SHARED DECISION MAKING - NHS Networks...1 | Introduction Shared decision making, self care and self management are all ways in which the individual can gain greater choice and control

How to introduce a shared decision making approach

SHARED DECISION MAKING

getting started... a guide for primary care and community

teams

Yorkshire and the Humber


SHARED DECISION MAKING | How to introduce a shared decision making approach 2

Contents

1 Introduction 3

2 Whatisshareddecisionmaking? 4

3 DevelopingshareddecisionmakingwithintheNHS 8

4 Theindividual’sperspective 10

5 Theteam’sperspective 12

6 Thepractitoner’sperspective 14

Annexe

One Corewebsitehomepagesforshareddecisionmaking 17

Two Backgroundpolicycontext 18

Three Personalisationresourcesandlinks–personalisedcare 20 planning,selfmanagementandcare,LocalAuthority approachtopersonalisation

Four Contributors 23

1 | Introduction

Shareddecisionmaking,selfcareandselfmanagementareallwaysinwhichtheindividualcangaingreaterchoiceandcontrolovertheircondition.

Example

Thisapproachcanbeusedbypracticeandcommunitynursingteamsworkingwithterminallyillindividualstoprovidesupportandinputbasedaroundtheindividualandtheirfamily’spreferences.Theindividualandtheircarerscanbeinvolvedfullyinconsideringoptions,includingthelevelofintervention(i.e.careinhospitalversusalowerlevelofinterventionathome),andthe‘endoflife’

decisionstoenablethepersontohavetheendoflifetheywish.

Thisapproachalsoneedstobeconsideredasnewpathwaysaredeveloped,tointroducepromptstoencourageshareddecisionmakingatkeypointsforboththepractitionerandtheindividual.

Example

Apersonwithkneeosteoarthritiscanbesupportedthroughtheuseofadecisionaidtobecomefullyawareofthealternativestosurgerybeforebeingreferredtoseean

orthopaedicconsultant.Havingworkedthroughthedecisionaid,theycanaskthemselves:dotheywantsurgery?Aretheyfitenoughforsurgeryiftheydowantit?Theycanbemoreawareoftheworktheywillneedtodopostsurgerytogainthemostbenefit.TheycantalkthroughthesewiththeirGP/physiotherapisttoenablethemtoreachtheirfinaldecision.

Theresourceexplainswhatshareddecisionmakingis–andhowitlinksintootherperson-centredapproachessuchaspersonalisedcareplanning,selfcareandselfmanagement.Itoutlineshowtointroduceasharedecisionmakingapproach,withreferencesandweblinksforshareddecisionmaking,personalisedcareplanningandselfmanagement.Therearealsolinksmadetothepersonalisationapproachwithinsocialcareandlocalauthorities.

Eachsectiongivesanoverviewofaparticularaspectofshareddecisionmaking,togetherwithcorereferenceswhicharelinkedtothattheme.FurtherresourcesandlinksaregivenintheAnnexe.

Thisresourceisoneofthreedevelopedforintroducingshareddecisionmaking;

Shared Decision Making; Getting Started...A guide for primary care and community teams,isadetailedreferenceforclinicalcommissioninggroupsandfortrainingpurposes.

Shared Decision Making; Getting Started ...A short guide for practitioners,isareminderofthepurpose,principlesandpracticefromtheaboveresource.

Shared Decision Making; A resource for commissioners,isahighlevelguidetotakecommissionersthroughthekeyareasthattheyneedtoconsider,whensupportingashareddecisionmakingapproachlocally.

TheseresourceshavebeenproducedforYorkshireandHumber–partofNHSNorthofEngland–toraiseawarenessofshareddecisionmakinganditsimportanceinembeddinginhealthcarecultures.

Shared decision making used in a consistent and effective way can ensure greater ownership and engagement from patients, reduced levels of major surgery and emergency admissions and improved satisfaction and experience for individuals and potential financial savings.


SHARED DECISION MAKINGA patient/carer and clinician

equally engaged in the decision making process to choose a

treatment, screening option or self management programme, which is consistent with the

individual’s values and preferences.

HEALTH COACHING

Unlocks the individual's potential to maximise their own health, through raising their awareness and sense

of responsibility to self care.

PERSONAL HEALTH BUDGET

An amount of money which is spent on meeting the health care and wellbeing needs of individuals, generally those

with a long term illness or disability.

PERSONAL HEALTH PLAN

A tool for individuals with long term conditions to help them adapt to life with the

condition(s) and take control of their care. May also be called

a personal/personalised care plan.

CASE MANAGEMENT

A tool in integrating services around the needs of individuals

with long term conditions. A targeted, community-based, pro-active approach involving

case-finding, assessment, care planning and

co-ordination.

PERSONAL SUPPORT PLAN

A tool used by local authorities and co produced

with anyone receiving a personal budget for

their social carerequirements.

PERSONALISATION APPROACH


2 | What is shared decision making?

Shareddecisionmakingformspartofthewiderpersonalisedapproachtoprovidinghealthandsocialcareandsupport.Theprincipleisbasedontherecognitionthattheindividualandprofessionalbothhaveanimportantparttoplay,andbothbringequalanddifferingknowledgetoanydecisionmakingprocess.Shareddecisionmakinginvolvesthepractitionersupportingandinformingtheindividual,sothattogethertheycanmakeaninformedchoiceaboutwhichwayforwardisgoingtobebestforthatperson–basedontheindividual’svalues,experiencesandpreferences.

Shareddecisionmakingasanapproachcanbeusedinawidevarietyofsettingsandformanydecisionmakingprocesses.Theindividualconcernedwillneedtohavesufficientcognitiveandcommunicationabilitiesandawishtoworkonthisbasis–andtheindividual’sconditionneedstobeappropriate.

Inrecognitionoftheequalpartnership,co-productionapproach,thetermpatientwillrarelybeusedwithinthisresource,unlessquotingfromareference.

How does shared decision making link into personalised care planning and self care and management?

Definitionsvary:someoftheabovearetakenfromNHSMidlandsandEast‘DeliveringSustainableCare’(https://www.eoe.nhs.uk/page.php?area_id=16) andKing’sFundCaseManagement;whatitisandhowitcanbestbeimplemented.(http://www.kingsfund.org.uk/publications/case management).

Definitions within a personalisation

approach

Treatment - Support Options

Outcomes

Assessment - Diagnosis

My attitude towards taking risks, making changes to my life and my preferences

What difference has this made to me?

Telling my story

Prognosis How I live my life and what's important to me. What impact will this have on my life in future?

SHARED DECISION

STAGE TWO

STAGE ONE

PRACTITIONER’S PERSPECTIVE

INDIVIDUAL OR CARER’S PERSPECTIVE

STAGE THREE

STAGE FOUR

STAGE FIVE


What are the principles of shared decision making?

