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Primary Care Leadership
Collaborative 2016 –
Impact Day 3
Introduction
@NHS_HealthEdEng #EoEPCLC
• Sabira Mohammad –
GP Trainee/Divisional General Manager
How to Get Things That Work for
the Masses
• Penny Wilson
Senior Specialist, AMR, Vaccines & Global Health,
Innovate UK
@NHS_HealthEdEng #EoEPCLC
Delivering Innovation to the Masses Dr Penny Wilson Senior Specialist, AMR, Vaccines & Global Health 29 March, 2017
Innovate UK The UK’s Innovation Agency • A non-departmental public body spun out of the DTI in 2007, sponsored by
the Department of Business, Energy & Industrial Strategy
• Remit to grow the UK economy by stimulating innovation in science, technology and business
• Since 2007, the organisation has: • invested up to £1.8bn of public money in innovation, drawing on a similar
investment from industry and partners • Supported ~ 7600 companies • Returned up to £13.1bn to the UK economy and created up to 55,000 jobs,
translating to over 7 jobs per company we’ve worked with
New sector structure • Emerging & Enabling
Technologies • Health & Life Sciences • Infrastructure Systems • Manufacturing & Materials
Five point plan
• Working with the research community and across Government
• Accelerating UK economic growth
• Building on innovation excellence throughout the UK
• Developing Catapults within a national innovation network
• Evolving our funding models
Opportunities
Push Pull
Technology
Society
Technology – Push
Revolution
new business models
new ecosystems
Society – Push
Creative Industries
Redefining needs
and desires
Technology – Pull
Evolution
strategic roadmaps
industrial strategies
Society – Pull
Citizens Consumers
societal challenges
insight into consumers
Health and life sciences – Catapults & Centres
What are Catapults?
Technology and Innovation Centres - Intermediate stage - Infrastructure and expertise on a UK level
Basic research Development Commercialisation
Infectious diseases
Degenerative disease
Ageing Population
Obesity
Increasing healthcare costs
Patient –focussed therapies
Challenges:
Precision and Discovery Medicine
Advanced Therapies
Improving agricultural productivity
Enhancing food quality
Health and Life Sciences – Priority themes B
ioec
on
om
y
Precision Medicine
• Launched October 2010
• Aims to realise the potential of precision medicine in the UK
• Right patients treated • Improved outcomes
• Right time • Fewer complications
• Right therapy/care management • Better use of finite resources
• Better understanding of pathology
• Ability to measure multiple markers faster and cheaper
• Development of more selective therapies
• People’s expectations
• Advances in digital health
• Health economics
Driven and enabled by
Additional £31.2m
from industry
£ 61.8m
Public sector investment
140
Projects supported
Personalised medicine Hippocrates 460 - 377 BC
Clinical need
Fundamental Science
Sustainable products and
services
Medicines Discovery
Precision Medicine
Advanced Therapies
Food and Agriculture
Nutrition One Health Agenda Antimicrobial Resistance
Digital Health Enabling Technologies
Discovery Adoption
Reactive Medicine Disease Prevention & Wellbeing
Innovate UK’s Health & Life Sciences Sector
Deliver across the healthcare continuum
15
Relative
Disease
Severity
Relative
Treatment
Efficacy
Reactive medicine Predictive medicine
Predictive Medicine Earlier diagnosis + effective treatment = better long term outcome
Care
Primary Care
GP etc
Secondary Care
Hospital trusts etc
Independent systems
Independent systems
Independent systems
Interco
nn
ectin
g systems
Direct to Consumer Independent
systems
Large requirement for interoperability and linkage
Converging technologies • Biomarker discovery and validation
• Biosensors
• Novel chemistries
• The omics (proteomics, genomics)
• MEMS (including microfluidics)
• Engineering
• Sequencing technologies
• Nanotechnology
• Advanced materials
• Bioinformatics
• Information and communication technologies
• Data mining and fusion
• Big data
• High value manufacturing
• Social and behavioural science
• Economics
• Design
Converging technologies
What’s the relevance?
What’s the impact?
Results must lead to a decision
It’s not all about the technology!
2
0
Hour after hour….
“On my planned therapy day I need to be prepared to
spend the whole day at the hospital”
• waiting for my blood to be taken
• waiting for the blood to be analysed
• waiting for the results to be assessed
• waiting for the drugs to be mixed
• waiting to see the oncologist
and then the endless infusion time….
