NHS Dorset clinical commissioning group: leadership award runner-up

Clinical leads from Dorset CCG. The Great Leaders programme has helped family doctors to speak authoritatively about their work and priorities. Photograph: Dorset CCG/Columbia Photography

The Great Leaders programme developed for GPs in Dorset has given them the confidence they need to take on their new role as NHS commissioners, with responsibility for a £900m budget and a 766,000 patient population.

The scheme, which involves 40-50 GPs who have lead roles in the county-wide clinical commissioning group (CCG), has also made family doctors more "media savvy", so that they can speak authoritatively and clearly about the work they are doing and their priorities.

Since the programme was launched in June last year, the GPs involved in it have increased their public profile. They were behind an awareness campaign concerning when the public should use the new 111 out-of-hours telephone advice line and they also launched The Big Ask public consultation exercise seeking patients' views about local services.

GPs also organised two large public meetings to invite comments about the CCG's strategy.

On the commissioning front, the GPs were instrumental in introducing new dementia services following negotiations with their local authority health and wellbeing boards. They have also lad on commissioning services that help avoid emergency hospital admissions, as well as others such as targeting chronic obstructive pulmonary disease services in the over-75s and establishing a community-based pain management service.

The CCG's director of engagement and development, Charles Summers, says the list of achievements illustrates the success of the programme, as the GPs have moved from taking responsibility for the care of their own practice list to having responsibility for a county-wide population.

Having confident GP commissioners has also changed the focus of conversations with providers for the better. "It's now about 'how can your contract support me and my patients?', often in the past those conversations have been financially lead," says Summers.

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D2 Digital by Design: service delivery innovation award runner-up

Service users are sent personalised messages of support by the Response Prevention Project team. Photograph: Jason Lock/Jason Lock Photography

Text messages that support people recovering from alcohol misuse has significantly cut the number of people who relapse and have to be referred back to services.

Daily personalised support messages – which prompt a service user who has recently completed an alcohol misuse programme to reflect on their recovery – are delivered automatically as part of the Bolton Response Prevention Project called Shine.

The questions take into account the user's triggers to drink, such as the time of day they are likely to crave alcohol and also what motivates them to stop drinking such as their relationships with their family.

Service users are also asked whether they feel OK, or are struggling and need more support, and are sent appropriate messages.

Project manager Renate Kalnina at digital technology company D2 Digital by Design in Manchester, which is behind the initiative, says: "If they respond 'OK' we send them back a congratulatory message; if they are 'struggling' then the personalised intervention messages come into play.

"If they say that they need more support then the services get notified within 15 minutes and they get in touch with the client."

Service users are also sent a reminder via text message for appointments as part of the project, which ran from April 2010 to December 2012 in partnership with alcohol misuse services in Bolton.

Only 2.2% of Shine service users had to be re-referred for treatment, compared to 9.5% of non-Shine service users; a significant" reduction according to an analysis of the project.

Clients' attendance rates for relapse prevention programmes improved – rising from 42% to 72% in tier three services (medical intervention and psychosocial support) and from 17% to 72% in tier two services, which offer less intensive support and aftercare, the analysis revealed.

It is estimated the initiative has saved between £68,260 and £399,150, depending on individual client need.

D2 Digital by Design is in discussion with Public Health England about using the same model to support opiate users.

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Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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Healthcare Innovation Awards - profiles

Connect and Do, delivered in Lambeth, brings people together through shared interests and a desire to meet new people

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Guardian Healthcare Innovation Awards ceremony - in pictures

Richard Stubbs, head of commercial and international innovation at NHS England addresses the audience at the innovation awards. Photograph: Anna Gordon

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Department of primary care health sciences, University of Oxford: winner, service delivery innovation award

Daniel Lasserson, senior clinical researcher, and Maggie Webb, unit manager, in the emergency multidisciplinary unit.

An emergency unit designed exclusively for old and frail patients is keeping them out of acute hospital and helping to prevent bed-blocking.

The emergency multidisciplinary unit (EMU) established at Abingdon community hospital in Oxfordshire is hoped to become the national model for the future of emergency care for older people.

Patients can be referred to the EMU, which is seen as an alternative to an acute hospital A&E, by either their own GP, a community nurse or ambulance paramedic.