Activeengagementofindividualsand/ortheircarersinmakinginformeddecisionsabouttheirhealthcare,whichcanbeusedinmanyclinicalconsultations

Aholisticapproachwhichisbuiltaroundtheprioritiesoftheindividual,theirlifestyleandpreferences

Informingtheindividualabouttheircondition,aboutthetreatmentand/orsupportoptionsavailableandthebenefitsandrisksofthese

Basinganydecisiononamutualunderstandingoftheavailableinformation/evidence

Askingtherightquestionsattherighttimetosupporttheindividualtoarticulatetheirunderstandingoftheirhealthissueandwhattheyhopetreatmentorselfmanagementsupportwillachieve

Understandingwhatdecisionsupporttoolsareavailableandhowtousethem,whilstrecognisingthatthetoolsarejustonepartoftheshareddecisionmakingprocess

Understandingthesystemwideapproache.g.fromchooseandbookthroughtoinformedconsentforproceduresandthelinkstopersonalisationwithinsocialcaresystems

Recordingandimplementingtheagreeddecisionwhoisresponsibleforwhatandrecordinganagreementonthesharingofrisks

Recognitionthatindividualsandpractitionersbringequalanddifferentlevelsofexpertisetothedecisionmakingprocess:

‘No decision about me without

me’...

(adaptedfromRightCareabouttheShareddecisionmakingprogramme‘Whatarewesharing?’http://www.rightcare.nhs.uk/index.php/shared-decision-making.)

Shared decision making process

Core Reading Suggestions


What are the potential benefits of shared decision making?

Reduceduseofhigh-costservicesandunplannedadmissionsandcomplications

Fewerindividualschoosingmajorsurgeryorelectivesurgeryingeneral

Helpsindividualschoosethetreatmentorsupportwhichismostcloselyalignedtotheirpersonalvalues,principlesandpreferences

Potentialtoincreaseanindividual’scommitmenttothechosenapproachandinthecaseofmedicationorselfcareincreasedadherenceandunderstanding

Improvedconfidenceandcopingskills

Clearerexpectationsofrolesandresponsibilitiesandimprovedrelationshipwiththeindividual

Improvedclinicaloutcomes

Improvedclinicalsafety

Increasedattendanceatappointments

Reducedduplicationoftests

Evidencethatdecisionaidscanimproveindividualexperienceandthattheshareddecisionmakingapproachgenerally,canimproveanindividual’ssatisfactionandexperience

Mayprovideagoodsourceofinformationforcommissionersontheneedsandpreferencesofindividuals,toinformfutureservicemodeldevelopment.Thereispotentialtocontributetomanagingdemandandreducinginappropriatelocalvariationifusedeffectivelyandconsistently.

Making shared decision-making a reality: No decision about me, without me (KingsFund,July2011)

http://www.kingsfund.org.uk/publications/nhs_decisionmaking.html

Awide-rangingcorepapercoveringthepolicycontextforshareddecisionmaking,thepotentialclinicalandnon-clinicalbenefits,ethicalandprofessionalissuesinvolvedindevelopingshareddecisionmaking,andpotentialbarrierstoadoptionintherealworld.Theauthors’highlightthatthereisasoundethicalbasisforshareddecisionmaking:‘Themostimportantreasonforpractisingshareddecision-makingisthatitistherightthingtodo’.

Shared Decision Making: essential reading (QIPPRightCare,Dec20110)

http://www.rightcare.nhs.uk/wp-content/uploads/2011/09/sdm_reading_list1.pdf

Adigestofsystematicreviewpapersrelatingtoshareddecisionmaking,plustheKingsFundreportandotherresourcesincludedinthisguide.

Analysis: Implementing shared decision making in the NHS (BMJ2010;341:c5146)

http://www.bmj.com/content/341/bmj.c5146

Atleastthreeconditionsmustbeinplaceforshareddecisionmakingtobecomepartofmainstreamclinicalpractice:

readyaccesstoevidencebasedinformationabouttreatmentoptions;

guidanceonhowtoweighuptheprosandconsofdifferentoptions;

andasupportiveclinicalculturethatfacilitatespatientengagement.

Good Medical Practice (consultationdraft),(GMC,October2011)

http://www.gmc-uk.org/Good_Medical_Practice_2012___Draft_for_consultation.pdf_45081179.pdf

NewdraftguidancefromtheGeneralMedicalCouncil(GMC)forallregistereddoctors:

Doctors“mustsupportpatientsincaringforthemselvestoempowerthemtoimproveandmaintaintheirhealth”.

Thismayincludeencouragingpatients,includingthosewithlong-termconditions,tostayinorreturntoemploymentorotherpurposefulactivity.

Doctorsmayalsoadvisepatientsontheeffectsoftheirlifechoicesontheirhealthandwell-beingandthepossibleoutcomesoftheirtreatments.



NICE clinical guidance 136 (CG136) Service user experience in adult mental health(NICE,December2011).

http://www.nice.org.uk/guidance/qualitystandards/service-user-experience-in-adult-mental-health/index.jsp

Includesthefollowingstandards:

Standard3-Peopleusingmentalhealthservicesareactivelyinvolvedinshareddecision-makingandsupportedinself-management.

Standard7-Peopleusingmentalhealthservicesunderstandtheassessmentprocess,theirdiagnosisandtreatmentoptions,andreceiveemotionalsupportforanysensitiveissues.

Royal Pharmaceutical Society: Involvement, Shared Decision Making and Medicines (RPS,Dec2011).

http://www.rpharms.com/news-story-downloads/rpsresearchreport.pdf

Assessespractical,ethicalandprofessionalissuesinvolvedinshareddecisionmakinginrelationtomedicinesmanagementandwarnsthatsimplisticapproachestoitsimplementationmayresultinsub-optimaloutcomesforpatients.

Notallofthegapbetweenidealsandpracticeshouldbeseenasmere‘resistance’or‘drag’onthepartofhealthcareprofessionals.Inparticular :

Therightinfrastructureandtoolsneedtobeputinplaceifcallsforwidespreadpartnershipworkingaretoberealistic;

Someofthegapbetweenidealsandpracticestemsfromvalidconcernsandfromtheinherentcomplexitiesofinvolvement-orpartnership-relatedvalues.



3 | Developing Shared Decision Making within the NHS

When to use shared decision making?