“I cannot express to you the psychological
pain I go through…….”
Patients Insights
Discussions with clinicians and payers is
imperative
Design is the key ,
gadgets
need to look what
they are…
Simple is not
always
the best solution
Am I hearing voices? If it doesn’t move I cant see it
What we’ve learnt through co creation
Integrated Innovation TM
Integrated
Innovation
Business
Innovation
Social Innovation
Science/Technology
Innovation
grandchallenges.ca
Levels of Infrastructure Defined Essential for understanding user need and product profile
Advanced/
Moderate
• Hospitals and
urban clinics
• Electricity, clean water, well-equipped laboratories, trained clinicians
Minimal
• Health clinics (Africa),
rural clinics (Asia,
Latin America)
• No reliable electricity
or clean water, no
laboratory, minimal
expertise
None
• Village or
community
• No electricity,
clean water,
physical
infrastructure, or
trained staff
Infrastructural Levels – considerations for technology development
1 2 3
Venipuncture Impossible Unlikely Routine
Sputum processing Impossible Difficult Acceptable (not
children)
Acceptable time to
result < 1 hour < I hour
Clinic < 1h
Hospital – not
critical
Physician
oversight None None Routine
UK Government Office for Science
The Ideal Diagnostic - ASSURED
• Affordable
• Sensitive
• Specific
• User-friendly
• Rapid and Robust
• Equipment -free
• Delivered to those who need it.
Developed by WHO
Annual per capita health care expenditure
0200400
600800
10001200
14001600
High income
countries
Low-income
countries
Africa
Viral Load monitoring
• Of ~35 million HIV infected individuals, 70% in sub-Saharan Africa
• 36% of infected patients on treatment
• Currently, most treatment failure identified at clinical or immunologic
failure
• 20-30% failure rates expected – Regular therapy monitoring needed
Why PCR in Africa?
Early Infant Diagnosis (EID)
• 1,5M HIV infected pregnant women, only 67% on treatment
• 1.9 million babies expected to acquire HIV by 2020
• < 40% of babies born to HIV infected mothers tested
• Without diagnosis and treatment 50% will die by age 2
Zika & Ebola only a flight away….....
Automated centralized nucleic acid testing system (Abbott, M-
2000)
Room 1: Nucleic acid extraction
Room 2: Detection by fluorescence
Two separate rooms required for sample preparation & amplification detection
Two enclosed systems allow for both processes to be done in the same room
SAMBA I system – 2013
SAMBAprep
SAMBAamp
Goal of SAMBA: nucleic acid testing at the point-of-
care
Sample prep Amplification Detection
3 hoods and 8 machines
SAMBA machine - Sample in - Result out
188 components in 4 cartridges
CE marked instrument & tests
listed for procurement by The Global Fund
Assay Module Tablet Printer
Current SAMBA placement in Africa
Country SAMBA I (No. sites)
SAMBAprep SAMBAamp
Uganda 3 (2) 8
Malawi 6 (6) 13
Kenya 1 (1) 3
Zimbabwe 1 (1) 3
Nigeria 2 (2) 4
Total 13 (12) 31
Country SAMBA II (No. sites)
Cameroon 3 (2)
CAR 2 (3)
Uganda 11 (4)
Kenya 8 (3)
Malawi 6 (2)
Zimbabwe 4 (1)
Total 29 (15)
73 SAMBA machines, 27 sites, 7 countries
Examples of rural testing sites
Malawi
Kenya
Samba testing in rural clinics (MSF data)
• 55,925 viral Load tests performed at MSF rural clinics in
Malawi & Uganda
Country # Samples Invalid rate Repeat invalid
rate
Uganda 20,847 0.55% 0.11%
Malawi 35,078 0.27% 0.031%
55,925 0.37% 0.06%
85% patients received results on the same day
Industry standard invalid rate 3-5%
In-country evaluation for regulatory approval
SAMBA I HIV Viral Load vs Roche/Abbott as gold standard
Country Site No. samples Concordance
Malawi (2011)
MSF 200 98.0%
Uganda (2011)
MSF 154 94.8%
Kenya (2014)
CDC - KEMRI 197 95.9%
Zimbabwe
(2014)
National Reference
Laboratory
193 96.4%
Instrument performance (MSF data)
• Overall performance
Mean time between failure (days) 169
Mean time to repair (days) 1.14
% uptime of machines 99.3
