A Common Understanding 2012 - Working Together For Patients

Appendix E: Examples of Joint-working Projects and Programmes in Scotland (Case Studies)

1. Scottish Medicines Consortium/Association British Pharmaceutical Industry (SMC/ABPI)
2. Scottish Neuro Endocrine Tumour (SCONET) Guidelines
3. Scottish Intercollegiate Guidelines Network (SIGN) Respiratory Guidelines
4. MRSA Complicated Skin & Soft Tissue Infection (CSSTI) Management Evaluation
5. Rheumatoid Arthritis Stop Smoking Campaign
6. Grampian Risk Assessment & Intervention (GRANITE)
7. Specialist Registrar (SPR) Training
8. Cancer Service Redesign in NHS Grampian

1. Scottish Medicines Consortium

Name of Collaboration

Scottish Medicines Consortium (SMC) and Association of the British Pharmaceutical Industry (ABPI)

NHSScotland Partner
SMC

External Partner
ABPI

Aim of the work
The SMC came into being in 2001, providing guidance to the NHSScotland Boards on the clinical and cost effectiveness of all newly licensed medicines. In establishing the early systems and processes the SMC worked collaboratively with the ABPI establishing a formal forum in 2002, known as the SMC User Group.

What was done?
Three industry representatives are full members of SMC with the lead representative also Chairing the SMC User Group Forum. This Group comprises representatives of the pharmaceutical industry with knowledge of Health Technology Appraisals, who meet quarterly with representatives of the SMC Executive, the New Drugs Committee (NDC), pharmacy and health economic assessors and the secretariat. The aim of this Group is to provide a forum for industry and NHS stakeholders involved in the SMC to jointly identify, address, resolve and improve process and methods issues arising in relation to pharmaceutical company submissions and interactions with the SMC. Selection of industry members for the UGF is via an open and transparent process.

Supporting quote from lead clinician
“Partnership working with the pharmaceutical industry has been a major component of SMC’s success. There were expected to be challenges for Scotland, as a small country, in achieving the participation of a global industry in its HTA process. Industry partners have, however, been integral since the outset in setting up the ways of working as well as participating fully in the decision-making process. This allows the industry as a whole to be sure that due process is being followed and that decisions are being made fairly and to objective criteria. The SMC ABPI partnership is an excellent example of a true partnership that has had immense benefits for patients in Scotland as a result of early access to clinically effective and cost-effective new medicines.”

Professor Angela Timoney, Chair, Scottish Medicines Consortium

Outcomes Delivered:

• Patients benefit from the rapid review of new medicines leading to early access in some instances
• The NHS benefits from a robust process of review which provides guidance on the cost effectiveness of new treatments for NHSScotland
• Pharmaceutical companies benefit from the ABPI contribution to the evolution of SMC policy, methods and process, subsequent communication back to industry and support in adhering to the agreed way of working.
• NHSScotland benefits by utilising their limited resources in the most cost-effective treatments.

2. Scottish Neuro Endocrine Tumour Guidelines

Name of Collaboration
SCONET (Scottish Neuro Endocrine Tumour) Guidelines

NHSScotland Partner
SCONET Group

External Partner
Novartis Pharmaceuticals

Aim of the work
To have a clear patient pathway that would ensure patients are identified and receive access to the most efficient and effective care whilst ensuring equity across Scotland (Scotland has a large geographical area, with some rural hospitals, and accounts for 8% of UK population).

What was done?

• Identified the key health care professionals (HCP) and gained their commitment to support the development of patient pathway. This was for all stages. This included Radiology, Pharmacy, Oncology, Endocrinology, Surgery, Pathology.
• Organised and facilitated the Guideline meeting.

Supporting quote from lead clinician
“The Scottish Neuro Endocrine Tumour Group (SCONET) is in the process of developing the first Scottish Neuro Endocrine Guidelines which are expected to be finalised by April 2012. The guideline will ensure the equitable management of patients with this rare disease across Scotland and support integration of newer treatments as they are licensed. This project has demonstrated a good working relationship between the clinicians and industry which has helped to develop effective clinical guidelines.”