Deciding on...Shareddecisionmakingcanandshouldbeusedinmanyclinicalsituationsincluding:

Makingalifestylechangeortakingresponsibilityforsomeaspectoftreatment

Majortreatmentdecisions,e.g.agreementtoundergomajorsurgery

Whenthereareseveralpotentialoptionsavailablefortreatmentorsupport

Personalisedhealth/careplanning:focusingonsettingandachievinggoalsfortheoutcomefortheindividual(usuallyforanindividualwithlongtermscondition(s))

Dischargeplanning

Introducingorchangingmedication

Screeningordiagnostictests

Advancecareplanning(endoflifecare,dementiacare,etc)

(AdaptedfromtheKing’sFund‘Makingshareddecision-makingareality:Nodecisionaboutme,withoutme’July2011http://www.kingsfund.org.uk/publications/nhs_decisionmaking.html)

The Right Care programme http://www.rightcare.nhs.uk/index.php/shared-decision-

making/about-the-sdm-programme

AnationalworkstreamintheDepartmentofHealthQualityInnovationProductivityandPreventionprogramme(QIPP).Thisisacorewebsitetogainfurtherunderstandingofshareddecisionmaking,howitlinksintowiderinitiativesaroundlongtermconditionsandthecommissioner’sperspective.

Itfocusesonincreasingvalueandimprovingqualitythroughaddressingvariationandinparticularunwarrantedvariation,throughpromotingtheuseofhealthinvestmenttoolssuchasprogrammebudgeting,andthroughsustainablesystemsandpopulationplanning.

Therearefiveworkstreams

http://www.rightcare.nhs.uk/index.php/presentations/the-accountable-integrated-care-system:

PopulationPlanningandProgrammeBudgetingClinicalNetworksandSystemsofCareBetterValueClinicalPractice Shared Decision MakingPopulationMedicine

Shared decision making workstream(partofthenationalprogrammeabove)

http://www.rightcare.nhs.uk/index.php/shared-decision-making/about-the-sdm-programme/

TheworkstreamwithinRightCarefocusesonmanagingtheconstantlygrowingdemandforhealthcarewheredemandismanagedbyinformedandempoweredpatientsmakingrationalhealthcaredecisions.LedbyNHSMidlandsandEastofEngland.(https://www.eoe.nhs.uk/page.php?page_id=2165providesafurtherlinktoshareddecisionmakingresources).

Thethreekeyelementsoftheprogrammeare

PatientDecisionAidsandPatientDecisionSupport:selfadministeredinformationaltoolsthatpreparepatientsformakinginformeddecisionsaboutmedicaltestsortreatments

OnlinedecisionaidsforspecificconditionsDecisionsupportprovidedbyNHSDirectandpotentiallyotherorganisations

Embeddingshareddecisionmakinginpractice

toolsforpractitioners(e.g.promptsinreferrersystemsetc)

Creatingareceptivecultureforshareddecisionmaking:

NationalengagementprogrammeToolsforcommissionerstoembeddingofshareddecisionmakingincontracts


Shared decision-making within a personalised care approach

Personal Health Budgets learning network http://www.personalhealthbudgets.dh.gov.uk

CentralDepartmentofHealthresourceforpersonalisedbudgetsandprovidinglinkstootherpersonalisationinformationandresources.

Key elements of personalised care planning in long term conditions and personal health budgets (DH/HelenSandersonAssociates,June2010)http://www.personalhealthbudgets.dh.gov.uk/_library/Resources/Personalhealthbudgets/LTC_discussion_paper_Jul_10.pdf

Ausefuloverviewofthekeyelementsofpersonalisedcareplanningforpeoplewithlongtermconditions,althoughitdoesnotcovershareddecisionmakingindetail.

Improving Care for people with long term conditions – Information Sheets (DH,November2010)http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121603

Aseriesofinformationsheetsforthosedeliveringpersonalhealthbudgets,alliedhealthprofessionals,healthtrainersandanyonesupportingindividualswithlongtermconditions.

Shareddecisionmakingisnotcoveredindetail,sheet1includesasectiononplanningandpreparingforadiscussionwithpatients/carersinthedevelopmentofpersonalisedcareplans.

Information sheet 1: Personalisedcareplanning

Information sheet 2: Personalisedcareplanningdiagram

Information sheet 3: Carecoordination

Information sheet 4: Managingneedandassessmentofrisk

Information sheet 5: Howinformationsupportspersonalisedcareplanningandsupportforselfcare

Information sheet 6: Whatmotivatespeopletoselfcare

Information sheet 7: Goalsettingandactionplanningaspartofpersonalisedcareplanning

Information sheet 8: Endoflifecareandpersonalisedcareplanning

Thefollowingresourcesrefertopersonalisedcareandarenotspecifictoshareddecisionmaking:however,theymayprovideusefulcontextforpractitionersandhelptosetthesceneforthedevelopmentofshareddecisionmakingforrelevantpatientgroupsandclinicalconditions.


4 | The individual’s perspective

In the consultation

Possiblequestionstoencourageindividualstoask:

What’s it like for the individual working through the decision aids?

“I was diagnosed some years ago with a number of long term health conditions, with a poor long term prognosis... I was particularly interested to see how the Patient Decision Aid would fit in with the ethos of self- management. The Patient Decision Aid respectfully and gently guides you through all aspects... I felt it was like having a long, unhurried session with a top knowledgeable specialist, plus the benefit of extra advice from the videos, if you wish. The aid really relates to you as an individual, and how the condition affects you... to think what is important to you in deciding which treatment you prefer, and what is right for you. You then have a summary, a personal record of your journey, which you can print off to share with your health professionals, or just keep for reference.“

SummarisedquotefromanindividualfromtheEastofEngland,followthelinkhttps://www.eoe.nhs.uk/page.

php?page_id=2165forthefullinterview.

“Actually, it makes you think more about your condition and how best to help yourself. Instead of you telling me what I have to do, I do what is right because of the information you have given me previously – it is like being your own physician. If I am having slight hypo I can tell straight away and I know what to do exactly.”

SummarisedquotefromanindividualinYorkshireandHumber,followthelinktowatchthefullinterview–shareddecisionmakingwithinpersonalisedcareplanning.http://www.yorksandhumber.nhs.uk/what_

we_do/improving_patient_care_and_service_quality/informing_decisions_improving_care_/personalised_

care_planning

- What are my options?- What will happen if I choose to do nothing?- What are the pros and cons of these options? (benefits and risks)- How likely are these to happen?- What else do I need to know before making my decision?


Healthtalkonline.org: Shared Decision Making (HealthExperiencesResearchGroup,April2011)

http://www.healthtalkonline.org/Improving_health_care/shared_decision_making

ComprehensivesetofpatientinterviewscollectedbyTheHealthExperiencesResearchGroup(UniversityofOxford)ontheirexperiencesofdecision-makingandtheplaceofshareddecisionmakinginarangeofcontexts.