Average calls per year 1.50
Mean time between failure Days
2013 50
2014 142
2015 207
2016 329
• Improvement over time
Comparison of SAMBA vs other POCs
Features SAMBA II Alere Q Cepheid
Quantitation Semi-quantitative Quantitative Quantitative
Reagent
shelf life
2-37oC
4-30oC 2-28oC
Machine
operating range 10-38oC 4-30°C 15-30oC
Error rate 0.4 % 5-10**% 2 - 8.6%^
Toxic waste
(cyanide) No No Yes
In-country
approval
Kenya, Malawi,
Uganda, Zimbabwe No No
*WHO list of prequalified in vitro diagnostic products -
July2016 ** Hsaio et al, 2016
^Ceffa et al, 2016
Looking to the future…”Beyond zero” mobile
clinics
Mobile truck
Key dates
H&LS Competition Round 2 2016
Time line Dates
Competition Opens 6th February 2017
Briefing Event 9th February 2017
Registration Closes Noon 5th April 2017
Submission Deadline Noon 12th April 2017
Decision to applicants By end of June 2017
The Longitude prize www.longitudeprize.org
Innovate UK has contributed £5million to the prize fund
How to Survive and Keep Going
When it Goes Wrong
• Jean-Pierre Allain
Emeritus Professor of Transfusion Medicine,
University of Cambridge
@NHS_HealthEdEng #EoEPCLC
How to survive and keep going when it goes wrong
Jean-Pierre Allain Emeritus professor of Transfusion Medicine
University of Cambridge
Genesis of home/self-treatment for haemophiliacs
Lazerson J. Hemophilia home transfusion program: effect on school attendance. J Pediatr 1972;81:330-2.
Lazerson J. Hemophilia home transfusion program: effect of cryoprecipitate utilization. J Pediatr 1973;82:857-9.
Lazerson J. Hemophilia home transfusion program: analysis of cost data. J Pediatr 1973;83:623-5.
Levine PH. Efficacy of self-therapy in hemophilia. A study of 72 patients with hemophilia A and B. N Engl J Med 1974; 291: 1381-4.
Development of self-treatment in France
Allain JP, Estrabaut M, Tran J, Gutton P. Treatment of hemophilia by self-infusion: clinical and psychological approach. Nouv Rev Fr Hematol 1975;15:147-58.
Allain JP. Management of hemophilia in France. Thromb Haemost 1976;35:553-8.
Two important factors concerning the management of hemophilia in France are considered. The supply of factors VIII and IX for replacement therapy meets the current demand but as the demand increases with the development of self-infusion programs, the production will also have to increase. This can only be done through more effective use of all of the blood components and will require careful evaluation of the needs of each patient. Programs which teach self-infusion and the other aspects of home care are gradually developing in France but must be expanded to improve the general care of all French hemophiliacs.
Allain JP. Home treatment of hemophiliacs in France. Scand J Haematol Suppl. 1977;31:5-8.
Allain JP, Blombäck M, Brackmann HH, De Vreker RA, Jeanty L, Jones P, Josephson AM, Levine P, Panicucci F, Schmitz TH, Taub R, Verstraete M. Recommendations on home treatment of hemophilias. Scand J Haematol Suppl. 1977;31:75-7.
Home/self treatment in UK
HOME TREATMENT FOR PATIENTS WITH HÆMOPHILIA Le Quesne B, Maragaki C, Britten MI, Dormandy KM The Lancet 1974; 304: 507-9 Abstract In a programme for the home treatment of hæmophiliacs, 31 patients or close relatives of theirs have learnt to prepare and administer plasma fractions intravenously. 25 of these patients (19 with factor-VIII deficiency, 6 with factor-IX deficiency) are on regular home treatment, while the remaining 6 reserve self-treatment for when they go away. The main benefits have been a general improvement in the lives of these patients, and easing of the work-load for "on-call" hæmophilia-centre staff and for the patients' transport service. There has been no increase in the consumption of therapeutic materials nor any complication which could not be rectified. A close liaison must be maintained between these patients and the staff of the centre.
