NHS Policy pages of this website

Long Term Conditions page of NHS England

General:

• Clinical commissioning group allocations 2013-14 
• NHS documents (NHS Commissioning Framework - online and pdf
• Latest guidance on Practice Based Commisioning Clinical commissioning: our vision for practice-based commissioning
• Practice Based Commisioning Practical Implementation published 29 Nov 06 - very useful guide to how it will work, audience: practices and PCTs.
• Commissioning Framework for Health and Well-being
• NHS Networks Commissioning homepage
• Comprehensive handbook from Melton Rutland and Harborough PCT (online and pdf)
• Improvement Foundation website; practice-based Commissioning:
• Practice-based commissioning: From good idea to effective practice

Commissioning for long term conditions:

• Unique Care (Management of patients with complex needs)
• Commissioning for long term conditions is a collaboration between Asthma UK, Diabetes UK and British Heart Foundation and has a website with a lot of useful resources:
• For the most detailed information on commissioning a long term condition, see the Diabetes commissioning toolkit by DH National Diabetes Support Team, Diabetes UK, PCDS, ABCD, Yorkshire and Humber Public Health Observatory
• http://www.dh.gov.uk/assetRoot/04/14/02/85/04140285.pdf
• [note that no Public Health Observatory has the respiratory lead]

Commissioning respiratory care:

(02/06/08) Commissioning and Developing Home Oxygen Clinical Assessment and Follow Up Services from the Department of Health is available now. See this link.

Lung cancer care 2010:

The UK Lung Cancer Coalition has developed a toolkit to help clinicians involved in lung cancer care to engage with their local commissioners and make the case for improvements in lung cancer services. It includes:

• Background on the UK Lung Cancer Coalition and its priorities for action
• Data on how each Cancer Network area performs on lung cancer, and how this compares to the rest of the country
• Contact details for local PCT commissioners of lung cancer services
• A template e-mail for lung cancer clinicians to use to approach their local commissioner for a meeting
• Things that clinicians may wish to consider when engaging with their local commissioner of lung cancer services, and advice on making their case as convincing as possible
• Links to other sources of information on lung cancer

How to promote self care
http://www.wipp.nhs.uk/self-care

The Picker Institute works with patients, professionals and policy makers to promote understanding of the patient's perspective at all levels of healthcare policy and practice and has much new research and policy statements athttp://www.pickereurope.org/

A valuable review of the evidence on patient-focused interventions Primer
http://www.pickereurope.org/Filestore/Downloads/Policy_Primer_Sept_07_3.pdf
or the full report http://www.pickereurope.org/Filestore/Publications/QEI_Review_AB.pdf

See also Angela Coulter's conclusion that whilst evidence that strategies to strengthen patient engagement are effective is substantial, any strategy to reduce health inequalities must promote health literacy
http://www.bmj.com/cgi/content/full/335/7609/24?ijkey=puwRPL3NPgfHgM6&keytype=ref

Public involvement: top tips
http://www.pickereurope.org/page.php?id=7

The NHS Centre for Involvement has a large resource section
http://www.nhscentreforinvolvement.nhs.uk/index.cfm

Involving patients, reconciling population based approaches and individual need,

Healthy Democracy book by Involve and NHS Centre for Involvement at Warwick,
http://83.223.102.125/involvenew/mt/archives/blog_37/Healthy_Democracy/Healthy_Democracy.pdf

www.nationalvoices.org.uk
(to be launched by end of September 2007)

NHS Choices -
www.nhs.uk

http://www.nhs.uk/conditions/Asthma/Pages/Questions.aspx?url=Pages/Questionstoask.aspx
Video of Peter Barnes talking on asthma

http://www.nhs.uk/conditions/Chronic-obstructive-pulmonary-disease/Pages/questionstoaskpage.aspx?url=Pages/Questionstoasktab.aspx
Featuring Keith Prowse on COPD

End of Life Care Strategy July 2008: NHS Website: http://www.endoflifecareforadults.nhs.uk/eolc/ DH website:http://www.dh.gov.uk/en/Healthcare/IntegratedCare/Endoflifecare/index.htm

DH England End of life care programme websiteCarers strategy: Carers at the heart of 21st century families and communities: a caring system on your side, a life of your own. Click here.

Review of literature on predicting risk that concludes that clinical judgement alone is insufficient as there
is a regression to the mean.
http://www.kingsfund.org.uk/current_projects/predictive_risk/index.html

This link is to the predictive risk tool, PARR and PARR ++ used by an estimated 70% (estimated by Health Dialog, the supplier) PCTs now, in some form.

http://www.kingsfund.org.uk/current_projects/predictive_risk/patients_at_risk.html

This is the link to the combined predictive model that aims to identify prospectively those patients likely to be at very high risk of admission. It also uses more data sets than PARR so it can identify those along the whole continuum of risk.
http://www.kingsfund.org.uk/current_projects/predictive_risk/combined.html

Data collection by providers
Data analysis by commissioners
Eliciting patient views and experience

NICE commissioning guides are available to commissioners (a password is required to access the spreadsheets, but everyone has access to the text) for assisted discharge
http://www.nice.org.uk/page.aspx?o=376706 and pulmonary rehabilitation
http://www.nice.org.uk/page.aspx?o=375968 for COPD patients

The criticism levelled at these is that they don't tell you the skillmix required as they focus in on patient-centred delivery. However, they are a useful start in terms of understanding the scale of the issue.