Engaging people with MS in decision-making: The concept of evidence-based patient information(WayAhead2010;14(4):6-9)

http://www.mstrust.org.uk/professionals/information/wayahead/articles/14042010_03.jsp

Discussionpaperoutliningthepotentialadvantagesofprovidingpeoplewithmultiplesclerosiswithevidence-basedinformationaspartofanongoingshareddecisionmakingapproach.

Partners in Care: a guide to implementing a care planning approach to diabetes care (NationalDiabetesSupportTeam,February2008)

http://www.diabetes.nhs.uk/year_of_care/care_planning

Aguidetoimplementingpersonalisedcarewithasectionontheroleofshareddecisionmakinginachievingqualitycareplans,andpracticalsuggestionstosupportshareddecisionmaking.

Patients’ perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice.

http://www.ncbi.nlm.nih.gov/pubmed/20464744

Thesystematicreviewlooksatinterventionsfromthepatientperspective.Itfoundthatamultifacetedapproach,includingeducatinghealthprofessionalsaboutshareddecisionmakingandpatient-mediatedinterventionssuchaspatientdecisionaids,appearpromisingforimprovinghealthprofessionals’adoptionofshareddecisionmakinginroutineclinicalpractice.

Expert Patients http://www.expertpatients.co.uk/about-us/what-we-do

Acommunityinterestcompanyprovidingfreetrainingaimedathelpingpeoplewhoarelivingwithalong-termhealthconditiontomanagetheirconditionbetteronadailybasis.Includestrainingoncommunicatingwithprofessionals(whichcouldsupportthedevelopmentofeffectiveshareddecisionmakingforthisgroup).

Patient questions in shared decision making http://www.cardiffandvaleuhb.wales.nhs.uk/whatisit

Makingsurepeoplegettheanswerstothequestionsandallowingthemtoexplainwhatisimportanttothemwillmakesurethatindividualsareinvolvedinshareddecisionmaking.



5 | The team’s perspective

Introducing shared decision making locally

Asshareddecisionmakingisanintegralpartofimplementingpersonalisedcareplanning,asmallnumberofpracticesimplementingpersonalisedcareplanningacrossYorkshireandHumbertookpartinstructuredinterviews.Thefollowingaresomeofthekeylearningpoints:

The Team...

Thepractice needs to recognise that it wants to work more closely with their patients in a partnership approach

Senior staff in the practice need to supporttheapproachandbeactivelyinvolved

Champions–eachpracticeshouldidentifyaleadnurseorGPtosupportthisapproach

Thechampionshouldengage everyone involvedearlyon

Trainingisimportantinunderstandingthedifferentlanguagetouse,questionstoaskandthechangeinrolesandresponsibilities–e.g.indevelopingcoaching/motivationalinterviewingstyles–havingtherightskillsisimportant

Whototryitoutonfirst?Thepracticemaychoseadiscretegroupofpatientsinitiallyto try out the approach

Good communicationisessentialbothwithinthepracticeandwithpatients.Itislikelythatsomepatientswillneedremindingaboutthisstyleofapproach

The practice websitecangiveinformation/makelinkstorelevantconditions.

Systems and Processes...

Flexibilityinapproachinusinganytoolsisessential,asisrememberingthattheindividual’s views are central to success

Useofdifferentappointmenttimings:Shorterappointmentsforpeoplebeingseenforonecondition,longerforthosewithmultipleconditions

Allowmoretimefortheinitialappointment–longerfirstappointmentsmeanslesstimemaybeneededlateronandalsoanytestscanallbedoneinonesession

Tests – if required, arrange for these to be done in advance of any care planning session.Ensuringthattheindividualhasreceivedtheresultsofanytestresults(e.g.whereregulartestsarecarriedoutrelatingtoalongtermcondition)inadvanceofanappointmentallowsthepersontothinkthroughanyquestionsinadvance

Work through the relevant pathway and processes before making the changes,eveniftheyneedfurtherchangeslater

Theapproachhasworkedwellfordiabetes,smokingcessationandweightloss.

The Individual...

Good communication within the practice and with patientsisessential.Somepeoplewillneedremindingaboutthisstyleofapproachandthattheyneedtobringtheirinformationwiththem.

Developing an accurate patient information packaboutshareddecisionmaking,whichcanbesentoutinadvance,outliningthechangesthatpeoplecanexpecttoexperience.

Allowing time for people to understand and accept and support the changes.Patientshavespentmanyyearslearninghowtobepatients.Cultural change is slow for everyone!

“How you plan and what happens in practice can be two different things – stay flexible.”


SHA Shared Decision Making Projects (NHSNetworks)

http://www.networks.nhs.uk/nhs-networks/sha-shared-decision-making-and-information-giving

Linkstooutputsfrompathfinderprojectsondevelopmentofshareddecisionmakingincluding‘SupportingSharedDecisionMaking’below.

Supporting Shared Decision Making: a pathfinder project for NHS North West (PickerInstituteEurope,August2011)

http://www.northwest.nhs.uk/document_uploads/Publications/NHS%20NW%20SDM%20Pathfinder%20Project%20Report%20August%202011.pdf

Reportofaqualitativeresearchprojectwithcliniciansandpatientsontheperceivedbenefitsofshareddecisionmakingandtheissuesinvolvedinitsdevelopmentinpractice.

What does a patient engaged organisation look like and how do we get there?: Clinical and staff perspectives on shared decision making and information giving (HertsValleyClinicalCommissioningGroup,Sep2011)

http://www.networks.nhs.uk/nhs-networks/sha-shared-decision-making-and-information-giving/documents/HVCCG%20patient%20engaged%20organisation%20report%20version%201.0%20final.docx

Big Change, Small Steps - what does a patient engaged organisation look like and how do we get there? (InHealthAssociatesforSouthendEstuaryClinicalCommissioningGroup,July2011)

http://www.networks.nhs.uk/nhs-networks/sha-shared-decision-making-and-information-giving/documents/Big%20changes-%20Small%20steps%20final%20report.pdf

TwoprojectsleadingtorecommendationsonhowtobuildpatientparticipationintotheworkofclinicalcommissioninggroupsbasedonworkbyclinicalcommissioninggroupsinNHSEastofEngland;

Theseprojectsfocusedonimprovingpatientengagementatorganisationallevelincommissioningstrategyandpracticedelivery(outsidethescopeofthisresourceguide)aswellasonthedevelopmentoforganisationsabletodevelopshareddecisionmakingwithpatientsatanindividuallevel.

Increasingshareddecision-makingintheclinicalencounterisseenasonestrandofanoverallstrategytoimprovepatientengagementmoregenerally.