Comparative data on numbers of centres and numbers of patients in 1975 and 1976
Criteria for home treatment eligibility
May 1978
Mai 1978
Freeing haemophiliacs
with home/ self-treatment
How something good can generate something bad
1974-80 Home treatment by patients or parents liberated haemophiliacs from dependence on physicians and opened access to ‘normal’ life in school and at work
1978-80s This liberation caused increase of factor VIII and IX consumption and created demand for easy to use concentrates instead of cryoprecipitate
1980-85 Domestic production of clotting factors being insufficient, importation of US products became necessary to meet demand
1980-85 Imported concentrates and subsequently French products were contaminated with HIV
1983 Haemophilia patients and doctors refused to ‘retrograde’ to ‘safer’ French cryoprecipitate leading to catastrophic HIV infections
Year Science Doctors Patients Producers <1981 Develop self TT Treated in Cryo frozen Home Care Hospital lyophilised 1981 AIDS identified Increase demand Concentrate - Imported - Domestic 1983 AIDS in French Prophylaxis Increase demand haemophiliac Discover HIV-1 Return to cryo? No change Imported Heat TT conc to life style heat-treated
1984 Heat TT fails Reject
non-A,non-B tech transfer French infectious 20-50% anti-HIV+ Clinical significance? Involved decisions
1985 02 HT prevents HIV Identify HIV+/- 04 Tech transfer
03 Anti-HIV screen 10 screen donor 100% heat TT
Summarised history of the HIV crisis in France
Blood Trends: Risk and Cost
1950 2000 1970 1960 1980 1990
Risk Cost
High
Low
Relative risk of post-transfusion viral
infection pre-NAT (from K. Calman 1996)
1 102 104 106 107
High
Moderate
Low
Very low
Minimal
Negligible
Ris
k c
ate
gory
1:X risk (log scale)
smoking 10/d
Influenza
Road accident
Playing soccer
Railway accident
Hit by a lightning
HCV
HIV
Death in 1 year from
Pre-NAT
Post-NAT
Estimated Residual Risk after implementation of NAT J Coste, May, 2002
HIV
HCV
HBV
1:1 370 000
1:860 000
1:470 000
1:2 740 000
1:8 150 000
ND*
Residual Risk after NAT
implementation 1/nb of donations
2.5 M donations/year
Residual Risk before NAT implementation
1/nb of donations
* Only individual sample testing would significantly decrease risk
HIV
Blood
Crisis
HIV
Blood
Crisis
Litigation
Transfusion Service
Medicine & Public Health
Society Government
Consequences of the HIV crisis. 1
• Compromised patient - doctor relationship
• Increased frequency of medical litigations
• Affected image of medical profession
• Negative image of volunteer blood transfusion service
• Decreased donor recruitment
• Disincentive for transfusion & haemophilia specialists
Consequences of HIV crisis. 2
• Attention to dysfunction between medicine & public health
• Reorganisation of Transfusion Services
• Improved Safety of Blood products & Bioproducts
• Initiated haemovigilance programmes
• Changed balance of criteria in decision making
• Induced or tightened control of Blood Transfusion
• Focused media & public attention on safety issues
How did I get mixed up in all this?
After quitting the haemophilia centre in 1977
Came to national blood transfusion centre as head of R&D for
plasma derivatives; continuing taking care of 30 haemophiliacs
Supervised control of clotting factor content of production
Supervised in vivo checks of FVIII activity of imported products
Conducted 1st study of CD4+ cell count in patients
Designed and chaired a collaborative study group on acquired
immunodeficiency in French haemophiliacs
How did I get mixed up in all this?
In 1984 attempted to connect CNTS with company to transfer heat treatment technology for FVIII and FIX products
In 1985 succeeded in such transfer after 18m battle with management
In 12-84 col study showed anti-HIV in recipients of imported more than French FVIII (pooled) not with cryo
Efficacy of heat-treatment for HIV evidenced in March 1985
Start of CNTS products heat-treatment May 1985
Full capacity in 10-85 (interim period heated & non-heated)
October 1985 start anti-HIV screening of blood donors
How did I get mixed up in all this?
March 1986 fired from CNTS for disagreement with management over heat-treatment and patient information
04-1986 moved to USA Abbott labs as medical director of Hepatitis and HIV diagnostic products
Dec 1990 provided documents that helped make compensation case for haemophiliacs
Feb 1991 called as witness by French legal system
April 1991 took professorship of Transfusion Medicine
April 1992 indicted for negligence leading to HIV infection
07 1994 convicted in appeal: 4 years in jail, 2 years suspended
Being in jail
Private cell
Separated from prison crowd (for protection!)