London Health Observatory links to respiratory datasets:
http://www.lho.org.uk/HIL/Disease_Groups/RespiratoryDisease.aspx

Other PHO data sets eg South West PHO
http://www.swpho.nhs.uk/resource/browse.aspx?RID=26 has admissions data for England, plus detailed PCT
and hospital trust data for the region for all respiratory, asthma, COPD, and pneumonia using HES data.

Improvement Foundation guidance based on the COPD collaborative and primary care access collaborative work
http://www.improvementfoundation.org/theme/long-term-conditions

SNOMED and other HRG coding discussions
http://www.connectingforhealth.nhs.uk/terminology/snomed

HES data and enquiry service from Information Centre:
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=192

Self service HES
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=654

Request a tailor made service (charge)
http://www.hesonline.org.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=468

Community health profiles by Public Health observatories:
http://www.communityhealthprofiles.info/

Health poverty index http://www.hpi.org.uk/

http://www.lho.org.uk/HEALTH_INEQUALITIES/Basket_Of_Indicators/BasketOfIndicators.aspx

For a review of the evidence about transforming chronic care, see University of Manchester's HMSC rapid review of transforming chronic care:
http://www.hsmc.bham.ac.uk/news/TransformingChronicCare.pdf

At the macro level, there are a number of interesting papers about integrated care. The best overview is from the NHS Confederation - review of evidence Building Integrated Care by Naomi Fulop et al that can be downloaded from their Integrated Care site
http://www.nhsconfed.org/issues/issues-2279.cfm

There is also a provocative and interesting opinion piece by Andy Black on the future of acute care published by NHS Confederation Nov 2006
http://www.networks.nhs.uk/uploads/06/12/thefutureofacutecarenhsconfed.pdf

One of the models that Andy Black and Naomi Fulop draw attention to, is the new Central Middlesex Hospital BECaD that has been built to improve integration and patient flow. For the respiratory model see
http://www.nwlh.nhs.uk/devprojects/documents/BrentRespiratoryModel.pdf

The NHS institute programme on shift that looks in detail at 5 field sites testing new approaches:
http://www.institute.nhs.uk/care_outside_hospital/care/care_outside_hospital.html

The shift to the community is predicted in a simulation by Office for Public Management (OPM) about the future of primary care (providing and commissioning): "primary care in the future will increasingly be defined as a setting rather than a level of specialisation.":
http://www.opm.co.uk/resources/papers/health/levers_contracts_choice.pdf

Options for primary care trust provider services: an evidence-based policy-analysis for NHS West Midlands. University of Birmingham School of Public Policy, Health Services Management Centre (HSMC). Nov 2006 downloaded at www.networks.nhs.uk prmary_care_provided_services_uob_nov06.pdf

Creating capacity in primary care: the WIPP programme
http://www.wipp.nhs.uk/1.php

Virtual wards - the intervention developed in Croydon PCT to respond to the application of the risk stratification process:
www.networks.nhs.uk/uploads/06/12/croydon_virtual_wards_case_study.pdf

Understanding the tariff
Improving safety
Improving patient experience (no pain, good outcomes)
Understanding and improving patient flows
Reducing waste (delays, inefficient use of staff)
Improving equity
Designing sustainable pathways
Don Berwick's work for clinicians on the dimensions of quality (eg My Right Knee - Annals of Internal Medicine:http://www.annals.org/cgi/reprint/142/2/121.pdf

Payment by results, including the tariff:
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Financeandplanning/NHSFinancialReforms/index.htm

NHS Institute testing of improving flow and service transformation using Lean and 6 Sigma
http://www.institute.nhs.uk/quality_and_value/introduction/quality_and_value.html

The essential Improvement Leaders Guides
http://www.institute.nhs.uk/building_capability/building_improvement_capability/improvement_leaders'_guides

ISIP resources (Integrated Service Improvement Programme)
http://www.isip.nhs.uk/guidance/

Evidence from National Electronic Library for Health, Respiratory Section
http://www.library.nhs.uk/respiratory/

Examples from NHS Institute, NHS networks eg North West London Respiratory Network
http://www.networks.nhs.uk/networks.php?pid=320

Long Term Conditions pages in NHS Networks
http://www.networks.nhs.uk/3.php

Top tips on pathway design by NHS Confed/Improvement Foundation/RCGP
http://www.improve.nhs.uk/documents/Early wins and top tips.pdf

Cancer collaborative evidence on sustainable pathways that meet NSF targets
http://www.cancerimprovement.nhs.uk/View.aspx?page=/sustainability/pathways.html

