- GlaxoSmithKline UK
- Joint Working
- Case studies
- StHealth PBC Consortium
StHealth PBC Consortium and GSK HSJ Awards 2010 ‘Primary Care Organisation of the Year’ Finalist.
Winner of the 2010 Association of the British Pharmaceutical Industry (ABPI) & Pharma Times Joint Working Awards.
Sharon Greenwood, a board member of the StHealth PBC Group, wanted to see how pooling GSK’s expertise with the Consortium’s local knowledge could help optimise the management of COPD patients in accordance with NICE standards of care.
In helping to develop the project plan, GSK learnt about the challenges of Practice-Based Commissioning and worked with StHealth to overcome the hurdles and bring a very complex project to fruition.
GSK was able to provide data from the POINTS* system which, in conjunction with the data already available to the NHS, provided the baseline metrics necessary to demonstrate project effectiveness.
The Challenge
StHealth is the largest PBC group within NHS Halton and St Helens serving a population of approximately 137,000 people over 24 practices and employing nearly 200 Healthcare Professionals.
NHS Halton and St Helens is in the top 10% of PCTs for recorded COPD prevalence, with a prevalence rate of 2.4% (national average 1.4%)1 due to socio-economic deprivation, high smoking rates and a history of heavy industry. Despite this, modelling predicts that prevalence for StHealth will become closer to 5.5% by 2020, leaving almost 4,000 patients still to be diagnosed.2 COPD represents a significant cost burden to StHealth with spend on emergency COPD admissions approaching £1m and an emergency admission rate 45% higher than the national average in 2008/09.3
The objectives of the StHealth COPD Project can be categorised by the principles of QIPP (Quality, Innovation, Prevention and Productivity):
- Deliver better patient outcomes by achieving NICE standard care in the management of COPD
- Improve equality of care by reducing the variability in the management of COPD across practices within StHealth
- Bring care ‘closer to home’ through training healthcare providers to manage patients in the community whilst making better use of existing resources within the St Helens locality
- Slow disease progression by implementing a COPD6 screening program to identify undiagnosed COPD patients in a more cost effective way than spirometry
- Increase efficiency by optimising the patient pathway and reducing inappropriate referrals
- Reduce spend on unplanned hospital admissions
The Solution
The very first step was the development of a joint business case, which clearly specified the proposition, deliverables, roles/responsibilities, key outcomes and measures for patients, StHealth and GSK. Among other things, this included:
- Patient pathway and treatment protocol developed in line with NICE guidelines. Approved by respiratory consultant and PCT.
- A bespoke training programme to up-skill nurses to deliver NICE Standard care developed together with recognised respiratory specialists
- POINTS* patient audit tool installed in all practices to enable effective prioritisation of COPD patients for review, as well as a measurement of change from QoF to NICE Standard of care
- Enable earlier diagnosis by investing in a COPD6 FEV1 monitor for every clinical consulting room
- A patient experience survey to measure quality of the patient’s annual review with the nurse
(All project documentation is aligned with DH and ABPI Guidance on Joint Working)
Outcomes as of July 2010
Patient
- There has been an overall improvement in the quality of patient review towards NICE standards from 32% to 85%4
- 55% patients report that their understanding of how to manage their symptoms has increased following their review and 92% said they were either satisfied or very satisfied with the quality of the review. In addition areas of improvement were identified in that 44% were not offered self-care plans5
- Patients are now more likely to get the same standard of care in all StHealth clinics as variability in the standard of review has been reduced by 73%6
StHealth
- A reduction in year-on-year COPD admissions of 9.2% in 2009/10 compared to 2.8% for the rest of the PCT. This equates to approximately £100,000 tariff savings.7
- COPD6 screening has identified an additional 376 patients from 2055 screened who could benefit from earlier treatment to slow disease progression8
- The HCP training program has led to 80% of practice nurses stating they now feel confident about when it is appropriate to refer patients to secondary care.9 This may mean more appropriate use of resources and patients receiving care ‘closer to home’
GSK
- 10% increase in the use of appropriate respiratory medicines, including GSK medicines, in the context of a NICE education programme.10
- Relationships between GSK and NHS staff in NHS Halton and St Helens have become more open:"Our working relationship is founded on trust, honesty and transparency and bodes well for future Joint Working initiatives". Sharon Greenwood, Practice Manager, StHealth
- Learnings from this project have helped accelerate other NHS and GSK Joint Working Projects
- QoF Prevalence data tables 2008/09, NHS Information Centre. http://www.ic.nhs.uk/statistics-and-data-collections/supporting-information/audits-and-performance/the-quality-and-outcomes-framework/qof-2008/09/data-tables/prevalence-data-tables Accessed January 2011
- Modelled estimates and projections of COPD for PCTs in England (updated Oct 08), http://www.erpho.org.uk/viewResource.aspx?id=18025 Accessed January 2011
- COPD admissions data, NHS Comparators, StHealth PBC Consortia, March 2010
- POINTS data from sample of 923 patients Collected and supplied by Quintiles. Data Analysis by GSK, March 2010
- COPD Patient Experience Survey. Data collected and analysed from 198 respondents by Ipsos MORI, May 2010
- POINTS data from sample of 923 patients Collected and supplied by Quintiles. Data Analysis by GSK, March 2010
- SUS data based on ICD10 primary diagnosis codes J40-J44, StHealth PBC Consortium, July 2010
- COPD6 screening results, StHealth PBC Consortium, July 2010
- Internal Survey of 20 Practice Nurses, StHealth PBC Consortium, December 2009
- POINTS data from sample of 923 patients Collected and supplied by Quintiles.
Data Analysis by GSK, March 2010
*The Patient Outcomes and Information Service (POINTS) is provided by GSK and is delivered on behalf of GSK by Quintiles.
UK/PPM/0026a/10 – October 2010
