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Creating a culture of evidence-led practice

A key focus of our work is to create a culture of evidence-led best practice across our healthcare community here in the West of England.

The NHS has not always been consistent in applying and spreading evidence based practice, resulting in care variations. Variations in care are not good for patients and can indicate inefficiencies and waste.

We work with healthcare clinicians and managers to implement research evidence and use quality improvement techniques in areas such as commissioning and delivery of services so that best care for patients and best value for the NHS are achieved at the same time.

Key stats

10 GP Clinical Evidence Fellows are working with all 7 of our CCGs

142 commissioners attended our evidence and evaluation workshops

Don’t Wait to Anticoagulate has potentially prevented 21 strokes to date

GP Clinical Evidence Fellowship

We are now into the third year of our GP Clinical Evidence Fellowship programme, with four new GP recruits joining the six who have continued in post for another year. These 10 GP fellows are based in a clinical commissioning group (CCG) for half a day a week, acting as ‘evidence champions’.

Working closely with commissioners, they find and review best clinical evidence, and embed it into commissioning planning discussions and decision-making to ensure scarce resources are used effectively.

The fellows are based in the same CCG throughout the year, with all seven of the CCGs in the West of England hosting at least one clinical evidence fellow. This year four of our CCGs have opted to fund another session per week to secure additional dedicated resource to support evidence-informed commissioning.

The fellowship programme is an excellent opportunity for professional development for the GPs, with the fellows learning all about their CCG through engagement with its staff and activities. The programme also encourages and supports each fellow to develop skills in critical appraisal, and in training through co-delivering the workshops, ‘Finding the Evidence’ and ‘Getting Started with Evaluation’.

Some examples of work that the fellows have been involved in to date include:

  • Reviewing evidence on the use of computers and apps in depression and anxiety
  • Near-patient CRP (C-reactive protein) testing to reduce antibiotic prescribing in an out-of-hours setting
  • Redesign of Chronic Obstructive Pulmonary Disease (COPD) patient pathway to improve patient care and reduce hospital admissions
  • Evidence review for exercise and spinal injections in musculoskeletal management (MSK)
  • Implementation and evaluation of Patient Activation Measures in MSK pathways
  • Evaluation of the use of Comprehensive Geriatric Assessment in primary care.

Online Evidence & Evaluation Works toolkits and workshops

Commissioning decisions should be informed by the best available evidence. This helps to improve outcomes for patients and makes sure that scarce resources are used efficiently and effectively.

To support commissioners, we worked in partnership with the Avon Primary Care Research Collaborative (APCRC) and the Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) to develop two online toolkits: Evidence Works and Evaluation Works.

The toolkits are intended for anyone working in or with health commissioning organisations to help them identify the best available evidence, plan and carry out an evaluation for informing decision-making.

They both feature a fivepoint guide to finding and using evidence, or planning and implementing a service evaluation. They also include links to resources, training, case studies and useful contacts.

Both toolkits are available to use free of charge. During the course of the year, the accompanying workshops, ‘Finding the Evidence’ and ‘Getting Started with Evaluation’ have reached 142 people. One participant reported that as a result of the training, they were inspired to carry out an evidence review that led to a potential full year saving of approximately £400,000.

 Swindon Wound improvement Project (SWIPE)

Launched in June 2016, the Swindon Wound Care Improvement Project (SWIPE) is helping to make improvements to wound care pathways for patients.

The project is run by Swindon Clinical Commissioning Group (CCG), working with GP practices and Great Western Hospitals NHS Foundation Trust.

We have supported SWIPE by providing quality improvement training to tissue viability staff from across primary, community and secondary care. The principle behind the methodology is to put the needs of the patient at the heart of change, allowing change to be developed and delivered by those staff who provide the care, supported by managerial and clinical leadership.

Don’t Wait to Anticoagulate

Working in collaboration with Gloucestershire CCG and Bayer, our innovative Don’t Wait to Anticoagulate project (DWAC) is helping to prevent strokes amongst patients with atrial fibrillation (AF). Receiving national recognition, a number of AHSNs around the country now have plans to run the scheme across their regions.

During phases one and two of the project’s roll-out in Gloucestershire, DWAC has potentially prevented 21 strokes amongst people with AF, representing a saving of over £489,000 by optimising medicines management in primary care.

Phase three of DWAC was rolled out in partnership with Bristol CCG to all primary care practices. Completed in March 2017, the full evaluation of this latest phase will be available in the autumn. In addition, the Bristol, North Somerset and South Gloucestershire (BNSSG) Sustainability and Transformation Partnership (STP) is considering DWAC as part of their stroke prevention pathway, which we hope will form phase four of the local rollout.

Co-designed with a wide range of stakeholders, including NICE, patient representatives and clinical partners, DWAC provides an easy-to-use toolkit and information materials for patients, clinicians and pharmacists to support shared decision making and optimise anticoagulation. Further support is also provided in the form of quality improvement and clinical skills training.

DWAC received a Pharmaceutical Market Europe (PME) Award for ‘Excellence in Healthcare Collaboration and Partnerships’ in 2016, and has been recognised as best practice in the Healthcare Pioneers 2017 report, which was developed by the AF Association and endorsed by the All-Party Parliamentary Group on Atrial Fibrillation.

Download the full annual report here as a PDF or read it below via Issuu.