Interaction only with other ‘isolated’: police officers, legal professions, white collars
Took courses in clinical psychology leading to MSc
Taught English to inmates
Took on painting (mostly portraits of inmates)
Writing diary and reviewing manuscripts for scientific journals
Learned how to avoid frustration
Consequences of conviction
Full and sustained support from University of Cambridge
Dismissed by NHS with ban from blood centre facilities
Affected ‘friends’, colleagues, grants, fellowships, interaction
with public both sides
Stigmata that bleed from time to time
June 2003 French supreme court dismissed all charges
2005 reintegrated into NHS as head Molecular Virology lab
In 1995 I returned to Cambridge and made decisions
1. After publishing 45 articles (4 NEJM, 3 Lancet, 1
Science, 6 Blood) stop doing research on HIV
2. Stop having any clinical activity
3. Resume research on other aspects of blood safety
4. After disappointments in obtaining funding for HCV
5. Decided to address neglected blood borne viruses
in sub-Saharan Africa:
- Hepatitis B virus
- Parvovirus B19
- Herpesviruses
- Finally malaria
Started collaboration in 1995 Sabbatical year in 1999-2000
Virology Laboratory
1999 2005
Testing at a Mobile Blood Drive
Evolution of the blood supply in Kumasi, Ghana
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
0
1
2
3
4
5
6
7
8
9
10
Year
Total
VNRD
F/R D
Algorithm of viral screening in Kumasi
Pre-donation screen with rapid tests
Negative Positive
Blood quarantined Defer donor and enter donor care
Pools of 10 units
Triplex NAT Visit blood centre
Negative Positive
Release units Resolve pool
Negative Positive Counseling and referral
Redo Rapid test
EIA if negative
AIMS flow diagram Lancet 2016; 387: 1753
Evaluable 164
Exposed 65
Patients assessed for eligibility = 2887 Not blood group O = 1746
High risk death in <28days = 205 Requiring >2 WB units = 422 Previously transfused = 200 <18y or pregnant = 76 Declined consent = 9 Out of staff hours = 153 Other = 76
Eligible consented = 227
Withdrew consent = 1
Enrolled-randomised = 226
Not transfused = 4
Treated = 110 Allocation Untreated (control) = 112 2 anti-malarial 1 mixed treated/untreated 1 mixed 1 withdrew consent
2 died Lost to follow-up 1 died N = 105 Analysed N = 109
Parasitaemic Non-parasitaemic Non-parasitaemic Parasitaemic 23 82 82 27 Parasitaemic WB 28 37 transfused
Parasite load distribution in Mirasol treated and untreated WB
Para
site
load
tra
nsf
use
d X
10
E6 c
op
ies
Median 25x106 copies
N= 28 N=37
TTM irrespective of allelic matching TTM with allelic matching
TTM defined as D3-D28 post-transfusion parasitemia in non-parasitemic patients transfused with parasitemic WB
Summary of 20 years of activity in Kumasi, Ghana
- Sabbatical year 1999/2000 as head KATH blood service
- Develop pre-donation donor screening 2005
- Increase volunteer (70%) and family donors to reach >10u/1000
- Develop donor care for deferred HIV/HBV/HCV infection 2009
- Transfer and implement
Triplex NAT (HIV-1/HBV/HCV) in pools of 10 2005
Molecular detection/quantification of Plasmodium 2014
- Conduct RCT of pathogen reduction system for malaria 2016
- Published 41 articles in peer reviewed international journals
- KATH model for blood transfusion in sub-Saharan Africa
N articles published/y 1967-2016
N citations of articles/y 1969-2017
Lessons to learn from my experience
Determine what you want to do
Do it the best you can with complete dedication
Keep out of media, legal system and politics
Do what you think is right irrespective of ‘political correctness’
Do what other people don’t do is key to innovation
My grandmother’s wisdom: to live happy, live hidden
Truth is hard as a diamond and fragile as a peach bloom (Ghandi)
@NHS_HealthEdEng #EoEPCLC
10:20 – 10:30
Refreshment Break & Networking
Location of discussion groups
• Box 1 – Jen Ashton & Rachel Morris Blue
• Box 2 – John Howard Green
• Box 5 – Mark Attah Orange
• Box 6 - Sabira Mohammed Yellow
• Box 7 – Nick Barker Red
@NHS_HealthEdEng #EoEPCLC
Disruptive Innovation and How to
Implement Ideas
• Mark Otto Smith
Healthcare Business Consultant,
Eastern Academic Health Science Network
@NHS_HealthEdEng #EoEPCLC
Primary Care
Leadership
29 March 2017
Disruptive Innovation
How to develop and implement ideas
Mark Otto Smith
Economic Growth & Innovation Programmes
Accelerating Innovation
Today
1. Introduce you to Eastern AHSN & the AHSN network
2. Give examples of innovations that have / are being
adopted in the NHS
3. Give examples of innovations that are being
developed with industry & NHS
4. Show you how to replicate/ get involved
Accelerating Innovation
Eastern AHSN: Our purpose
Galvanizing people to advance health and wealth.