Improvedpatientaccesstotheirownclinicalinformationwillbeanecessarysupporttoshareddecisionmaking

Existingtoolsandsupportforshareddecision-makingneedtobecollatedandshared(largelythroughexistingcommunicationchannels),includingtheExpertPatientProgramme,carers’championsineachpracticeandadirectoryofvoluntarysectorsupportorganisations.

The MAGIC programme(HealthFoundation) http://www.health.org.uk/areas-of-work/programmes/

shared-decision-making TheMAGICprogrammeisworkingwithfrontlinehealthprofessionalsandtheirpriorityprojectsacrosstheUKtotesthowtoembedbestpracticeandovercomethebarrierstochange.TheHealthFoundationworkstosupportmakinghealthcaremorepatient-centredandinfluencingmorehealthcareprofessionalstogivepatientsthechoiceandinvolvement.

Understanding and shaping culture change: implementing personal health budgets(NHSY&H,2011)

http://www.yorksandhumber.nhs.uk/document.php?o=8136

Apracticalandaccessibleguidetoleadingculturechangeinpractice:producedforuseindevelopingpersonalhealthbudgetsbutalsoapplicabletodevelopmentofshareddecisionmakinginthewidercontext,e.g.inrelationtotheconditionscoveredbyexistingonlinedecisionaids.

Teleconsultation and telemonitoring http://yhhiec.org.uk/wp-content/

uploads/2011/10/11092020_tele_consultation_workbk.pdf

http://yhhiec.org.uk/wp-content/uploads/2011/10/11070604_Tele_Moni_Workbk.pdf

Practicalguidestousingassistivetechnologyinnewservicemodels:again,notdirectlyrelatedtoshareddecisionmakingandpotentiallyhelpfulindevelopinganongoingshareddecisionmakingapproachwithappropriatepatientgroups.



6 | The practitioner’s perspective

What is needed?Allshareddecisionmakingbuildsontheexistingcommunicationandconsultingskillsofthe

practitioner.Thisapproachmakestheindividual’sand/orcarersviewsandpreferencestheprimary

focusoftheconsultation.

Goodrecordkeepingandrecordingofinformation–decisionsmade,riskagreement,review

Accessibleinformationandrecordsforboththeindividualandprofessionals

Consultingstyleofpractitionersincludes

Empathyandrelationshipbuilding

Listeningskills

Flexibility

Abilitytoaskopenquestions

Translatingtheindividual’swordsintogoalswherehelpful

Supportingtheindividualtothinkthroughtheprosandcons

Informing,educatingandcommunicatingrisk

Promotingselfcareandmanagement

Makingthedecision

Documentingthedecision,agreedactions,ongoingrolesandresponsibilitiesandanyrisksharingagreement

Workingwithindividualsunwillingtoengageinshareddecisionmaking

(AdaptedfromtheKing’sFund‘Makingshareddecision-makingareality:Nodecisionaboutme,withoutme’July2011(http://www.kingsfund.org.uk/publications/

nhs_decisionmaking.html)andFromInvolvement,shareddecisionmakingandmedicines,RoyalPharmaceuticalSocietyNovember2011(http://www.rpharms.com/

news-story-downloads/rpsresearchreport.pdf)

‘Patients need different information, not more of the same, and there is an urgent need for more honesty about the limitations of medicine and the uncertainties of medical knowledge. Patients need to be aware of the possibility of both benefits and harms and helped to make decisions based on their own valuation of the various possible outcomes.’

(IonaHeathBMJVolume32711October2003bmj.com)

continued overleaf...

Strategies for practitioners:

Adecisionneedstobemadeandthatthereisno‘best’choice

Donothingormaintainthestatusquoisalsoanoption

Discusstheprosandconsofeach–thebenefitsandrisks

Elicittheperson’sideas,concernsandexpectationsabouttheiroptions,theirbenefitsandconcernsbyaskingopenquestions

Possiblequestionstoasktheindividual:

AdaptedfromthearticleShareddecisionmaking:reallyputtingpatientsatthecentreofhealthcareBMJJanuary2012http://www.nelm.nhs.uk/en/NeLM-Area/News/2012---January/27/Analysis-Shared-decision-making---really-putting-

patients-at-the-centre-of-healthcare


Summary...Shared decision making involves ensuring that the individual and/or carer views and preferences are the focus of the consultation. When used consistently and effectively, shared decision making can result in gains for the individual, the practitioner and commissioners.

- What do you know about the treatment or self-management support available?

- What do you expect from the treatment or support for your condition?

- Do you have all the information you need to weigh up the options?

- What aspects of the treatment or procedure are you most concerned about?

- How do the benefits of each option compare? How do the risks compare?

- Thinking about this decision, what is the most important aspect for you to consider?

- Who else do you need to talk to, before making this decision?

- Having got all the information, is there anything else you need to think about before making a decision?


Shared Decision Making Decision Aids

http://www.nhsdirect.nhs.uk/DecisionAids

Links to online decision aids (hosted by NHS Direct) for:

Advanced kidney disease Benign prostatic hyperplasia (BPH). Cataracts Localised prostate cancer

PSA testing CVS and amniocentesis Breast cancer Knee arthritis Osteoarthritis of the hip


Consultation styles

http://www.healthtalkonline.org/Improving_health_care/shared_decision_making/Topic/4038

Usefuldiscussionwithinamoregeneralresource(seeIntroducingshareddecisionmakinglocallyonpage12)lookingatstylesofconsultationandtheirusefulnessinshareddecisionmaking.

Shared Decision Making: really putting patients at the centre of healthcare

http://www.nelm.nhs.uk/en/NeLM-Area/News/2012---January/27/Analysis-Shared-decision-making---really-putting-patients-at-the-centre-of-healthcare

ThispaperbytheBMJoutlinesbestpracticeexamplesandstrategiesthatcliniciansandtheirorganisationscanusetosupportpatientstobecomeinvolvedindecisionmaking.Ausefulcorepaperforclinicians.

Partners in Care: stories about NHS patients and their doctors (BMA, 2009)

http://www.bma.org.uk/images/partnersincare2009_tcm41-184628.pdf

Aseriesofanecdotalarticlesaboutsuccessfuldoctor-patientrelationships.Itisnotspecificallydirectedtothedevelopmentofshareddecisionmaking,butpotentiallyusefulasameansofdiscussingoptionsforchangesinpracticetosupportshareddecisionmakingwithinthepractice.

Medicines management – pharmacy input to compliance

http://www.npc.nhs.uk/patients_medicines

http://www.npc.nhs.uk/local_decision_making/guiding_principles.php

TheNationalPrescribingCentrehasproducedhighlevelprinciplesintermsofmakinglocaldecisionsaboutmedicineswhichalsoreferencestheinputoftheindividual.

