The North West London Collaboration of Clinical Commissioning Groups is making incredible strides in implementing integrated care through the successful development and deployment of its WSIC Dashboards. So just what could this innovative digital platform mean for #tomorrowspatient?
Integrated care is an on-going commitment for the Government and our National Health Service. With a population that’s living longer, and requiring support and treatment across varying specialisms, a process of ‘joined up’ care makes it easier for health and social care professionals to work more closely and effectively together.
By integrating services through an integrated health record there is better visibility across the care settings to proactively intervene in a patients care pathway and prevent a health crisis. Given that health and social care is delivered by different organisations that work separately, with service users continually frustrated at having to repeat the same information to various doctors, carers and specialists, the ambition of integrated care is easier said than done.
The North West London Collaboration of Clinical Commissioning Groups (CCGs) however, is making incredible strides in this area, with the development and implementation of their Whole Systems Integrated Care (WSIC) programme.
The WSIC Dashboard links provider data from four acute, two mental health and two community Trusts across eight CCGs, social care data from eight boroughs and 380 GP practices to generate an integrated care record. This electronic record can be reviewed by the range of health and social care providers, and health professionals, involved in a patient’s treatment, thereby providing a joined up care history.
The record is transferred to and stored in a data warehouse, its use governed by a legal document: the North West London Digital ISA. This agreement supports the sharing of patient information between signatory care providers, ensuring that people’s information is stored securely and shared for the correct purpose.
For health and care professionals accessing the record, the WSIC Dashboards help to deliver care in the following ways:
- Helps to identify patients for targeted care with watch lists which update automatically in response to new information from multiple care settings.
- Facilitates MDT discussion and coordination between care professionals from different settings by providing a shared patient narrative.
- Provides visibility of patient activity across the patient pathway across all care settings, regardless of source clinical system, without requiring manual data collection.
- Reduces reliance on hard-copies of notes and multiple system access, aiding transparency of information between multidisciplinary team members.
- Aids the monitoring of patient outcomes for both individuals and groups in practice populations.
- Provides visibility of patient level costings.
- Provides a summary snap shot view to gain an overview of a patient’s care.
One of the clear benefits for patients provided by the WSIC Dashboards is that they do not need to repeat their medical history, medications or treatments every time they see a new health or care professional, providing a more efficient way of reviewing a patient’s care history.
The WSIC Dashboards present a more holistic way of viewing a patient’s care history to allow patients to receive a more joined up care. The dashboards are designed to connect patients with the right care professionals, best suited to managing their particular needs. Ensuring people have access to the right care at the right time and in the right place, improves self-management and ‘patient activation’.
Varsha, a Care Coordinator for Wellcare, shares an example to highlight how the WSIC Dashboard has been used to identify gaps in a patients care pathway and pro-actively intervene:
“I have used the watch lists to see which patients may have gaps in their current care plan which need to be addressed. For example, an elderly patient who has been in and out of hospital and also needing extensive community support was later seen to need more support from the voluntary sector as they were isolated and not eating well.”
For clinicians the WSIC dashboard supplements local and practice knowledge, it has been developed to be used with local clinical systems to help identify patients for pro-active care.
“Hillingdon Care Connection Teams review the dashboard prior to practice huddles and take a selection of patients that would benefit from discussion. The aim of these discussions is to confirm whether a patient can be managed differently and whether a Care Plan is required.”
Care Connection Team MetroHealth, Hillingdon
“Practices are ‘running out of local intelligence’ and the WSIC Dashboards are helping to identify patients who are becoming unstable.”
Care Coordination Team, Hillingdon Network: Metro Health
The WSIC Dashboard enables care planning and case finding through providing visibility across all care settings, this allows care to be targeted where it is most needed. Patient activity is viewed across care coordination teams, practices and community nursing teams to enable earlier intervention and ensure resources are better managed.