We work with industry and business to
accelerate access for the NHS to the best
innovations.
We connect health and social care providers with
researchers and industry in our region to accelerate the
spread of service and technology innovations – all with clear
focus on improving people’s health outcomes.
We champion evidence-based, collaborative solutions and
support networks to enable widespread adoption
NHS
Business
Academia
Academic Health Science
Networks
We are part of a national network of AHSNs..
15 Academic Health Science Networks across
England
• Licensed and funded by NHS England
• Promoting innovation in healthcare
• Disseminating innovation – from the UK
and beyond
• Improving care across whole systems
• Providing access to the NHS for industry
• Creating wealth and health
Accelerating Innovation
Primary Care Leadership 29 March 2017
Adopting Disruptive Innovations:
Working with the STPs in our region
• Eastern AHSN has developed an STP
support offer available to all STP
participants in the Eastern region
• Currently there are 3 completed and
14 active STP projects in the region,
with an additional 3 being scoped for
17/18
• Projects range from supporting the
development of transformation bids,
simulating likely impacts, process
redesign support and supporting the
adoption of innovation products across
geographies
Primary care at scale support
Simulation modelling
Innovation Exchanges
Provider productivity
Bid review support
Digital self-care roll out
Cambridgeshire and Peterborough
Suffolk and North East Essex
Norfolk and Waveney
Increased patient activation to manage own condition
Improved medication adherence
Reduction in acute admissions/readmissions
Effective management of Long Term Conditions
Disruptive Technology
An estimated 80,000 people will have an opportunity to access
digitally supported self care
• Eastern AHSN is working in partnership with the Suffolk Local Digital Roadmap team to implement a
digital self care support for up to 40,000 people across three primary care practices.
• The technique has already been successfully used in secondary care and show benefits such as
improved medication adherence and good patient experience. The roll out has started and evaluation is
built in to check that the benefits reported in secondary care are transferable to the primary / community
setting.
• The project contains a plan for adoption and spread built in so that should evaluation show positive
results, others could benefit from this support quickly.
• Eastern AHSN provide bespoke innovation exchanges for STP areas. These events bring
together senior NHS and other public sector workers and successful innovators from
industry and VCS. Areas are matched with possible innovators and conversations follow to
see if the solution is relevant to the specific challenges brought to the event.
• Each potential partnership is supported through further conversations and Eastern AHSN
provides implementation support such as supporting process redesign, patient
communication, user training etc. to help a successful start to the most promising fledgling
partnerships.
• Our current ratio of impact is 15 conversations: 3 partnerships
Enthusiasm and awareness of potential solutions
Partnerships developed between Health Tech and NHS & LA
Cambridgeshire and Peterborough
Suffolk and North East Essex
+
Bespoke events for requesting STP
Reach can vary dependent upon the theme of the innovation exchange chosen
Testing & Selecting
Disrupting Commercial models
• Eastern AHSN supported the Greater Peterborough Network to self-assess their readiness
to adopt a multi-specialty community provider model.
• Each practice was invited to attend a conversation to share their views on readiness for
change against the 10 component parts of the MCP framework, published by NHS England.
• The findings were fed back to the federation executive and to the members to inform their
next steps.
Capacity in primary care through back office consolidation
Evaluation of alternative consultation methods to increase efficiency
Improved citizen engagement with online services
Cambridgeshire and Peterborough
Suffolk and North East Essex
Norfolk and Waveney Hertfordshire and West
Essex
Our primary care business accelerator supports federations and single
practices to leverage business and clinical economies of scale
X 10,000
Testing & modelling
• Eastern AHSN supported three areas with user training and software licenses to run
simulation modelling on their plans for strategic change.