Core website home pages for shared decision making


Annex One

Right Care http://www.rightcare.nhs.uk/index.php/shared-decision-

making/about-the-sdm-programme

TheRightCarewebsitefocusesspecificallyonshareddecisionmakingandDeliveringRightCareforPatientsfocusesonthreeinterdependentelementsofSharedDecisionMaking;PatientDecisionAidsforspecificconditions,PatientDecisionSupport:andEmbeddinginPractice:CreatingareceptivecultureforSharedDecisionMakingwithinpracticesandteams.

Shared decision making decision aids http://www.nhsdirect.nhs.uk/DecisionAids

Linkstoonlinedecisionaids(hostedbyNHSDirect)for :Advancedkidneydisease,Benignprostatichyperplasia(BPH),Cataracts,Localisedprostatecancer,PSAtesting,CVSandamniocentesis,Breastcancer,Kneearthritis,Osteoarthritisofthehip.

BMJ Shared decision making: really putting patients at the centre of healthcare

http://www.nelm.nhs.uk/en/NeLM-Area/News/2012---January/27/Analysis-Shared-decision-making---really-putting-patients-at-the-centre-of-healthcare

TheBMJwebsitehasseveralusefularticlesonshareddecisionmakingincludingsystematicreviews.

Kings Fund Makingshareddecision-makingareality:Nodecisionaboutme,withoutme(KingsFund,July2011)

http://www.kingsfund.org.uk/publications/nhs_decisionmaking.html

Thispaperprovidesavaluableoverviewofshareddecisionmakingandlinkstoexistingworknationally.Italsoprovidesmoredetailedcoaching-stylequestionsforpractitionerstouse.

NHS East of England https://www.eoe.nhs.uk/page.php?page_id=533

NHSEastofEnglandhaveproducedmanyresourcesaroundshareddecisionmakingandpersonalhealthplanning.Ausefulwebsiteasastartingpointtolookathowotherplacesareintroducingamorepersonalisedapproachtocareandsupport.

Department of Health http://www.dh.gov.uk/en/index.htm

Allthekeyregulationsandguidanceanddiscussionpapersrelatingtopersonalisation,shareddecisionmakingandpersonalhealthbudgetsareavailableonthiswebsite.

Allthelinksgivenwithintheresourcearecorrectatthetimeofpublication,inthefuturesomespecificlinksmaychange,sothehomepageorequivalentlinksaregivenbelowforthecorenationalresources.

Shared decision making: background policy context


Annex Two

The Operating Framework for the NHS in England 2012/13(DH,November2011)

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131360

Setsouttheplanning,performanceandfinancialrequirementsforNHSorganisationsin2012/13basedonthecurrentNHSstrategicvision.

Key points:

Commissionersarerequiredtoimprovepatientempowermentincludingtheexpansionofshareddecisionmaking(sections3.22–3.25)andthereforepractices/practitionersneedtobeawareofandpreparingtointroducethisapproach.

PCTclustersshouldprepareforallpatientswithNHScontinuingcaretobeofferedapersonalhealthbudgetforrelevantaspectsofcarebyApril2014.

LocaldeliveryofpersonalhealthbudgetsshouldformpartoftransitionplanningbyPCTclustersandClinicalCommissioningGroups(CCGs).

White Paper: “Equity & Excellence: Liberating the NHS”(DH,July2010)

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf

Health and Social Care Bill 2011 (draft)

http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm

ProposalsfortransformationalculturechangeacrosstheNHS,includingbuildingagreateremphasisonpartnershipbetweenpatientsandprofessionalsinbothcommissioninganddeliveryofcaretotheindividual.

Key points:

Shareddecisionmakingwillbecomethenorm:‘nodecisionaboutmewithoutme’.

Shareddecisionmakingrelatestodecisionsmadeaboutindividualcaredeliveryandalsotostrategyandcommissioningdevelopmentandco-productionofhealthcare.

Accessforpatientstoinformationisessentialtoenablethemtomakechoicesabouttheircare.Thiswillincludeincreasedaccessandcontrolbypatientsovertheirowncarerecordsandinformationontheperformanceofproviders.

Shareddecisionmakingwillincludedecisionsaboutservicemodel(s)tobedeliveredtotheindividualandtheprovider(s)whowilldeliverit.

Measuringoutcomesforpatients(includingtheirparticipationindecision-making)willbeattheheartofperformancemanagementoftheNHSinfuture,asopposedtoafocusonthemeasurementofindividualprocesses.

Liberating the NHS: Legislative Framework and Next Steps(DH,December2010)

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122707.pdf

Key points:

“Commissionerswillneedtomakepathwaysflexibleenoughtoallowpatientsthescopetomakedecisionsabouttheircare,usingdecisionaidswhereappropriate,andtopromoteself-care.”

TheNHSCommissioningBoardwillhaveadutytohaveregardtotheneedtopromotetheinvolvementofpatientsandtheircarersindecisionsabouttheprovisionofhealthservicestothem.

NHS Constitution(DH,Jan2009)



Thefollowingsectionhighlightsthepolicyaboutwhatneedstobeinplaceforsuccessfullysupportingashareddecisionmakingapproach.

Handbook to the NHS Constitution(DH,March2010)


SetsouttheprinciplesandvaluesoftheNHSinEnglandandtherightsandresponsibilitieswhichpatients,staffandthepublicowetooneanothertoensurethattheNHSoperatesfairlyandeffectively.

Key points:

PatientshavetherighttomakechoicesaboutNHScareandtoinformationtosupportthesechoices.

Theoptionsavailabletopatients(i.e.thescopeofthechoicesavailabletothem)willdevelopovertimeanddependonindividualneeds.

High quality care for all: NHS Next Stage Review final report 2008

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085828.pdf

EndorsedtheneedtoincreasepatientempowermentinNHScare,andwasamajorinfluenceonthedevelopmentoftheNHSConstitution.


All the links

are correct at the time of writing, some specific

links may change. The home page or equivalent links

are given in Annexe One for the core

resources

Personalisation resources and links - Personalised care planning, self management and self care, Local Authority approach to personalisation.


Annex Three

Thissectionidentifiessomeofthewiderweblinkswhichprovideusefulcontextforshareddecisionmaking.Itincludesthemostrecentinformationonthelocalauthorityapproachtopersonalisation.