Dr Nicholas Reed, Consultant Oncologist, Beatson Oncology Centre, Glasgow

Outcomes Delivered:

• The patients benefit by receiving the most appropriate management and treatment for their disease in their locality, in a timely manner
• The prescribers benefit by having a clear patient treatment pathway
• The payors benefit by having a rare cancer service that ensures both equitable and appropriate patient management

3. SIGN Respiratory Guidelines

Name of Collaboration
Scottish Intercollegiate Guidelines Network (SIGN)/ABPI Scottish Respiratory Industry Group (SRIG)

NHSScotland Partner
SIGN/National Advisory Group (NAG) for Respiratory Managed Clinical Networks

External Partners
Asthma UK Scotland/ABPI Scottish Respiratory Industry Group (SRIG) [including the following companies: AstraZeneca, Boehringer-Ingerheim, Chiesi, GSK, MSD, Napp and Novartis]

Aim of the work
Implementation of the SIGN/British Thoracic Society Guidelines: SIGN 101, British Guideline on the Management of Asthma: A national Clinical Guideline.

What was done?
A steering group (SIGN/NAG/Asthma UK/SRIG) has been set up to deliver an implementation process for the guideline; this will involve three regional workshops, match funded by SIGN and SRIG which will run during May 2012 with the following aims, objectives and outcomes.

Aims and Objectives of the Day:

• An opportunity to consider the asthma priorities
• An opportunity to share examples of asthma good practice and models of service delivery
• To help design the benchmark criteria to facilitate implementation
• An opportunity to influence future improvement planning process
• To inspire and motivate continued focus on the delivery of care to patients with asthma
• An opportunity to network with colleagues from your region

Expected Outcomes:

• Agreed asthma priorities
• Clear understanding of any regional variations
• Increased knowledge of different clinical and service models to help deliver good practice
• Benchmark criteria to support future implementation

Supporting quote from lead clinician
“Collaborative work, such as the regional workshops, brings a unique opportunity to link evidence, priorities and direct benefits for patients. The workshops allow all stakeholders to influence asthma priorities in different regions across Scotland.”

Dr Keith Brown, SIGN Chair

Outcomes Delivered:

• Patient benefit: Improved service, improved access to the service, improved health outcomes
• NHS benefit: Improved service, equity of service across all Health Boards (HBs) within Scotland, which will be benchmarked and monitored.
• Company/Companies benefit: Joint-working project to support improved delivery of care within a Long Term Condition (LTC) where inequality of care is evident across HBs, this will include benchmarking and monitoring of improvement. Better understanding of how health is being managed and improved in asthma.
• Societal/wider NHS benefit: Improved service, equity of service across all HBs within Scotland, which will be benchmarked and monitored.

4. MRSA management Evaluation

Name of Collaboration
MRSA CSSTI (Complicated Skin and Soft Tissue Infection) management evaluation

NHSScotland Partner
NHS Greater Glasgow and Clyde

External Partner
Pfizer

Aim of the work
To establish a robust methodology for reviewing the hospital records of patients with confirmed MRSA related CSSTIs to better understand the scale and impacts of the problem and explore early discharge as a potentially significant factor in the solution.

What was done?
Robust methodology agreed by three lead clinicians and an independent research organisation based on a 15-month retrospective review of the hospital records of patients with confirmed MRSA CSSTIs. A representative sample of 173 eligible patients was identified, along with the relevant therapy areas and types of infection and the management of their condition analysed in detail.

Supporting quote from lead clinician
“We recognised before this study was undertaken that there was the theoretical potential for earlier discharge of patients with MRSA CSSTI, either on oral antibiotics or utilising our OPAT (Outpatient Parenteral Antibiotic Therapy) services. This would have obvious benefits for the patients who could return home earlier, and for the hospitals involved by allowing them to make the most appropriate use of available bed resources. However, we did not have the data to accurately assess the true extent of that potential. This project provided us the opportunity to gather the data we needed to answer that question.”

Professor John E Coia Consultant Clinical Microbiologist Director Scottish Microbiology Reference Laboratories, Glasgow

Outcomes Delivered:

For the patient

• The work identified that the median attributable length of stay until discharge was 15 days and that 29 patients (or 26.4%) were potentially suitable for discharge on oral therapy or OPAT (Outpatient Parenteral Antimicrobial Therapy).
• This, in turn, indicates that a significant number of patients may benefit from spending less time in hospital and resume their normal lives more quickly.
• Also of benefit to patients may be the positive contribution the findings could make to new thinking in the control and management of MRSA CSSTI.

For the NHS

• It was established that MRSA CSSTI accounted for 4,352 bed days, equating to 9 beds per day.
• Barriers to early discharge identified included management buy-in, clinician confidence, the need to monitor outcomes, provide support and develop new models of care.
• However, the proportion of patients who may benefit shows the potential for helping reduce infection, reduce costs through shorter stays, meet RTT targets and cut waiting lists.
• If a 25% reduction in HCAI could be achieved in surgical, orthopaedic, gynaecology and urology patients combined, 8,000 additional patients could be treated every year.