• The plans ranged from testing urgent and emergency care scenarios to testing the potential
impact of social prescribing on activity and workforce levels.
• By understanding the potential impact of plans prior to implementation, significant risks can
be identified and mitigating plans developed.
Capacity in primary care through back office consolidation
Evaluation of alternative consultation methods to increase efficiency
Improved citizen engagement with online services
Cambridgeshire and Peterborough
Norfolk and Waveney
Our simulation modelling support provides the training and software to
organisations and systems that de-risk strategic transformation plans
Primary Care Leadership 29 March 2017
Developing Disruptive Innovations:
Working with the SBRI Healthcare
www.sbrihealthcare.co.uk
Competition process
Problem Identification
Open call to Industry
Feasibility Testing
Prototype development
Typically undertaken by
clinicians – service driven
Workshops with industry to
support understanding
Typically 6 months – max
of £100k
Typically 18 months –
milestones agreed & monitored
Due diligence & contracts
SBRI Healthcare
3 monthly reviews access to support
Due diligence & contracting. Fix and agree milestones.
Interview Panel: 360 assessment – investor style consideration of tech, business and clinical considerations
Clinical assessment: match to identified need. Provenance of science/technology approach. Team
– engagement of clinical/ user voice
Tech assessment: competitive environment/ IP / technology development / assessment of project plan & deliverables
Workshop & briefings: specialist help from problem holders – guidance to companies on NHS market access & reality of workplace environment
Needs identification: policy context/service assessments / detailed workplace considerations
AHSN support • Access to key clinicians • Access to patient groups • Trial/pilot sites • Roll out from one to
many
SBRI team support • Health Economic analysis &
market access understanding • Support through ethics approval
& establishing clinical trials • Connection to UKTI, HMRA &
others
Approx 300/comp
Approx 130 apply
Approx 60
Approx 15 (12%)
Managing Risk
www.sbrihealthcare.co.uk
Case study:
Diabetes is the most common cause of preventable adult blindness in the developed world. Treating it costs the NHS about £1bn a year. Currently treatment costs of as much as £10,000 per patient for each eye.
The PolyPhotonix bio-photonic research and development company has developed a light therapy sleep mask costs £250 for 12 weeks’ treatment
Trials have shown that eye disease can be reversed with significant results after as little as six months. Approximately 30 clinics around the country are trialling the product including Moorfields eye hospital. It is anticipated that Noctura 400 will receive NICE approval by the end of 2017.
• £1,458,158 awarded
Estimated savings at £1 billion per annum
60 employees directly created as a result of SBRI funding. Approximately £2 million of additional investment has also been secured by the company.
www.sbrihealthcare.co.uk
Case study:
An estimated 5.3 million people suffer from chronic pain in England which has a major
impact on sufferers’ lives, with 24% reporting a diagnosis of depression and 26%
reporting an impact on employment.
Self-help digital products to support people with chronic pain. The technology will enable
both patient and practitioner to have a balanced step-wise process to self-assess, self-
manage, and self-monitor changes in pain.
Pathways through Chronic Pain is being developed as a cost-effective Cognitive
Behavioural Therapy (CBT)-based pain management programme without the need for
direct involvement by a therapist or clinician.
This service is now being prescribed by 150+
GP practices in the Leeds area
£885,970.00 awarded Estimated savings to NHS at £20 million per annum
– 4 jobs created currently
Primary Care Leadership 29 March 2017
Disruptive clinical innovators:
working with clinical entrepreneurs
Non-injectable arterial connector (NIC)
• Accidental injection into an arterial line dangerous for
patients
• NIC invented by doctors at Queen Elizabeth Hospital,
King’s Lynn
• Development and testing supported by EAHSN patient
safety clinical study group
• Potentially ends a “never event”
• Advice given for IP, investment and production by
British company
Accelerating Innovation
Case study: patient safety
“The Eastern AHSN has been both helpful and essential in enabling the difficult process of implementation – they are the missing piece in the jigsaw that allows us to get great safety innovations from the grassroots to the bedside.” Dr Peter Young
• PSCs introduced nationally following the Berwick report
• Run by the 15 AHSNs
• Eastern AHSN PSC launched in October 2014
• In discussion with our region we have set two priorities:
• Across the AHSN system - to develop a Quality
Improvement Infrastructure which will support continued
service improvement and innovation
• At the point of care - to listen and
to address the concerns of older
people, their carers and the staff
caring for them
Accelerating Innovation
Patient Safety Collaborative
Dr Mike Durkin, NHS England’s national director of patient
safety at our PSC launch
Our working definition is:
• people aged over 85 diagnosed as frail or at risk.