“Helps to plan patient care and coordinate across providers, promoting joint working and proactive care. [The WSIC Dashboard] enables you to target resources for those most in need, support changes to working patterns and manage the challenges of the future”
Dr Martin Hall, Partner of Devonshire Lodge and Clinical Lead for the CCG
Metro Health has embedded the WSIC Dashboards into local care processes and into the Network Service Level Agreement (SLA) with the practices. The SLAs aims to support delivery of Network KPIs and the practices are expected to use the WSIC Dashboards as a risk stratification tool to help monitor and identify high cost and activity patients and report these to the monthly Network MDTs.
Moreover, use of the WSIC Dashboards as a key enabling tool has been incorporated into the job description for Care Coordinators (four of whom are already in place across Metro Health) and an additional five are being appointed to support the other Networks across Hillingdon.
Over 30 organisations, community groups, and lay partners from across North West London, including service users and carers, initially came together to develop a shared vision of the WSIC Programme. The WSIC Programme has been developed to support and enable the delivery of the STP plans to make them efficient and effective.
The overarching objective is to improve the quality of care for individuals, carers and families; empowering and supporting people to maintain independence and to lead full lives as active participants in their community.
To date, the programme team has kicked off deployment of the WSIC Dashboards to 224 GP practices across North West London; 69 per cent of practices have signed the NWL ISA; and WSIC Dashboards are now live in 115 practices.
This tool continues to develop and evolve in response to clinical feedback through the WSIC Dashboard Clinical Advisory Group. This Group currently consists of Clinical Leads from across North West London. Through handing ownership of the tool to the users of the Dashboard the product is adapting to the needs of the clinicians in North West London, this flexibility ensures it can continue to evolve as population needs change. Through the Clinical Advisory Group, views within the WSIC Dashboard are becoming more relevant to specific clinical pathways, with work under way on a Diabetes radar and COPD radar.
In addition to keeping partners well-informed with the latest deployment and development updates via a monthly newsletter, the programme team has ensured that health care professionals are supported to use the Dashboard. ELearning tools comprising a series of video training modules and downloadable user guides to support health care professionals in using the WSIC dashboard are available via the dedicated website. There is also a service desk that users can contact for help accessing the dashboards.
Challenges of implementation
The WSIC Dashboard team encountered three main challenges in implementing the dashboards:
1. Information Governance
Information sharing is a critical enabler for direct care, but for this to happen the appropriate legal framework needed to be in place. The WSIC Dashboard team needed to get all providers to sign up to this legal framework within North West London across the eight CCG’s.
2. Models of Local Services
The WSIC Dashboards are a key enabler to a broader NWL strategic plan. New models of Local Services are emerging across North West London, and this is prioritised upon strengthening care teams and evolving at-scale primary care. Getting clinicians to start using the WSIC Dashboards in this evolving organisational moving landscape has proved challenging. To address this, the team has worked with early adoption at-scale primary care networks across Hillingdon, West London and Brent to develop positive use cases that explain the WSIC Dashboards can be effectively used at practice and network level.
3. Stakeholder Engagement
The NWL geography is made up of eight boroughs, eight CCG’s and local authorities, over 380 GP practices, four acute and specialist hospitals, four mental health trusts and two community trusts, providing services to over two million service users. The programme aims to deploy the WSIC Dashboards to care professionals across all these organisations. The initial focus has been deployment to primary care, gaining momentum there, and moving onto secondary health services and social care providers.
Impact on healthcare system
The North West London Sustainability and Transformation plan is focussed on the ‘triple aim’ reflecting the three main health and social care challenges within North West London:
- Improving health and wellbeing
- Improving care and quality
- Improving productivity and closing the financial gap
Five delivery areas have been identified to help tackle these challenges, the WSIC Dashboards are a key enabler to the following four priorities:
- Radically upgrading prevention and wellbeing: supporting people who are mainly healthy to stay mentally and physically well, enabling and empowering them to make healthy choices and look after themselves.
- Eliminating unwarranted variation and improving LTC management: reducing unwarranted variation in the management of long term conditions- diabetes, cardiovascular disease and respiratory disease. Ensuring people access the right care in the right place at the right time.
- Improving outcomes for people with mental health needs: reduce the gap in life expectancy between adults with serious and long term mental health needs and the rest of the population.
- Ensuring we have safe and sustainable acute services: improve consistency in patient outcomes and experience regardless of the day of the week that services are accessed.