Evidence based innovation

Evidence based innovation

Dr Robert VarnamHead of general practice development, NHS England

[email protected] @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


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





NHS Change Modelbit.ly/c2aGP




a)Finding innovationb)Implementing changec)Unease about innovators & innovationsd)Concern about causality

bit.ly/c2aGP


Unease about innovators & innovations

The innovators• Whacky / unappealing

• Too brainy

• Too creative

• Too hard working

Admirable but not me


Unease about innovators & innovations

The innovations• Experimental / unfinished / risky

• Too niche

• Too context-specific

Interesting but not for me





bit.ly/c2aGP


The innovation itself is not enough


2. GP Access Fund


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


About the GP Access Fund

57 schemes

~150 ‘federations’

2500 providers

18m patients

Wave one: Apr 2014Wave two: Apr 2015


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


Schemes' initial plans for measurement

Three approaches:

a) External academic unit

b) Project manager time set aside

c) No detailed plan


Inputs from innovation support programme

• Webinars• Workshops• Advice from evaluation team• Coaching from NHS IQ• Team reviews• Direct conversations


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


An exception…


Some of the NHS is ill-prepared to measure innovation in everyday care, and some of our baselines are weak.


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


a) Budget & plan for measurement

It doesn’t just happen



3. Five top tips


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



3. Five top tips


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?



3. Five top tips


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.


Change 1


Change 2

Change 3

Change 4

Change 5


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



3. Five top tips


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


You can do all this… but it doesn’t just happen



3. Five top tips


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

[email protected]


Evidence based innovation

Healthcare

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