The unit, which is open seven days a week from 8am-8pm on weekdays and 10am-4pm on weekends, is not available for patients who have suffered a stroke or a heart attack, who would still be taken to the local acute hospital's A&E. The majority of the 5,500 patients it has seen arrive with chest or bladder infection or heart failure. The average patient age is 89.

Staffed by elderly care physicians, GPs, nurses, healthcare assistants, therapists and social workers, the unit can quickly assess a patient. It has point of care blood testing with rapid results and X-ray facilities so the unit can guarantee speedy diagnosis.

The EMU has five hospital beds available for patients who may need to be kept in for a maximum 72 hours. A "hospital at home" nursing team is also available to provide support to patients who are sent home to recover.

"I would say that the EMU is more than just a casualty for older frail patients – it's more intensive because we aim to provide care for the episode at the time or for a number of days," says Dr Daniel Lasserson, a GP and senior clinical researcher at the department of primary care health sciences, University of Oxford, who helped design this new model of care.

Lasserson adds: "Its aims to deliver an acute care pathway for frail older patients that does not rely on bed-based care, yet can still provide appropriate medical, nursing and therapist treatments within an individually tailored care plan as close to the patient's home as possible.

"It was designed to challenge the existing urgent care pathway of admission to an acute hospital with its associated harms of unfamiliar and physically challenging environment and loss of independence."

The EMU, he says, addresses the dilemmas of how to best care for a growing elderly population with complex needs and multiple chronic conditions and to provide an alternative to "office hours" general practice or acute hospital bed-based care.

According to the EMU audit, 65% of patients who are assessed by the unit are able to stay in their own home – only 17% of patients need acute hospital care.

Lasserson says this new way of working, known as "interface medicine", is challenging the traditional medical training and care. Oxford has created an Interface Medicines Fellowship and is in discussions with Health Education England about how it can be developed nationally.

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Sussex partnership NHS trust: winner, hospital admissions award

Dr Lisa Page says the way the trust uses mental health triage nurses is unique. Photograph: Sussex Partnership NHS Trust

A year ago people with mental health problems turning up at A&E in Brighton often had to wait four hours to be seen. Around 12% of patients would get fed up waiting and leave; those who were prepared to sit it out frequently ended up being inappropriately admitted to the hospital's observation ward, where they stayed until being assessed by the specialist mental health team.

But today, the number of patients with mental health problems being admitted to the observation ward at the Royal Sussex county hospital through A&E has dropped by 50%. More than 85% of patients are seen and assessed by the mental health team within four hours. Anybody turning up and A&E with a mental health problem is automatically referred to a specialist mental health triage nurse within an hour – something which Dr Lisa Page, consultant in liaison psychiatry at Sussex partnership NHS trust, says is unique. "I don't know of any other hospital which uses the triage nurse in the way that we do, although others do have proactive teams in A&E."

The improvement in waiting times and the introduction of the mental health triage nurse is part of the Brighton Urgent Response Service (Burs), which was introduced in January to tackle the 30% year-on-year rise in unscheduled mental health attendances at the East Sussex seaside town's A&E.

Page says the reduction in observation ward admissions is good news for patients and A&E staff but also for the clinical commissioning group (CCG) because of the high tariff associated with this kind of admission. "That is where the savings are coming from as we are no longer having that large number of patients admitted," she says.

Burs, set up by Sussex partnership NHS trust in collaboration with Brighton CCG and the acute trust, also includes a 24-hour urgent phone line for GPs, mental health patients and carers who are new to the system. GPs can book a patient a next-day appointment at the mental health clinic – rather than the previous minimum five-day referral. Patients and carers are offered telephone advice from a Burs practitioner and are referred as necessary. A dedicated mental health nurse is also available in the community between 8am and 8pm Monday to Friday and from 8am to 6pm at weekends. A new waiting room for people with mental health problems, which provides a calm and quiet environment has also been established at the Royal Sussex as part of the scheme.

Page says her mental health team is busier than ever and that it is too soon to say whether the number of people turning up at A&E has pulled back from its 30% year-on-year rise. But she feels Burs is ensuring that people are seen more appropriately and more quickly. She says: "Referrals to our team have gone up by a third because we are now seeing people who in the past would have come to A&E and left. We haven't curtailed the 30% but we have made some inroads – it would have been even busier without Burs."

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