Link to the Brighton GP Referrals Section embedded within the Map of Medicine.

Detail of how to access are here on the PCT website

Click the "Feedback" button to let us know what you think of each page.

We initially used Dizziness as a referral pathway to learn how to use the Map.
Some background work is being done bringing together all the links and forms related GP referrals.
The Early Adopter Plan is being formulated.
It is also planned to move the hosting onto the www to allow access at home, and to allow individual logins to gain access to further features like personal notes.
See docs below for an idea of the plans and progress.

• The Map of Medicine (MoM) is software designed initially with clinicians at the Royal Free Hospital London to create Clinical pathways/guidelines.
• It is designed to be visual, consistent, to chunk information and to encourage feedback.
• It is structured to show the evidence-based and record the information governance behind pathways.
  
• It is now part of the National Program for IT, backed by the National Knowledge Service.
  
• They are working together with professional bodies (including many Royal Colleges) to accredit current pathways and plan new ones.
• So far they have created about 400 Evidence-Based National Clinical Pathways.

We have access to a local copy of these to "localise" for Brighton and & Hove if we wish.

There are two levels of localisation.

1. Local Admin Info  (such as adding local clinic times/contacts/leaflets at an appropriate part of a Pathway)
2. Clinical Localisation  (changing the clinical content or creating a whole new Pathway)

(This is a Chapter heading - if you wish to see the titles of the pages below this chapter then click the title of this page)
Click the link to take a Quick Tour of the features of this book.

A place to start putting your drawings

"off to the PROMs!"

Steth decides to check out Patient Reported Outcome Measures

This is a protocol for the investigation of raised LFTs

Not for the faint hearted

The collapse of the Fujitsu contract in the South has meant that some "interim solutions" are being sought to fill the gaps.
More info as we get it.

I am also starting a list of  IT/Comms projects that you may wish to know about below.

uploaded doc

Choice architecture?
Libertarian paternalism?
by Richard H. Thaler (Author), Cass R. Sunstein (Author)
I have just started reading this, will let you know how it goes.

Helen Bevan, Director of Service Transformation, NHS Institute for
Innovation and Improvement.
Chris Ham, Professor of Health Policy and Management,
Health Services Management Centre, University of Birmingham
Paul E Plsek, Director, Paul E Plsek & Associates Inc,
Roswell, Georgia, USA

Interesting comments from Gene Watch (anyone know how reliable they are?)
"(vi) The appointment of Dr Walport to jointly run the consultation is inexplicable, given his ongoing role in lobbying for access to electronic medical record data by the pharmaceutical and biotech industries, including access to sensitive personal information in the ‘sealed’ and ‘sealed and locked’ envelopes of electronic medical records for research (contrary to the recommendations of the Health Select Committee)"

The Helsinki Declaration states: (22) “The subject should be informed of the right to abstain from participation in the study or to withdraw consent to participate at any time without reprisal”.

NICE guidance on 2WW. Good to refresh on symptoms/condition not all covered on the 2ww referral proformas

DoH Doc

As well as sharing information, another of my interests is Quality of Life.
I would like to start a chapter devoted to develop a better understanding of QoL and how to ensure improving/maintaining it as part of Health services.
Maybe we could assign Qool points to processes?.

Link to the Docs on the DoH site website

The Future Direction of General Practice

Putting patients first.
A plan for primary care in the 21st century from the
Royal College of General Practitioners

Useful preparation document for your trainer when it comes to preparing for CBD. Difficult to find on RCGP website.
http://www.rcgp.org.uk/docs/nMRCGP_CBD%20Discussion%20Notes%20Sheet.doc

Starting to collect cases:

Civil Aviation Authority guidance on Fitness to Fly

A one page summary of the salient points in a Gynaecological History

These are the Guidelines for Antibiotic use from South Downs Health Mar 2007

STANDARDS:
http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Olderpeople...

http://www.dh.gov.uk/en/Healthcare/Emergencycare/Modernisingemergencycar...

A vital part of Reforming Emergency Care

Introduction

Emergency care networks are a vital part of Reforming Emergency Care. This framework aims to clarify their purpose and makes suggestions for membership and terms of reference.

It must be emphasised, however, that the network size/scale is for local determination. These are suggestions only, the important thing is that the network makes sense locally and enables local delivery.