For Pfizer

• Further strengthen the company’s relationship with NHS Greater Glasgow and Clyde.
• Insight gained into local customer and patient needs.

5. Rheumatoid Arthritis Stop Smoking Campaign

Name of Collaboration
Rheumatoid Arthritis Stop Smoking Campaign

NHSScotland Partner
NHS Fife/Fife Rheumatic Diseases Unit (FRDU)

External Partners
National Rheumatoid Arthritis Society (NRAS)/Pfizer

Aim of the work

• Drive public and healthcare professional awareness of the Rheumatoid Arthritis (RA) and smoking campaign in Fife;
• Raise public understanding of the impact smoking may have on RA disease activity and treatment efficacy;
• Encourage RA patients to recognise the link between RA and smoking and seek professional advice.

What was done?
At a preliminary meeting Rheumatology Consultant raised the idea of creating an image that reflected the link between RA and smoking, e.g. using cigarettes
as part of the hand image. Set up a discussion group of healthcare professionals, Chaired by Consultant Rheumatologist to discuss the current issues and challenges around RA and smoking and review a selection of creative concepts for the Disease Awareness Campaign – Establishment of patient pathways in smoking and RA to improve the management of these patients. Engaged with NRAS, to develop and distribute a Detailed Patient Evaluation survey to a selection of patients in order to gain their perspective on the campaign. Interestingly, the creative concepts which provided empowering positive messages were rated more highly than the more hard-hitting concepts. Developed materials based on this feedback: A3 posters, patient leaflets, postcards, patient factsheet, NRAS publication. The Consultant Rheumatologist completed an audit before and after campaign. NHS Fife and NRAS contacted to collate results from campaign.

Supporting quote from lead clinician
“Many individuals with RA are not aware of the impact smoking may have on their disease or the services that are available to help them stop. We hope this campaign will educate people on the additional risks of smoking and empower them to make positive steps towards giving up.”

Dr Helen Harris, Consultant Rheumatologist at Fife Rheumatic Diseases Unit, Whytemans Brae Hospital

“We are delighted to be working together with NHS Fife and Pfizer to create a campaign which truly responds to the needs of patients in Fife. It is over 30 years ago since I developed RA and at the time, I smoked. I do now wonder if this was the trigger, or one of the triggers, which led to me developing RA.”

Ailsa Bosworth, CEO of NRAS

Outcomes Delivered:

Patient benefits

Raise awareness of the link between rheumatoid arthritis and smoking. Results at 4 weeks of launch include:

• 4 pieces of coverage achieved: The Courier, Dunfermline Press, Kingdom FM & Tay FM,
• 289,660 media impressions have been secured,
• 300 hits on NRAS website,
• Over 100 impressions on Facebook and 205 views on NHS Fife staff intranet.

NHS benefits

Increase throughput to stop smoking services to increase number of quitters and improve symptoms of RA and adherence to anti-tnf (tumour necrosis factor) medications. Results: 35 referrals from rheumatology clinic at 4 weeks of launch to stop smoking services. In terms of RA symptoms “early results suggest we expect a reduction in DAS and improvement in medication adherence.”

Dr Helen Harris

Benefits to Pfizer

• To further enhance our reputation and trust within NHS Fife
• To use insights gained to continue to help us improve our services
• To use the opportunity to develop our understanding of customer and patient needs
• To strengthen our collaborative reputation and review appropriate use of medicine

6. GRANITE

Name of Collaboration
Grampian Risk Assessment & Intervention: GRANITE

NHSScotland Partner
NHS Grampian, specifically Grampian Cardiovascular MCN and Peterhead Health Centre

External Partner
AstraZeneca UK Limited
AstraZeneca provided a Sponsorship Grant for this collaborative working programme

Aim of the work
Targeted case-finding for cardiovascular disease (CVD) prevention may be preferable to universal screening. Quality Improvement Scotland (QIS) has recommended that identification of high-risk individuals is needed. In this study, probable CVD risk in patients within the 40-70 years age range who were not on the CHD, Diabetes and Stroke registers and who were not already receiving statins was analysed using a predictive software toolkit which utilised the Assessing cardiovascular risk using SIGN (ASSIGN) risk calculator.

