1. Joint Working Workshop
The “7 Step framework”
Sharing best practice
Identifying opportunities using real world data
Kevin Blakemore, National Partnership Manager| ABPI
Helen Wheeler, National Project Manager | Sanofi
Hassan Chaudhury, Director of Health Intelligence | Health iQ

2. Our common goal
Win:Win:Win:Win:Win
Public
NHS
Academia
Voluntary
Sector
Industry
Social
Care

3. Quick Start Guide – May 2012

4. Flow Chart

5. Promotion Joint
Working
MEGS Sponsorship
For patient benefit
Yes Yes Yes Yes
NHS/Pharma company pool resources
X Yes X X
Pharma company investment
Yes Yes Yes Yes
NHS investment
X Yes X O
Detailed agreement in place
X Yes X X
Shared commitment to successful
delivery
X Yes Yes Yes
Details of the agreement are made
public
X Yes O X
Prospective ROI Yes Yes X X
Outcomes must be measured
X Yes O X

6. The Charles Town Project-
Having the confidence to share
gives us confidence to learn
Helen Wheeler, National Project Manager | Sanofi

7. Original Proposal
•Aim was to form a collaborative group to undertake a programme of
activities developed to address the health issues around Diabetes
•To be known collectively as the “NHS Charles Town and Industry
Maximising Resources and Outcomes in Diabetes (Concord )”project
Goals
•To ensure delivery of high quality diabetes care
•To reduce diabetes health inequalities
•Improve outcomes for all patients with diabetes in Charles Town regardless
of where they live.

8. Objectives of the Project
1) To reduce the rate / number of avoidable admissions to hospital for patients with diabetes
and diabetes related illness.
2) To reduce the rate of inappropriate / avoidable utilisation of emergency services for people
with diabetes related illnesses.
3) To develop and implement a coherent care planning approach to the management of
people with diabetes across primary, secondary and community services, which ensures
that all patients have the opportunity to be actively involved in decisions about how their
diabetes is managed.
4) To work in partnership with all stakeholders including the pharmaceutical industry, in an
innovative and inclusive way throughout the project to achieve outcomes which benefit
patients with diabetes in Charles Town
5) To ensure that all activities are developed and implemented in a way which improves the
quality, efficiency and cost effectiveness of care in line with national QIPP objectives.

9. Primary Care
Clinician
/Secondary Care
Clinician
Primary Care
Nurse
(with diabetes
expertise)
Community
Pharmacy/PBC
cluster
managers and
clinical leads
Charles Town
“City Health”
(provider arm)
/NHS Charles
Town Health
promotion
NHS Charles Town
Public Health/ NHS
Charles Town Clinical
Audit/ NHS Charles
Town Commissioning
Directorate
Pharmaceutical
Industry
(one seat per
organisation)
NHS Charles
Town Primary
Care Contracting/
NHS Charles
Town Medicines
Management
+ 8 industry partners
Patient
Representative
Developed and managed in partnership with the ABPI Outreach Project who formed a group of
interested member companies to act as equal stakeholders throughout.
PCT-led project managed by a multi-professional multi-agency steering group consisting of a
lead from each of the following stakeholder groups:
Project Methodology

10. In a Nutshell
• In-Patient Audit commissioned by the LOCAL IMPLEMENTATION GROUP
• Driven through a PROJECT GROUP
• Managed by a highly experienced independent PROJECT MANAGER paid by the
Project sponsors through the budget.

11. Different stakeholders theoretically agreed with the project aims and rationale
Equity of industry and NHS
Endorsement of the Project from a high level (Chief Executive)
Collaborative concept was good
Excellent launch - with motivational and national figures in support
Innovation project based upon a well established and successful project that the Project
Manager had led previously
In theory should have just replicated the last CHD project
PM was a third party and theoretically objective and skilled
What worked well

12. Became a duel
between commissioning
lead/clinical leads and
project lead
Scepticism between
NHS and industry had
not left the room
Industry was diluted -
too many partners
Skill set in the project
team not utilised
Industry had much
of the data that
was needed
Level of investment did
not = level of voice
Project lead became a
facilitator between
Industry & NHS - should
have been left behind
once partnership
agreed
Poor dynamics
Too controlled and
inhibited freedom of
speech
Declaration of interest
to other industry outside
of the group
Did the Project team
fully understand the
therapy area?
No clear timelines
What did not go so well

13. What went wrong: key
Communication
between
Stakeholders
No real Equity of
Voice

14. Outcomes
Questions were asked around:
– Freedom of entry - became a closed shop
– Competition Law
– Lack of transparency due to communication between the PM and the LIG
– Industry skill set not maximised/ Project Management experience
– Loss of confidence by the LIG
– LIG pulled out money - returned to industry

15. What needs to happen
– The Patient must be at the centre of all this otherwise what is it all about?
– Old ways need to be left behind – innovation
trust need to be our future
honesty
– Some one needs to step up and say:
“Is this project going to lead to better Health outcomes for the Patient?”
if the answer is yes
“Have we as potential partners got the right resource and capacity together to drive this
through”?
if the answer is yes
“well let‟s just get on with it”

16. Where are we now?
• LIG still see the Value in the Project
• DUK still see value in the project
• Industry has much of the data that is needed as well as the skill set and capacity to project
manage
• Access still difficult between Secondary Care and Industry
• SC still very dominant and protective - this needs to change
• Patients still in the same place and could be better serviced- no body won and the war keeps
raging

17. Ensure a mechanism for genuine input
Use a more effective channel of communication to the LIG
Improve the equity of voice - but perhaps less voices??
Have clear terms of references
Better governance
Make a safe environment for all stakeholders to give an honest declaration of interest
- what do you want out of the project?
- how as a company are you going to measure success?
Ensure that the project is not dominated
Identify and utilise what you already have before buying more
Trust - do not move forward without this
How would we do this differently?