Some of early thinking (2001) about building integrated networks around care pathways
http://www.opm.co.uk/download/papers/networks.pdf

Healthcare Commission review of tobacco control by PCTs 28/02/07
www.healthcarecommission.org.uk/serviceproviderinformation/reviewsandinspections
/improvementreviews/tobaccocontrol.cfm

Primary care service frameworks - generic, comprehensive and enhanced service specification for PCT
commissioners and Practice Based Commissioners for 2007/08.

http://www.primarycarecontracting.nhs.uk/204.php

Cancer networks: http://www.cancerimprovement.nhs.uk/

Royal College of Paediatrics and Child Health: A Guide to Understanding Pathways and Implementing Networks - December 2006
It includes a guide to setting up networks.
http://www.rcpch.ac.uk/publications/recent_publications/Managed Networks.pdf

Scottish Managed clinical networks
http://www.nhshealthquality.org/

http://www.networks.nhs.uk/136.php
has links to all guidance papers and checklists on networks from Scotland and England. Neil Goodwin papers are good.

Nigel Edwards paper 2002 BMJ on PubMed
BMJ. 2002 January 12; 324(7329): 63
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1122027

IMPRESS standards click here. There is a reference in the full document to practice nurse standards. These are published by the GPIAG here. They make reference to templates to support the consultation. There are a number available and the GPIAG is not prescriptive about which to use. As an example, the GPIAG template is available here. Information about the Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE) templates for asthma and COPD here.

http://www.skillsforhealth.org.uk/page has all the information about competences including nationally agreed competence definitions and tools to create job descriptions based on competences.

Manchester's HSMC report on skillmix: http://www.hsmc.bham.ac.uk/LTCnetwork/

The duties, responsibilities and practice of physicians in general medicine and the specialties

Third edition 2005, general and respiratory chapter

http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=17

http://www.rcplondon.ac.uk/pubs/contents/c7a46a2a-567b-4d52-b707-ff27aad58431.pdf

NHS Institute work on enhancing engagment in medical leadership
http://www.institute.nhs.uk/building_capability/enhancing_engagement/engagement_in_medical_leadership.html

The National COPD Resources and Outcomes Project NCROP

http://www.rcplondon.ac.uk/college/ceeu/ceeu_copd_home.htm
Healthcare Commission reviews (eg report on COPD - summary:
http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?cit_id=4025&FAArea1=customWidgets.content_view_1&usecache=false
Full report:
http://www.healthcarecommission.org.uk/_db/_documents/COPD_report1.pdf

Home oxygen portal with sections for the NHS, healtcare professionals and patients, carers and the public
http://www.homeoxygen.nhs.uk/1.php

Smoking cessation
http://www.uknscc.org/2006_UKNSCC/presentations/alex_bobak_1.html
and
http://www.uknscc.org/index.html

Met Office forecasting COPD and Met Office forecasting - discussion thread and key contacts
http://www.networks.nhs.uk/forums/showthread.php?t=1902

Healthcare Commission Review No ifs, no buts Jan 2007
http://www.healthcarecommission.org.uk/_db/_documents/Tobacco_Control_improvement_
review_scores_for_public_by_local_area__All_England_-_SD.pdf

IMPRESS end of life quality markers

Effective Care - Effective Communication: Living and Dying with COPD educational resource from IMPRESS

National End of life programme

National Audit Office http://www.nao.org.uk/publications/0708/end_of_life_care.aspx

Rand Corporation, that produced the technical analysis to this NAO report

Scottish policy

Liverpool Care Pathway

Gold Standards Framework

National Council for Palliative Care

Kings Fund

Joanne Lynn Sourcebook open accesshttp://www.ncat.nhs.uk/our-work/living-with-beyond-cancer/holistic-needs-assessment

Pinnock H, Kendall M, Murray SA, Worth A, Levack P, Porter M, MacNee W, Sheikh A.Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study. BMJ. 2011 Jan 24;342:d142. doi: 10.1136/bmj.d142. Open accessThe team's findings challenge current assumptions underpinning provision of end of life care for people with COPD. They argue that the policy focus on identifying a time point for transition to palliative care has little resonance for people with COPD or their clinicians and is counter productive if it distracts from early phased introduction of supportive care. They suggest careful assessment of possible supportive and palliative care needs should be triggered at key disease milestones along a lifetime journey with COPD, in particular after hospital admission for an exacerbation.

IMPRESS summaries of two papers about integration with social care

NHS Confederation PCT Network briefing in association with Directors of Adult Social Services: Where next for health and social care integration?Paper from Chris Ham on progress in health and social care integration, focusing on Birmingham, Torbay and Northumbria.?

IMPRESS links to the evidence for integrated care including interim report of the independent evaluation of the 16 integrated care pilots in the NHS Ernst and Young and RAND Europe and Chris Ham paper on Clinical and service integration The route to improved outcomes.

Reablement - latest policy and funding documentation.