The emerging pathway components are:
• rapid support close to home at times of crisis
• good acute hospital care when needed
• high quality long term nursing and residential care for those who need it.
The priority processes are:
• identification and response to deterioration
• safe medication
• safe transfers in care.
Accelerating Innovation
Patient Safety Collaborative:
older people and frailty
• We commissioned a review by the Nuffield Trust of our clinical study
groups and projects.
• We discussed the findings at a workshop with our clinical leaders.
• Key learning for the future:
• Change is about people - engage
• Data-sharing and IT issues need to be overcome
• Engaging primary care is crucial and challenging
• Engage CCGs – give benefits
• Senior clinicians are vital for “easing the path” with others
• Widespread diffusion of good practice requires joint effort.
Accelerating Innovation
Learning for the future
Accelerating Innovation
• Take time to understand problems • Assess and evaluate before you select
innovations/ approach • User led – whether clinical users or patient
users • Test and model solutions for safety and
efficiency understanding • Energy & enthusiasm – work with the willing
Ingredients for Success
Accelerating Innovation
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Perspectives on Leadership
• Laura Fisher & Saba Syed
ST4 Commissioning Fellows
@NHS_HealthEdEng #EoEPCLC
ST4 interpretation of leadership Dr Laura Brennan
Definition
• Process by which an individual influences a group of individuals to achieve a common goal
• Leaders have the are those who manage to elevate vision beyond self-interest to that of the group and can make the difference between success and failure
• Appointment as a positional leader does not guarantee ability
Leadership Power
Positional power • Legitimate power - having status
or authority socially sanctioned through their appointed post. For example, the medical director of a hospital, the dean of a college
• Reward power – having the capacity to administer rewards to others, effectively bribery. For example, preferential opportunities to certain staff
• Coercive power – having the capacity to penalise a group member. For example, an uneven distribution of the workload or the withholding of a reference
Personal power • Referential power – being liked and identified
with by the group members. This is often closely linked with charisma. Hero worship is an example, as is role modelling. Some forms of preceptorship and mentoring actively use this power base
• Expert or sapiential power – being perceived as competent and knowledgeable by group members. The expertise and technical skill refers to the issue in hand. For example, a specialist clinical expertise may not be perceived as relevant in a non clinical situation where someone else’s skills may be more useful to the group. This is frequently an initial area of tension when people from different fields and professions gather to achieve a common goal; each is accustomed to being attributed power by virtue of their knowledge base in a different setting
Leadership styles
• Autocratic: The autocratic or commanding style creates a dependency on the leader who often makes decisions without reference to anyone else.
• Democratic/Participative leader listens to different perspectives and uses them to inform the decision making process.
• Visionary/Coaching style of leadership focuses on a connection between group members and the organisation's goals, creating shared aspirations. It builds long-term capacity and each raises performance.
• Paternalistic leaders appear as a ‘parent figure’. Although they may consult, ultimately they make the decisions.
• Laissez faire is sometimes described as ‘non-leadership’ where the nominated leader takes a hands off approach with no intervention.
Effective and ineffective leadership
Effective Leadership
• Ensures team work is motivated, inspired and energised to achieve certain goals.
• Social (emotional) intelligence
• Cultural intelligence; understands sensitively groups needs, appropriately assertive with the group
Ineffective Leadership • Command and control, with
toughness, disengages team members.
• Self sufficiency isolates other team members and disempowers
• The process of coercion that tyrants use is different, but it can be argued that they nevertheless exercise leadership, albeit as toxic leaders
Training groups - GPST
• Have a common purposes and goals
• The group has defined entry or membership criteria
• It has a hierarchy
• But most of all, a group is a group because its members recognise it to be a group
• Weekly meetings, lead by a leader
Within a Practice : Leader and team
Roles
• Role of Practice Manager • Role of Lead nurse • Role of Senior Partner • Role of other Partners • Role of Salaried
employees • Role of Reception
manager • Has the trainee got an
identified role?
Application of Belbin
