people with Parkinsons' disease
- Specialist carer support to people who care for family members or friends with alcohol problems
- Publication of a leaflet “Help for people affected by someone else’s problem drinking”
- Faster access to echocardiography
- Awareness raising about stroke prevention and vascular checks, aimed at high risk Black and minority ethnic groups
- Clinical education on primary care for people with alcohol problems for GPs and practice nurses
- Interactive education on correct inhaler technique for children with asthma
- Development of a new pathway for children with chest problems to help professionals make a correct diagnosis of childhood asthma
- Pilot of supported accommodation for people with long term mental health issues
- Transient Ischaemic Attack (“mini stroke”) four week reviews
- More pulmonary rehabilitation sessions targeted at people earlier in their disease progression
- “EARLI” risk finding tool being adopted across the city – designed to highlight people aged over 75 who are at risk of hospital admission in the next few months, and who could benefit from proactive health support
- Clinical education event held on heart failure for 220 GPs and practice nurses.
We hope that the lasting legacy of the BO4P programme will not only be the improvements themselves but also that the creative, dynamic approach that we followed will become a blueprint for future improvement work.
Learning initiatives
Once again the PEC has worked with partners to deliver a programme of educational events for GPs, Practice Nurses, Pharmacists and Dentists. A wide range of topics were covered in 2009 / 10, including:
- Common orthopaedic pathways
- Prevention of Stroke
- Chronic obstructive pulmonary disease (respiratory conditions)
- End of life care
- Swine flu: contingency planning
- Children’s health issues, including asthma, mental health, obesity and promoting breastfeeding
- Safeguarding children
- Improving the health of people with learning disabilities
- Decontamination and infection control for dentists
These events were well attended, and the evaluation showed that clinicians value the opportunity to update their knowledge, hear from experts, and exchange ideas with their peers. We hope to run further events in the future and to develop ways of capturing the impact of this learning as part of an ongoing audit. We would also like to explore interactive, web based learning as a supplement or alternative to attending events.
Ongoing core tasks for the PEC
As a sub – committee of the Board, and governed by Department of Health regulations, the PEC has a number of other core tasks which it needs to undertake. Many of these relate to clinical safety and quality, for example: approving clinical policies; quality assuring proposals for new services; encouraging best practice; supporting delivery of targets in key areas such as breastfeeding, stopping smoking and Chlamydia screening; and investigating poor performance. One of our PEC members has also been active in raising awareness of the need for carbon reduction, by promoting simple ideas which can reduce waste and reduce the environmental impact of the NHS.
As the clinical face of NHS Sheffield, PEC members are also called upon to give health advice to the public via the media, to react to news stories or to front education campaigns. This year we have given interviews on a wide range of topics including air quality and impact on health; the “Know Your Numbers” vascular risk campaign; contraception and depression.
PEC members continue to be involved in commissioning decisions and service design in various fields, for example: mental health, alcohol services, end of life care, bowel cancer, sexual health, respiratory disease and long term condition management.
Our PEC plans for 2010 – 11 and beyond
As Practice Based Commissioning Consortia have been developing their commissioning skills, we have seen the PEC role becoming less ‘hands on’ in terms of service design and more strategic.
We want to build on the work undertaken in the two clinical summits in 2009 to create a shared ownership of the issues facing our health economy, and agreed priorities to address these. We see PEC taking a role in creating the conditions for change, and an active leadership role with our clinical peers. We will continue to challenge cultures that block progress and stifle innovation, and to create new alliances and opportunities for clinical dialogue.
Next year, our core tasks will focus around:
- Clinical service improvement
- Patient safety
- Oversight and delivery of the Quality, Improvement, Productivity and Prevention (QIPP) approach.
Next page: Practice Based Commissioning (PBC)
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