1. Patient PathwaysPatient Pathways
Katy GordonKaty Gordon

2. NHS Plan (DoH 2000)NHS Plan (DoH 2000)
• Our aim is to redesign the system aroundOur aim is to redesign the system around
the patient….the patient….
• PCTs have been in operation giving localPCTs have been in operation giving local
health professionals more freedom tohealth professionals more freedom to
develop new services….develop new services….

3. NHS PlanNHS Plan
Patients should have fair access and highPatients should have fair access and high
standards of care wherever they live:standards of care wherever they live:
National standards for key conditions andNational standards for key conditions and
disease through the NSFsdisease through the NSFs
Clear guidance on best treatments andClear guidance on best treatments and
interventions from NICE to ensure a faster,interventions from NICE to ensure a faster,
more uniform uptake of treatment which workmore uniform uptake of treatment which work
best for patients.best for patients.

4. NHS PlanNHS Plan
The NHS has started to redesign the way healthThe NHS has started to redesign the way health
services work. This involves:services work. This involves:
 Looking at services from the wayLooking at services from the way the patientthe patient
receives themreceives them
 Planning the pathway that a patient takes from start toPlanning the pathway that a patient takes from start to
finish to see how it could be made easier & swifterfinish to see how it could be made easier & swifter
 Best, modern clinical practice is identified & decisionsBest, modern clinical practice is identified & decisions
made about which professional should best carry outmade about which professional should best carry out
which functionwhich function

5. NHS PlanNHS Plan
Results:Results:
Impact dramaticImpact dramatic
Improved services for patientsImproved services for patients
Improved productivityImproved productivity
Task of caring for patients easier for staffTask of caring for patients easier for staff
In many cases resources released toIn many cases resources released to
spend on other servicesspend on other services

6. Care PathwaysCare Pathways
www.nelh.nhs.uk/carepathways/www.nelh.nhs.uk/carepathways/
"People and perfect processes make a"People and perfect processes make a
quality health service - a poor qualityquality health service - a poor quality
service results from a badly designed andservice results from a badly designed and
operated process, not from lazy oroperated process, not from lazy or
incompetent health care workers" Johnincompetent health care workers" John
Ovretviet, Health Service Quality, 1992.Ovretviet, Health Service Quality, 1992.

8. ICPs – what are they?ICPs – what are they?
• A tool & a concept that embed guidelines,A tool & a concept that embed guidelines,
protocols & locally agreed, evidence-protocols & locally agreed, evidence-
based, patient-centred, best practice, intobased, patient-centred, best practice, into
everyday use for the individual patient.everyday use for the individual patient.
• ICPs record deviations from planned careICPs record deviations from planned care
in the form of variancein the form of variance

10. ICPsICPs
Aim to have:Aim to have:
The right peopleThe right people
Doing the right thingsDoing the right things
In the right orderIn the right order
At the right timeAt the right time
In the right placeIn the right place
With the right outcomeWith the right outcome
All with attention to the patient experienceAll with attention to the patient experience

11. And to compare planned care withAnd to compare planned care with
care actually givencare actually given

13. Heart Failure care/servicesHeart Failure care/services
See HF current pathwaySee HF current pathway

14. Heart Failure care/servicesHeart Failure care/services
See HF proposed pathwaySee HF proposed pathway

15. Proposed HF Project PlanProposed HF Project Plan
(May 2004)(May 2004)
Data collection on registersData collection on registers
Validation of registersValidation of registers
Use of technician for new diagnoses (?Use of technician for new diagnoses (?
use private contractor to provide thisuse private contractor to provide this
service)service)
Develop pilot of locally based diagnosticDevelop pilot of locally based diagnostic
clinic – GPwSI-led, including referralclinic – GPwSI-led, including referral

16. GPwSI-led serviceGPwSI-led service
One-stop diagnostic clinic with the followingOne-stop diagnostic clinic with the following
options:options:
Confirm/refute diagnosisConfirm/refute diagnosis
If HF, initiate treatmentIf HF, initiate treatment
Formulate management planFormulate management plan
Either refer back to patient’s own GPEither refer back to patient’s own GP
Or continue follow-upOr continue follow-up
Or urgent fast track referral to secondary careOr urgent fast track referral to secondary care
for review by specialist/further investigationsfor review by specialist/further investigations

17. Other aspects to considerOther aspects to consider
Develop the rest of the ICPDevelop the rest of the ICP
Streamline ‘front end’ of the proposed pathwayStreamline ‘front end’ of the proposed pathway
Patient/carer informationPatient/carer information
Community-based team – skill mix?Community-based team – skill mix?
Links to ongoing care and end-of-life options etcLinks to ongoing care and end-of-life options etc
Education/trainingEducation/training
Development and spread of care/serviceDevelopment and spread of care/service
provision across the PCTprovision across the PCT