Measuring quality of health care in the NHS: Giving a voice to the patients

The high profile role that the NHS played in Brexit and recent general election campaigns demonstrates that the health care system remains foremost in the minds of all political parties when considering how to present their policies | The Health Foundation

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These campaigns put a spotlight on the sustainability of the health care system, but may have also fuelled a fear over deteriorating health system performance. In 2017, the NHS was recently ranked by the Commonwealth Fund as the best performing health care system out of 11 countries, including Germany, Australia and the United States. However, 82% of the general public expressed concerns about the future of the NHS in a survey following the 2017 General Election, with quality of care identified as one reason for dissatisfaction previously. Arguably, this disparity may be the result of intense media coverage of the human and financial pressures on the NHS, which could have shaped public perception to some extent. However, it might also point to a deeper disparity: a disconnect between the general assessment of measurable health system performance versus the quality of care perceived by patients when accessing the NHS.

One reason for this relates to the difficulty in measuring quality of health care at the system level. Quality in the context of health care is a multi-dimensional framework that captures six domains:

  • Effectiveness
  • Efficiency
  • Equity
  • Safety
  • Timeliness
  • Patient-centeredness.

Read the full blog post by Rocco Friebel here

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CCG medicines optimisation service


The Pharmaceutical Services Negotiating Committee has published a case study on Bath and North East Somerset CCG medicines optimisation service.   

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To reduce excessive prescribing BANES CCG commissioned community pharmacy to actively review their patients medication and to look for opportunities to optimise their care. The community pharmacists identified items to either not dispense or optimise and then worked with the CCG employed practice support pharmacists to make the changes permanent on a patient’s record.

In the first eight weeks of the service (18th May 2017 – 12 July 2017) the five initial pilot pharmacies have identified £15,421 of annualised savings of which £9,396 have been actioned by the surgery, with £2,498 rejected and £3,528 awaiting resolution in the surgery. Currently 120 medicines optimisation opportunities have been identified by the community pharmacies with 69 being actioned by the CCG pharmacists.

The average annual saving per actioned suggestion is £136 (£9,396 / 69).  The £30 professional fee is only paid to the community pharmacist once the change has been actioned by the surgery. The 69 approved changes resulted in £2,070 being paid in a professional fee, which represents a return on investment of 1 : 4.5 (£2,070 : £9,396). In year two, the CCG will continue to gain the benefits of these savings with no additional professional fee.

Full case study: Bath and NE Somerset CCG Medicines Optimisation Service

Developing accountable care systems

Developing accountable care systems: lessons from Canterbury, New Zealand | The Kings Fund

This report examines how the Canterbury health system  in New Zealand has moderated demand for hospital care, particularly among older people, by investing in alternative models of provision and community-based services.  The transformation has taken more than a decade and required significant investment; this report considers the lessons that the NHS can learn.

New model of Primary Care provision

New report from the Nuffield Trust evaluates an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC).

The primary care home model was developed by the National Association of Primary Care as a response to workforce challenges, rising demand and opportunities to shape transformation in local health and care systems across England.

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Image source: nuffieldtrust.org.uk

This report from the Nufield Trust suggests that the new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis.

The evaluation found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups.

It was judged to be too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services.

Full report: Primary Care Home. Evaluating a new model of primary care.

Related: New primary care model needs resources, say experts | OnMedica

Improving care and support for children and young people with mental health problems

Three Royal Colleges have jointly agreed five shared principles designed to improve care and support for children and young people with mental health problems.

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The Royal College of General Practitioners, The Royal College of Paediatrics and Child Health and The Royal College of Psychiatrists have issued a position statement saying that as well as the commissioning of specialist treatment, an effective child and young people’s (CYP) mental health system required:

  • acknowledgment that CYP mental health is everybody’s business and should be supported by a shared vision for CYP mental health across all government departments
  • a preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion
  • a system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems
  • training and education for the whole children’s workforce in their role and responsibilities for CYP mental health
  • more support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to CAMHS.

Full document: Position statement on children and young peoples’ mental health

End of life care for people who have a learning disability

This guidance document provide resources and tips for commissioners, service providers and health and social care staff providing, or delivering care to people with a learning disability at the end of their lives. | NHS England

The resource provides a number of ‘ambitions’ regarding end of life care for people who have a learning disability, and contains ‘top tips’, resources and good practice examples to support the achievement of each ambition.

Full document: Delivering high quality end of life care for people who have a learning disability: Resources and tips for commissioners, service providers and health and social care staff.