Aim:

a. to optimise the emergency care of all patients in the locality
b. ensure that the patient perspective and quality of care are the priorities in planning emergency healthcare in the local health and social care community
c. to ensure ease of access to appropriate services at the appropriate time without unnecessary duplication for the patient and in line with national standards.
d. to co-ordinate emergency health care across all organisations in a community
e. to ensure the engagement of external organisations whose services contribute to the effective delivery of emergency care
f. to work with health and social care commissioners to determine priorities in emergency care
g. to promote knowledge of developments in emergency care amongst health and social care professionals and users
h. developing and maintaining improvement work including that initiated by the Emergency Services Collaborative
i. to agree and develop local standards and protocols to facilitate comparative audit and training.

Membership of EC Network

Suggested membership - For local determination/agreement:

Acute Trusts
Ambulance Services
Community Paediatric Services
Dental Services
Other networks/collaborative leads
Intermediate Care
Local council
Mental Health Trusts
Minor Injury units
NHS Direct
OOH Providers
PCT
Pharmacy (NHS and retail)
Social Services
Independent Sector - nursing and residential care homes
Strategic Health Authority
User representation (or a patient/carer forum that feeds into this group)
Nursing/Residential Home Representation
Older People's Champions
Police (e.g. mental health issues, security issues)
Walk-in Centres
Workforce confederation

Membership should include clinical and managerial staff and represent a broad spectrum of disciplines.

Example of Terms of Reference

The Network will specifically look at standards in the NHS Plan and develop whole systems solutions to achieving these standards. In particular the following standards will be considered and monitored at each meeting:-

* ambulance response times
* ambulance turnaround times
* primary care access (including OOHs)
* total time in A&E
* thrombolysis
* delayed transfer of care rate in acute Trusts

In order to achieve these the following measures may also be considered at each meeting:-

* service usage (PC, Ambulance, A&E)
* bed occupancy in acute Trusts
* capacity plans
* breaches of local and national standards within the local community
* untoward incidents

The network is responsible for issues across existing organisational boundaries. (The ECL is responsible for issues within an organisation).

Networks should ensure that if a patient presents at a location that currently does not provide the required services that the user can be transferred to the appropriate carer without unnecessary delay or duplication of work.

Network Checklist

The network will refer to the A&E target checklist issued in January 2003 and each organisation will report to the network meeting on any areas within this that are not undertaken by the relevant organisations - click on the link below to visit the A & E Plans page.

1. Direct access from primary care, ambulance services and A&E to the following services are available:-

Community nursing

* Community nursing and therapy services
* Rapid assessment teams (particularly for older people)
* Social care support in the home
* Intermediate care - residential
* Intermediate care - rapid response service
* Mental health services
* 24 hour pharmacy

2. Primary care have direct access to:-

* Urgent senior medical opinion from secondary care
* Social care assessment & services
* Urgent diagnostic services with same day reporting
* Minor injury units and W/Cs

3. A&E should have direct access to:-

* Urgent appointments in primary care
* Outpatient appointments within 72 hours
* Respite nursing home and residential beds
* Emergency social care access

4. Ambulance services have direct access to:-

* Primary care centres and OOH centres
* Urgent appointments in primary care
* Senior medical opinion
* Minor injury units and walk-in centres
* Rapid assessment team for older people
* Night sitting services

5. Bed management systems cover all beds in primary, secondary and continuing care. Systems should prevent delays in transfer between any of the beds. Capacity is planned to match expected emergency admissions (predicted on a daily basis) with elective and respite activity.

6. Residential and nursing home bed availability is mapped against expected hospital, primary care and community requirements.

7. Systems are available to allow appropriate distribution of emergency care workload taking account of clinical need, system workload and time constraints. Capacity can be managed in a dynamic operational way as well as strategically.

8. Systems are present, wherever possible, to achieve referral via guidelines rather than via traditional gatekeeper roles.

9. Documentation (paper and electronic) assists in avoiding duplication.

10. Data transfer is optimised between organisations. Information is shared to the benefit of the users, including outcome data to allow effective audit.

11. Patients not registered with a GP can initiate their registration from all sources of emergency care.

12. Users and carers are involved in all stages of planning and provision of emergency care.

13. Facilitate development of new working practices including looking at how individuals and groups can work across organisational and professional boundaries. Encourage autonomous practise rather than increase restricted and protocol bound practise.

14. Facilitate development of guidelines and care pathways that work across the whole network.

15. Ensure that any developments by one organisation do not adversely affect patient experience in another organisation or affect another organisation's ability to provide quality care. Ensure that delays are not occurring at interfaces.