Latest UK policy upholds the need to involve clinicians and patients in commissioning/planning decisions. The government's response to the Future Forum calls for widening clinical input to commissioning by establishing advisory clinical senates and clinical networks. In English policy it was first recognised in Our NHS, Our Future and World Class commissioning (WCC) , which required commissioners to:
At the time of World Class Commissioning we strongly advised that the local health economy set up, or expanded, existing networks/planning and strategy groups to ensure that there is representation of service users and carers, public health, smoking cessation and exercise experts, primary and secondary care clinicians (doctors, nurses and allied professionals), practice based commissioners, PCO commissioners, social care, and other parties who have expertise and local knowledge to contribute. There are useful resources from NHS Networks about running networks http://www.networks.nhs.uk/network-resources and from National Prescribing Centre http://www.npc.nhs.uk/personal_org_dev/working_others/resources_groups/quiz_buildingnetworks.swf
Since then many of the regional clinical leadership teams have supported the creation of networks at regional and local level, with the aim of meeting, sharing experience and starting to review data to trigger discussions about improvement.
Lessons from IMPRESS as a network role model
4. Use networks to horizon scan
The evidence about networks suggests that the inclusion of “boundary spanners” and a network manager is also vital to its success. We suggest its role should be to agree on an assessment of local need, undertake a gap analysis using pathway mapping or other improvement tools describe a vision for local services and set standards. In Scotland, where Managed Clinical Networks are an essential part of policy implementation, one of the key roles is overseeing the training and education requirements of local clinicians, audit, and monitoring service provision. In Scotland this role has come out of the findings of the needs assessment process that typically highlights a lack of knowledge amongst clinicians in primary care.
Example of a multi-disciplinary network focused on value/QIPP that has been in operation for several years:
"A NICE implementation group sat monthly and comprised GPs/consultants/finance/audit/IT/pharmacy reps and was chaired by the acute trust and PCT alternately. This considered all issues to do with horizon scanning, recently published guidance, Payment by Results, and financial implications for the whole health economy rather than 'them and us'.
Whenever a new guidance was published, a grid of recommendations was produced and this happened for COPD and TB. All stakeholders were then given the opportunity to respond to the guide and the collated response distributed so that everyone could see any hurdles to NICE implementation and (usually) any financial restrictions. There were timeframes for completion of these parts of the process and a database produced that could be accessed by both primary and secondary care. With regard to COPD, we were able to proceed with appointment of a GPwSI (with session for Consultant Respiratory Physician and training resource), establishment of a resource centre, community pulmonary rehabilitation and stronger links between our Consultant Respiratory Nurse and the PCT. There were inevitable frustrations regarding timeframes, finance, attendance and it certainly wasn't all 'rosy' but the model was at least one way, based on NICE, to have a structured dialogue which required a response, whether negative or positive."
What is the network’s role in service delivery?
The network may also have a role in service delivery. In the Scottish system, the network acts as an advocate, plugging into existing systems for provision and commissioning and offering /expert advice and facilitating change. In England, networks are less formally developed. However, the more successful the trust and relationships are between the network, the more likely it is that the commissioner would look to the network to advise on the service and to find ways to improve it. We await the outcome of the debate on the Health and Social Care Bill to know how networks, integration and competition will be balanced.
If a new service is required, with significant investment, then commissioners are likely to be bound by European Union rules on procurement, and they will have to decide how best to do that.
Some of these points are drawn out in a recent Health Services Management Centre paper Integrating Care and Transforming Community Services: What Works? Where Next? 2009.
NIHR SDO study on networks in health care
An NHS SDO research project has been published by Ewan Ferlie: Networks in health care: a comparative study of their management impact & performance click here to download an Executive Summary and full report. It asks the question "Should health care be organised through markets, hierarchies or networks?" It has used cancer networks as one of the study subjects, and has some interesting findings that IMPRESS would support from its experience as a network. Firstly, it points to existing evidence that "trust building is central to the functioning of networks" and that networks have emerged as the most logical way to support people with chronic disease that need to link health and social care and primary and secondary care across organisational and professional boundaries. It also highlights the role of networks in improvement programmes as a "governance mode able to diffuse good practice and rapid learning".It then highlights from its findings:
IMPRESS is in regular contact with the NHS Improvement - Lung launched by NHS Improvement to support the development of clinical networks and the implementation of the National Outcomes Strategy for COPD and asthma. Its team support respiratory leads in the regions, the development of Respiratory Networks, and pilot programmes to improve the management of respiratory disease. It will build on the successes of existing national improvement programmes in Cancer, Cardiac, Diagnostics and Stroke services. The Programme aims to support clinical teams, commissioners, service managers and other key stakeholders deliver effective clinical practice through process improvement and redesign. Click here.
IMPRESS will continue to work with the programme to share examples of good practice, and to support the development of local networks.
Presentation at IMPRESS inaugural conference from Dr Iain Small
Cancer networks: http://www.cancerimprovement.nhs.uk/
Royal College of Paediatrics and Child Health: A Guide to Understanding Pathways and Implementing Networks - December 2006
Scottish Managed clinical networks