USING A PERSONALISED APPROACH

Nurturing Power of Personalised Care

NewdraftguidancefromtheGeneralMedicalCouncil(GMC)saysdoctors“mustsupportpatientsincaringforthemselvestoempowerthemtoimproveandmaintaintheirhealth”.

http://www.gmc-uk.org/Good_Medical_Practice_2012___Draft_for_consultation.pdf_45081179.pdf

In Control

http://www.in-control.org.uk

InControlisasocialenterpriseoperatinganextensivecommunitynetwork,workingforchangeandtoprovidepeoplewiththeknowledge,powerandtoolstocontroltheirsupport.Theywerepioneeringpersonalisationandselfdirectedsupporttenyearsagoandhaveanumberofveryusefulpublicationsavailablerangingfromreportsanddiscussionpapersthroughtobooks,DVDsandtoolkits.Theresourcescoverallageranges;childrenthroughtoadultsacrosshealthandsocialcare.

THINK LOCAL ACT PERSONAL(TLAP)MAKING IT REAL(LOCALAUTHORITYAPPROACHTOPERSONALISATION)

http://www.thinklocalactpersonal.org.uk/_library/Resources/Personalisation/TLAP/MakingItReal.pdf

‘MakingitReal’highlightssixareas:informationandadvice,activeandsupportivecommunities,flexibleintegratedcareandsupport,workforce,riskenablementandpersonalbudgetsandselffunding.Theframeworkusesaseriesof‘Istatementswhichexpresswhatpeoplewanttoseeandexperienceifpersonalisationwithinlocalauthoritiesisreallyworkingwell.e.g.“Iamincontrolofplanningmycareandsupport”

PERSONAL HEALTH PLANNING

Personal Health Planning https://www.eoe.nhs.uk/page.php?page_id=533

Personalhealthplanningiswayofempoweringpeoplewithlongtermconditionstobeabletotakegreaterownershipandresponsibilityfortheircareandtohavemorecontroloverthemanagementoftheirlongtermcondition.

Thepersonalhealthplanisownedbytheindividualanditisuptoeachpersonwhatinformationtheywishtoinclude.Thecontentofthepersonalhealthplanislikelytochangeovertime.

http://www.cambridgeshire.nhs.uk/Your-health/long-term-conditions.htm

Personal health budget Thislinkistothelearningcommunityforprofessionalsdirectlyinvolvedinthehealthbudgetsprogramme.

http://www.personalhealthbudgets.dh.gov.uk/

Key points:

Peopletohavegreaterchoiceandcontrolovertheircare;andthefourthinterimevaluationreportonthepilot.

NHSChoices:www.nhs.uk/phbcommunity

Personalexperiencesandstories,plusthelaunchofthepersonalhealthbudgetsDVD“Storiesfromthepilotprogramme”.

Programmeupdate;workingwithpeoplewhohavebudgets,frontlinepractitionersandproviders.



Key elements of personalised care planning in long term conditions and personal health budgets Discussion paper June 2010

http://www.personalhealthbudgets.dh.gov.uk/_library/Resources/Personalhealthbudgets/LTC_discussion_paper_Jul_10.pdf

Key Points

Exploresbestpracticeincareplanningforlongtermconditions,andhowthismighthelpindevelopingcareplansforpersonalhealthbudgets.

Identifiescommonelementsofcareplanningfromarangeofinitiativesfocusingonlongtermconditions,aswellasidentifyingadditionalelementsthatmightberequiredforpersonalhealthbudgets.

Recognisesthedevelopmentofnewapproachestopersonalisedcareplanningisacrucialcomponentintheimplementationofeffectivepersonalhealthbudgets.

Offersasummaryoflearningfromlongtermconditions,withtheaimtoprovideausefulframeworktopilotsiteswhenapproachingtheplanningofpersonalhealthbudgets.

https://www.eoe.nhs.uk/page.php?page_id=540

http://www.norfolk.nhs.uk/personal-health-planning

PERSONAL CARE PLANNING

Personalised Care Planning

Personalisedcareaddresseseachpatient’srangeofneeds,andrecognisestheissuesbeyondmedicalneedsthatcanimpactonhealthandwell-being.ItcaninvolveGPs,practicenurses,consultants,communitymatrons,socialworkersandmore,andaimstoprovidethesupport,informationandtechnologyneededtoempowerpatientstomanagetheirownconditions,andretaincontroloftheirownlives.

http://www.southeastcoast.nhs.uk/Our%20Work/Personalised%20care.htm

Care and support planning for long term conditions

Aqualityframeworktosupportcommissionersandproviderstoimplementcareplanningisatoolforhealthcareprofessionalstousetobenchmarkexistingservicesandidentifyanygaps/areasthatneedtobelookedattodeliverhighqualitycareplanning.ItincludesaworkforceguidedevelopedbyNHSEastofEnglandtohelpkeyworkersandmanagersidentifyanddeveloptheskills,knowledgeandbehaviourrequiredtoimplementpersonalcareplanning,aswellasnationalguidance.

http://www.southeastcoast.nhs.uk/Our%20Work/Personalised%20care.htm

http://www.swdc.org.uk/system-development/longterm-conditions/care-planning-resource-pack/context-part-1/

Nursing Times web link

Variouslinksonpersonalisedcareplanpilotsupandrunning.

http://www.nursingtimes.net/whats-new-in-nursing/primary-care/personal-care-plan-pilots-up-and-running/5000423.article

http://www.nottspct.nhs.uk/my-nhs-services/personal-care-plans/635-care-plan-details.html

SELF CARE

The seven principles that underpin Self Care: Ensureindividualsareabletomakeinformedchoicestomanagetheirselfcareneeds.

Communicateeffectivelytoenableindividualstoassesstheirneeds,anddevelopandgainconfidencetoselfcare.

Supportandenableindividualstoaccessappropriateinformationtomanagetheirselfcareneeds.

Supportandenableindividualstodevelopskillsinselfcare.

Supportandenableindividualstousetechnologytosupportselfcare.

Adviseindividualshowtoaccesssupportnetworksandparticipateintheplanning,developmentandevaluationofservices.

Supportandenableriskmanagementandrisktakingtomaximiseindependenceandchoice.