18. Any Questions?

19. Group Work
1. How could some of these issues have been avoided? Refer to hand-out
2. How could the “7 Step framework” have been used?
3. Have you participated in a joint working project that was unsuccessful?
a. why was it unsuccessful?
b. what did you learn from it?
4. Of the 9 indicators for joint working, which are top 3 most important and why?
a. Are there any other indicators that should be included ?
Knowledge & Expertise
Trust
Ethics
Project management
Transparency
Openness
Respect
Effectiveness
Support

20. Identifying Joint Working
Opportunities-
7d
Using real world data
Hassan Chaudhury, Director of Health Intelligence | Health iQ

21. CCG Data
Quick Facts:
– Not in London (somewhere in the Midlands)
– Ethnically diverse.
– Population of 600,000 - which is rapidly rising.
– Over 50 GP Practices.
– Higher than average deprivation.
– Lower than average life expectancy with a lot of variation across the CCG.
– Prescribing costs have gone up faster than expected as have emergency
admissions.
– Mental health costs are very high.
• It has had discussions on choosing its 3 local measures for the Quality Premium
(c.f. http://www.england.nhs.uk/wp-content/uploads/2013/05/qual-premium.pdf)

22. What is the Quality Premium?
Four Areas to explain:
1.The „quality premium‟ is intended to reward clinical commissioning groups
(CCGs) for improvements in the quality of the services that they commission and
for associated improvements in health outcomes and reducing inequalities.
2.The quality premium paid to CCGs in 2014/15 – to reflect the quality of the
health services commissioned by them in 2013/14 – will be based on:
four national measures and three local measures.

23. What is the Quality Premium?
3. The four national measures, all of which are based on measures in the NHS
Outcomes Framework, are:
1) reducing potential years of lives lost through amenable mortality (12.5 per cent of
quality premium): the overarching objective for Domain 1 of the NHS Outcomes
Framework;
2) reducing avoidable emergency admissions (25 per cent of quality premium): a
composite measure drawn from four measures in Domains 2 and 3 of the NHS
Outcomes Framework;
3) ensuring roll-out of the Friends and Family Test and improving patient experience
of hospital services (12.5 per cent of quality premium), based on one of the
overarching objectives for Domain 4 of the NHS Outcomes Framework
4) preventing healthcare associated infections (12.5 per cent of quality premium),
based on one of the objectives for Domain 5 of the NHS Outcomes Framework.

24. What is the Quality Premium?
4. The three local measures should be based on local priorities such as those
identified in joint health and wellbeing strategies.
These will be agreed by individual CCGs with their Health and Wellbeing Boards
and with the area teams of the NHS Commissioning Board (NHS CB).
What they select must also be in line with other local priorities e.g.:
- Improved Outcomes
- High Quality Care
- Tackle unwarranted variation and strengthen out of hospital care
- Efficient and effective care pathways
- Development of integrated multi agency care pathways

25. What is the Quality Premium?
It was decided that the three local measures would be selected to also help achieve
the four national measures. The most significant of the national measures is on
emergency admissions (25% of the total).
- Last year there were over 56,000 emergency admissions of local residents.
- Giving a rate of 75 admissions per 1,000 people.
- Of these admissions over 25,400 (44%) are repeat emergency admissions.
- Over a half of all emergency admissions arrive via the hospital‟s A&E department.
- Nearly a third of admissions arrive from a General Practitioner (GP)
These two methods account for nearly 90% of all emergency admissions.
- The total cost of all emergency admissions by local
residents exceeded £90 million.

26. Group Work
Look at the following data on emergency admissions and decide: what
does the data demonstrate?
Can you use this information to select areas for your local measure or is
further information required?
If so, which areas would you want to focus on and what you would want to
achieve?
15 Minutes

27. Local Measures
The 3 areas they chose were CHD, COPD and Diabetes.
ACSC emergency admissions in the CCG now make up 14.1% of all emergency
hospital admissions, at a current cost of around £13 million annually.
This is what they wanted to achieve:
1. Increasing the number of patients with coronary heart disease who completed
cardiac rehabilitation.
2. Increasing the number of people with COPD referred to a pulmonary
rehabilitation programme.
3. Increasing the number of people with diabetes diagnosed less than a year
being referred to structured education.

28. Let’s focus on diabetes…
• What Joint Working opportunities can you think of?
• How can parties work together for the benefit of patients, industry and the NHS?
• How would you utilise the 7 step framework?
• Would you help with setting up a Diabetes Multidisciplinary Team (NDMT)
i.e. a group of specialist nurses, podiatrists, dieticians, diabetologists, and
multi-skilled practitioners: all dedicated to improving the quality of care and providing
people with diabetes with the training needed to help them self-manage
• Would you help with data?
• Patient support? Perhaps help to map pathways.
The choice is yours 15 Minutes

29. Closing Remarks7d
Outcomes and Feedback
Karen Thomas, Regional Partnership Manager London | ABPI

30. What do you see?

31. Working in Partnership

32. To achieve…….
“ High quality care for all, for now and for
the future generations”
NHS England