Post on 14-Apr-2017
Evidence based innovation
Dr Robert VarnamHead of general practice development, NHS England
robert.varnam@nhs.net @robertvarnam
www.england.nhs.uk #Expo15NHS @robertvarnam
The founding principles of UK primary care are admired the world over, and rightly so. General practice is a jewel in the crown of this country. Right now, general practice feels in a bad place. Constrained, hemmed-in and, to some, marginalised. Whatever the state of things in your part of the country, in general, I think it’s fair to say that, at the very least, general practice is currently constrained from delivering its full potential. We need to see increases in funding, a growth in the workforce, and improvements to premises. Without those, existing services may not be sustainable.
Overview
Common pitfalls
The GP Access Fund experience
Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
1. Common pitfalls
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Call to Action on General Practice
“How to promote, support & sustain adoption of effective innovations?”
a)Finding innovationb)Implementing changec) Unease about innovators & innovationsd)Concern about causality
bit.ly/c2aGP
www.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“How to promote, support & sustain adoption of effective innovations?”
a)Finding innovationb)Implementing changec) Unease about innovators & innovationsd)Concern about causality
bit.ly/c2aGP
www.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“How to promote, support & sustain adoption of effective innovations?”
a)Finding innovationb)Implementing changec) Unease about innovators & innovationsd)Concern about causality
NHS Change Modelbit.ly/c2aGP
www.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“How to promote, support & sustain adoption of effective innovations?”
a)Finding innovationb)Implementing changec)Unease about innovators & innovationsd)Concern about causality
bit.ly/c2aGP
www.england.nhs.uk #Expo15NHS @robertvarnam
Unease about innovators & innovations
The innovators• Whacky / unappealing
• Too brainy
• Too creative
• Too hard working
Admirable but not me
www.england.nhs.uk #Expo15NHS @robertvarnam
Unease about innovators & innovations
The innovations• Experimental / unfinished / risky
• Too niche
• Too context-specific
Interesting but not for me
www.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“How to promote, support & sustain adoption of effective innovations?”
a)Finding innovationb)Implementing changec) Unease about innovators & innovationsd)Concern about causality
bit.ly/c2aGP
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
The innovation itself is not enough
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
2. GP Access Fund
www.england.nhs.uk #Expo15NHS @robertvarnam
About the GP Access Fund
Aim: “to help improve access to general practice and stimulate innovative ways of providing primary care services”
• Wave one: Apr 2014£50m
• Wave two: Apr 2015£100m
Applications from practices covering nearly 2/3 of the population of England
www.england.nhs.uk #Expo15NHS @robertvarnam
About the GP Access Fund
57 schemes
~150 ‘federations’
2500 providers
18m patients
Wave one: Apr 2014Wave two: Apr 2015
www.england.nhs.uk #Expo15NHS @robertvarnam
An example of this in practice at the moment is the Prime Minister’s GP Access Fund. Now covering a significant proportion of the country, practices in this are implementing quite wide-ranging redesign of their services, acknowledging that extended hours are only one part of good access. The practices participating in this programme are already beginning to implement many of the transformational changes envisaged by the Five Year Forward View. This is generating valuable learning about the specific changes required, including the ways in which the system can make progress easier and more sustainable.
Innovations being tested
www.england.nhs.uk #Expo15NHS @robertvarnam
Schemes' initial plans for measurement
Three approaches:
a) External academic unit
b) Project manager time set aside
c) No detailed plan
www.england.nhs.uk #Expo15NHS @robertvarnam
Inputs from innovation support programme
• Webinars• Workshops• Advice from evaluation team• Coaching from NHS IQ• Team reviews• Direct conversations
www.england.nhs.uk #Expo15NHS @robertvarnam
The biggest data challenge of all …
Wave one: 19/20 schemes required helpDec 14: guide published, application preparation webinars Apr 15: welcome packWave two: 37/37 have requested help
General practice activity data
www.england.nhs.uk #Expo15NHS @robertvarnam
An exception…
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
Some of the NHS is ill-prepared to measure innovation in everyday care, and some of our baselines are weak.
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam
a) Budget & plan for measurement
It doesn’t just happen
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam
Innovations’ efficacy
Schemes’ efficacyFunding
Cost-effectiveness
b) Know your logic model
Patient satisfaction
Staff assessment
OOH attendance
A&E attendance
Extra appts in extended hours
Additional contact modes
Other access innovations
Changes in care model
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam
Innovations’ efficacy
Schemes’ efficacyFunding
Cost-effectiveness
Patient satisfaction
Staff assessment
OOH attendance
A&E attendance
Extra appts in extended hours
Additional contact modes
Other access innovations
Changes in care model
c) Measure to inspire and inform
Why should I
commit to this?
How might this workfor us?
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam
d) Measure in realtime
If you’re moving forward, why only look backwards?
#Expo15NHS @robertvarnam
Using periodic averages
Sample A Sample B0
20
40
60
80
100
120105
55
1st three month period
2nd three month period
Start
?Data
vacuum
This is our traditional approach. It is familiar but serves innovation leaders poorly.
How do you keep
momentum?
Averages prevent you
learning from variation
Statistical Process Control charts allow you to measure frequently, and draw statistically sound conclusions quickly.
97.3 % C.I.
This kind of analysis can be produced by a wide variety of software.
www.england.nhs.uk #Expo15NHS @robertvarnam
Change 1
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Change 2
Change 3
Change 4
Change 5
www.england.nhs.uk #Expo15NHS @robertvarnam
d) Measure in realtimeBenefits for innovators:
Keep staff motivated & curious Refine the innovation more rapidly Gather convincing evidence for others in shorter timescale Test multiple changes (eg phasing / multiple sites)
1 2 3 4
1
2
3
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam
e) Show it can work elsewhere
• Describe and measure your context (well enough for others to understand & compare)
• Test in multiple different contexts• Yourself• First followers
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
You can do all this… but it doesn’t just happen
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
3. Five top tips
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere
www.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
Using data in a change strategybit.ly/PMCFlessons1
Choosing metrics for innovationvimeo.com/111923411
Using retrospective case controlbit.ly/NuffieldRetroCaseControl
Logic modelswikipedia.org/wiki/Logic_model
Scaling up innovationow.ly/RBxYt
SPC guidesbit.ly/SPCguide1 & bit.ly/SPCguide2
robert.varnam@nhs.net
a) Budget & plan for measurementb) Know your logic modelc) Measure to inspire and informd) Measure in realtimee) Show it can work elsewhere