What was done?
AstraZeneca provided software to help the practice ensure that primary and secondary prevention patients were identified. The AstraZeneca Clinical Services Team provided the capacity to run initial clinics for the secondary prevention patients. The patients had their cholesterol measured and a treatment intervention was prompted if this was appropriate according to the protocol. The software included permission to use ASSIGN risk scoring to identify patients suitable for primary prevention.

Supporting quote from lead clinician
“Targeted CVD primary prevention identifies high-risk patients in a cost-effective manner. Structured assessment clinics identify and address unhealthy lifestyle and CVD risk factors. The GRANITE screening software effectively identified a patient population within the Peterhead practice who had a probable high 10-year CVD risk requiring intervention.”

John C Stout, GP lead, Managed Clinical Network Cardiology, Grampian

Outcomes Delivered:

• Targeted screening and levels of deprivation given equitable access to care;
• Cost-effective targeting of primary prevention patients;
• Right patients on the right drugs at the right time;
• A scalable pilot that can be replicated in other local Health Boards with the potential to reduce health inequalities in areas of deprivation.

Ref 1.<http://www.pccj.eu/index.php?option=com_content&view=article&id=757:original-research--the-granite-project-evaluating-a-novel-cardiovascular-prevention-model-in-scotland&catid=935:current-issue&Itemid=204>

7. Specialist registrar training

Name of Collaboration
Specialist registrar training (Spr)/Scottish Respiratory Industry Group (SRIG) [including the following companies: AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK, MSD, Napp and Novartis]

NHSScotland Partner

• Dr Adam Hill, Consultant Respiratory Physician & Associate PG Dean SE Scotland (Quality Management), Department of Respiratory Medicine, Royal Infirmary of Edinburgh
• NHS Education for Scotland (NES)

External Partner

• Scottish Thoracic Society (STS)

Aim of the work?
To develop a high quality, co-ordinated and equitable training programme for specialist registrars across Scotland. Easier access to high quality and accredited training that will improve the quality of patient care throughout Scotland.

What was done?
A representative from SRIG sat on the steering group that develops the training programme to fulfil the above objectives. They will be one of 12 members of the group. It is anticipated that the training will be delivered through 6 meetings annually. The cost of each meeting is approximately £1200.00. Subsistence level catering will be provided by SRIG and all other expenses and resources, including the time of those clinicians delivering the training, will be met by STS. On occasion, there may be funding to bring an international speaker to STS events. This budget will be provided by both partners. From SRIG this will be by member companies and from STS will be from NES funding.

Supporting quote from lead clinician
“The SRIG support for SpR training is appreciated. Industry has a lot to offer trainees with strengths in areas which complement the core training provided.”

Dr Adam Hill

Outcomes Delivered:
12 SpR training meetings have been supported by SRIG since 2010. An SRIG member has attended planning meetings to ensure member companies have been represented. This has allowed clear communication on what the pharmaceutical companies involved can and cannot participate in. This has helped build a fruitful alliance between the Deaneries involved and SRIG. There has also been easier access for SpR’s to high quality and accredited training that will improve the quality of patient care throughout Scotland.

8. Cancer service redesign in NHS Grampian

Name of Collaboration
Cancer service redesign in NHS Grampian

NHSScotland Partner
NOSCAN (North of Scotland Cancer Network)

External Partner
Novartis Pharmaceuticals

Aim of the work (what was the collaboration seeking to achieve)
The objective of this programme is to co-ordinate the delivery of the administration of bisphosphonates (Zometa) in community hospitals in NHS Grampian. A framework will be developed to determine a service model for delivering bisphosphonate and in the future other cancer treatments outside of the cancer centre.

What was done?

• Novartis supported the funding of a nurse to deliver and evaluate training and cover travel expenses of community nurses during training;
• Novartis supported the delivery of the educational programme in the community.

Supporting quote from lead clinician
“Industry Support in this case has enabled the development of innovative care within a local setting which fits a direction of travel of care consistent with patient needs.”

Peter Gent NOSCAN manager

Outcomes Delivered:

• Bisphosphonates are now administered safely in more than half of the community hospitals (7/13);
• Patients are benefiting from receiving their treatment locally, which enhances their quality of life;
• The number of times patients attend Aberdeen Royal Infirmary for review have been reduced or eliminated, which freed capacity for the hospital to provide other patient services;
• The skills of nurses in community hospitals have been optimised, and they can now benefit wider range of patients with other conditions requiring IV treatments;
• This project is creating a safe and appropriate infrastructure which allows the delivery of other cancer treatments;
• More patients are accessing Zometa and staying on Zometa because the service can now cope with the delivery and the capacity.