Theprinciplesaredescribedintermsofcompetence,thecontextinwhichitlies,theexpectedbehavioursandunderpinningknowledge.

http://www.swdc.org.uk/silo/files/common-core-principles-to-support-self-care-a-guide-to-support-implementation.pdf

Health Foundation: Self management support resource centre

Thisresourcecentreisfullofinformationandpracticalresourcesthatcanbeadoptedandadaptedlocallytohelpservicesandhealthprofessionalstodeveloptheirownselfmanagementsupportprogrammes.

http://www.health.org.uk/resource-centre/new-sms/

Chosensiteshavebeenworkinginpairstofocusononeoffourclinicalareas;COPD,Diabetes,DepressionandMSK.CasestudiescanalsobefoundincludingonefromCalderdaleandHuddersfieldNHSFoundationTrust.

http://www.health.org.uk/resource-centre/new-sms/real-stories

Self care library Theselfcarelibraryhasbeendesignedforusebypatients/usersandhealthcareprofessionalswhodealwithlongtermconditions.Thelibraryusesbothevidencebaseandcontainsinformationonefficiency,safetyandcost.

http://selfcare-library.info

CONDITION SPECIFIC – WITH LINKS TO


PERSONAL CARE PLANNING

Older People

TheNationalServiceFrameworkforolderpeoplesetsouteightstandardsthatcoverthefullrangeofcareolderpeoplemightneed.Thestandardsembodyfundamentalprinciplesensuringcareisbasedonclinicalneednotage,andthatservicestreatolderpeopleasindividualspromotingtheirqualityoflife,independence,dignityandtheirrighttomakechoicesabouttheirowncare.

http://www.nhs.uk/NHSEngland/NSF/Pages/Olderpeople.aspx

Multiple Sclerosis

Engaging people with MS in decision-making

Peoplearebeingencouragedtobepartnersinmedicaldecision-makingandMSisaparadigmaticconditionforashareddecision-makingapproach.AsnewMStreatmentoptionsemerge,patients’involvementintreatmentdecisionsbecomesincreasinglyimportant.Wellinformedpatientsmayalsobebetterabletorecogniseandcommunicateside-effects.ApersonalcareplantemplatehasbeendevelopedspecificallyforpeoplewithMS.

http://www.mstrust.org.uk/professionals/information/wayahead/articles/14042010_03.jsp

Epilepsy

AnewApproachtoDiseaseManagementforthe21stCenturyencouragespeopletoworkinpartnershipwithhealthcareprofessionalstomanagetheircondition.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4878899

Motor Neurone Disease

Living with MND: Personal care and care support

Changinglevelsofmobilityandindependencemeanmanypeopleneedhelpwithpersonalcare,includingwashing,dressing,andusingthetoilet.Peoplewanttopreservetheirdignityasfaraspossible,whilstatthesametimeacceptingpracticalhelp.

http://www.healthtalkonline.org/nerves_and_brain/motorneuronedisease/Topic/3441

Diabetes UK

InthecontextofYearofCare,careplanningisalsoameanstoanend.Thecareplanningconsultationidentifieswhateachindividualneedstosupportthemtoselfcareeffectively.

Careplanningwillalsobetheessentialportaltoaccessmanypersonalcareopportunitiessuchasindividualbudgets.

http://www.diabetes.org.uk/

http://www.diabetes.org.uk/Professionals/Service-improvement/Year-of-Care/The-Year-of-Care-concept/Year-of-Care---care-planning

Emphysema Foundation

TheNationalEmphysemaFoundationiscurrentlydevelopinganonlinepersonalhealthdiaryandhasvariousexercisesandactivitiesforselfmanagement.

http://www.emphysemafoundation.org

MEDICINES MANAGEMENT

Medicines management – pharmacy input to compliance

NationalPrescribingCentrehasproducedHighLevelPrinciplesintermsofmakinglocaldecisionsaboutmedicineswhichalsoreferencestheinputoftheindividual.

http://www.npc.nhs.uk/patients_medicines

http://www.npc.nhs.uk/local_decision_making/guiding_principles.php

New Medicines Service Thisserviceisaimedathelpingindividualsadheretotheirmedicinesbyofferingstructuredsupportafterdischargefromhospitalonanewmedicine.

http://www.psnc.org.uk/pages/nms.html#future

TELEHEALTH AS PART OF THE SHARED DECISION MAKING APPROACH

Kings Fund resources on telehealth and telecare Telehealthandtelecarehavethepotentialtoimprovethequalityofpatientcareandindividual’sinputtotheircare.TheKingsFundanalysisoftheevidenceonwhethertelehealthcanbeacost-effectivealternativetousualcare.Resourcesinclude:Perspectivesontelehealthandtelecare:Learningfromthe12WholeSystemDemonstratorActionNetwork(WSDAN)sites;Makingarealityoftelehealth:LessonsfromtheWholeSystemDemonstratorprogramme.

http://www.kingsfund.org.uk/topics/technology_and_telecare/index.html

E-consultations:

Clinicianssharetheirexperiencesofusingtechnologyandhowtheyhavechangedtheirwaysofworking-whathasworkedwell,whattheyhavelearnedandtipsforothersthathaveresultedingreaterefficiencyfortheirorganisationsandindividualshavebenefitincareclosertohome,reducingemergencyadmissions,reducingcostandimprovingaccessandcommunicationregardingtheircare.

http://www.yorksandhumber.nhs. uk/what_we_do/improving_patient_care_and_service_quality/informing_decisions_improving_care_/econsultations/#

All the links

are correct at the time of writing, some specific

links may change. The home page or equivalent links

are given in Annexe One or the core

resources.


Annex Four

Contributors to developing the resource

Stephanie Carson,DarleyConsulting,[email protected]

Lucy O’Leary,anassociateofDarleyConsulting

Caroline Nwagwu,ProjectManagerforshareddecisionmakingresource,NHSNorthofEngland(YorkshireandHumber)

GP Reviewers:

Dr Zak McMurray,WoodhouseHealthCentre,Woodhouse,Sheffield

Dr David Tooth,KivetonParkPrimaryCareCentre,KivetonPark,Sheffield

Steering Group members:

Jane Burbidge,NHSNorthofEngland(YorkshireandHumber)PatientExperience&PartnershipManager

Stephanie Carson,DarleyConsulting,ResourceDeveloper

Julia Coletta,NHSNorthofEngland(YorkshireandHumber)LongTermConditionsProgrammeLead

Michele Cossey,NHSNorthofEngland(YorkshireandHumber)AssociateDirector:PharmacyandPrescribing/SharedDecisionMakingLead

Dr Mark Hayes,ValeofYorkClinicalCommissioningConsortium

Michelle Place,NationalCoachQIPP-LTCWorkstream

Caroline Nwagwu,NHSNorthofEngland(YorkshireandHumber)ProjectManagerforshareddecisionmakingresource

Dr Adam Shepherd,Wakefield:AllianceCommissioningConsortia

Practices:

Marsh Surgery,Huddersfield

Phoenix Medical Centre,Bradford

Horton Park Medical Centre,Woodroyd

Greenway Medical Practice,Cleckheaton

Designworkbywww.candoocreative.com

Yorkshire and the Humber2012


From 3 October 2011 NHS North East, NHS North West, Yorkshire and the Humber - the three strategic health authorities in the North Of England - were placed under a single management framework and work together as NHS North of England

Documents

SHARED DECISION MAKING - NHS Networks...1 | Introduction Shared decision making, self care and self management are all ways in which the individual can gain greater choice and control