Integrated Care Pathways

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Integrated Care Pathways
Mark Fleming National ICP Co-ordinator
Ali El-Ghorr Programme Manager
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Overview of presentation

• Policy context
• Integrated Care Pathways
• Standards for ICPs
• Application in Primary Care
• Discussion

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John Loudon - Brin Jardine-Jill
Gillies-Sean Doherty - Mark Fleming-Rosie Cameron
Ali El Ghorr - Selina Clinch-Alastair Cook-Linda
McKechnie-Joyce Mouriki
Sam Atkinson - Trevor Johnstone - Elaine McKay -
Susan McGaff - Gary Morrison
NHS Quality Improvement Scotland Mental Health
ICP Team
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Conclusions

• NHS Scotland is taking a national approach to ICP
  development and implementation in mental health
• Focus on service user and meeting their needs
• Top-down policy combined with bottom-up local ICP
  development
• Supportive and facilitative approach
• ICPs being used as a tool for service redesign
  and continuous quality improvement

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Policy Context
Kerr report (2005)
Delivering for Health (2005)
Need to improve access, quality and efficiency
of NHS services
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Commitment 6 in Delivering for Mental Health
(2006) "NHS QIS will develop the standards
for ICPs for schizophrenia, bipolar disorder,
depression, dementia and personality disorder by
the end of 2007. NHS board areas will
develop and implement ICPs and these will be
accredited from 2008 onwards."
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Integrated Care Pathway
A tool to compare planned care with care
actually given
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Our Integrated Care Pathways

• Much more than a document of care given
• Encompass how care is organised, co-ordinated and
  governed
• Embody a system of continuous quality improvement

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Mental Health Services
NHS Primary Care, Secondary Care, CMHT,
others Local Authority Social Work
others Voluntary Sector Independent Sector Others
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Myth busting What ICPs are not

• national
• intended to stifle individualised care
• additional paperwork
• wholly dependant on IT systems
• (not all variance is bad)

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Why implement ICPs?

• Impossible to give evidence of current quality of
  services
• Lots of information currently being recorded
• Lots of duplication
• Lots of effort spent looking for information
• ICP offers opportunity to rationalise recording
  of information, bringing it all together into one
  document
• Opportunity to use resources more effectively

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Benefits to service users
the right care and treatment at the right
time

• ICPs will
• help improve assessment and care planning
• ensure care is delivered in accordance with
  evidence and best practice
• improve recording of care delivered and outcome
  achieved

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Benefits to services
expectations for local management

• ICPs will generate information for identifying
  areas for development
• training needs identified to close skill gaps
• need for service redesign
• focused use of existing resources

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National Standards

• Key standards for ICPs for the main diagnoses
• - schizophrenia
• - bipolar disorder
• - dementia
• - depression
• - borderline personality disorder

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ICP Standards

• Process standards (how ICPs are developed)

- Care standards (content of ICPs)
generic
condition specific

• Service improvement standards (how ICPs are
  implemented)

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Main Process Standards

• Stakeholder involvement
• Process mapping
• Leaders and project managers identified
• Recording and sharing of information
• Referral systems developed

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Care Standards

• Service user at the centre of care planning
• Comprehensive assessment
• Risk management
• A service user rated measure of needs (eg Avon)
• Use evidence based interventions
• Measure outcome

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Service Improvement Standards

• Support implementation of ICPs
• Describe systems for reporting and acting on
  variances
• Drive service redesign and continuous quality
  improvement

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Delivering together

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Implementing ICPs

• Will help NHS boards achieve their HEAT targets
• Stop increase in antidepressant prescribing
• Reduce suicide rates
• Reduce hospital re-admissions

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What does this mean to Primary Care?
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Primary Care Involvement

• 4 GPs on our ICP development groups
• GPs RCGP involved in consultation process
• GPs others to be involved in local ICP
  development
• CHPs to be involved in local ICP development

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What do Primary Care need to do?

• Consider sharing anonymous information about
  diagnosis with NHS board
• Liaise with mental health services about referral
  protocols and care plans
• Consider how best to be involved in depression
  dementia ICP care

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Possible incentives

• ICP links to Quality Outcomes Framework
  Mental health register
• Physical health checks
• Dementia review
• Depression screening
• Depression assessment using validated tool
• ICPs linked to HEAT target for reducing
  antidepressant prescribing

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Other incentives
Delivering for Mental Health Commitment 3
We will work with GPs to ensure that new
patients presenting with depression will have a
formal assessment using a standardised tool and a
matched therapy appropriate to the level of need.
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Benefits to Primary Care

• More and better quality information from mental
  health services
• Co-ordinated care package
• Holistic care based on service user needs
• Better outcomes for individuals and families

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Standalone Depression ICP Standard

• For people who do not have complex needs
• Objective measure of depression (eg PHQ9)
• Assessment of need leading to appropriate
  interventions (eg self-help, lifestyle advice)
• Depression-focused brief psychological therapies
  offered
• Treatment algorithm with threshold for
• antidepressant prescribing
• psychological therapies
• other evidence-based interventions

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Application
Mark Fleming National ICP Co-ordinator
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Conclusions

• NHS Scotland is taking a national approach to ICP
  development and implementation in mental health
• Focus on service user and meeting their needs
• Top-down policy combined with bottom-up local ICP
  development
• Supportive and facilitative approach
• ICPs being used as a tool for service redesign
  and continuous quality improvement