Update on PRSB projects

The PRSB updates on the key changes to four projects including child health events, the outpatient letter standard, the clinical referral information standard and the digital care and support planning standard.

The second child health workshop took place this month, focussing on primary care, health visiting and school nursing routine information.

The workshop was attended by more than 50 health and social care professionals, parents and system suppliers and is one of the key steps towards developing a standard for the Digital Child Health Strategy Information.

Working in collaboration with NHS Digital, the PRSB is developing the information sharing requirements for the community child health record which includes the Healthy Child Programme, as part of the NHS England Digital Child Health Strategy. It will mean that birth details, immunisation records and the outcome of developmental reviews will be shared digitally with health care professionals, and also made available to parents/carers through the personal electronic child health record (known as the e-red book). This will help ensure that every child receives the health and care support that they need as key clinical information will be available online where and when it is needed for safer and better care.

During the workshop, health workers and parents discussed headings for the child health records, to ensure that everything could be recorded in a way that will improve safety and efficiency for both parents and clinicians.

The third and final workshop will take place in July, before a survey is issued to gather wider feedback for the standard. For more information go to www.theprsb.org/projects.

Outpatient letters

The PRSB’s new standard for outpatient letters is now going through the endorsement process with PRSB members.

The outpatient letter standard is designed to improve and standardise the content of outpatient letters so that professionals, patients and carers receive consistent, reliable, high quality information.

Due to the rise in the number of specialist services delivered out of hospitals, well-structured outpatient letters have become increasingly important in ensuring good communications between clinicians and patients. They are the main method of contact and communication between hospital staff and GPs, and are often the sole record of the consultation held by the outpatient department and hospital.

Developed in conjunction with patients and health and care professionals, the standard is aiming to improve care by helping clinicians to communicate relevant information more quickly, reducing transcription errors by enabling re-use of key data in the GP system and producing better information for audit and research by carrying information in coded format, where appropriate.

The final standard will be published within the next three months, following endorsement. For more information go to www.theprsb.org/projects

Clinical referral information standard

In August, the PRSB will begin work to improve the quality of information sent in GP referral letters, so that hospital consultants can reduce inappropriate referrals and better manage heavy caseloads. This is essential given the ageing population and the number of people living with long-term conditions who need ongoing care. Currently there are also differences between GP systems and GP practices in the clinical content of referrals, with multiple templates in use. Although appointments can be booked online through the NHS Digital e-referrals service (NHS e-RS), many hospitals are still receiving paper letters.

Working with clinicians and patients, the PRSB will work to develop evidence-based standardised headings for referral letters and implementation guidance for electronic referrals from GPs to hospitals. Our aim is to produce standards that are practical to use, provide hospital clinicians with what they need to respond to a referral, help patients get the right care and help GPs to communicate the right information.

The scope of the project will be confirmed through discussion with stakeholders, with a project initiation document produced to confirm the final scope. Following a period of evidence gathering, we will hold a workshop, survey and consultation process. We expect a standard to be delivered in the first quarter of 2018. For more information go to www.theprsb.org/projects

Digital care and support planning standard

A workshop to develop the digital care and support planning standard will take place next month on 11 July.

As the number of people living with complex health conditions continues to increase, patients are utilising a greater range of health and social care services. Working in collaboration with the North West London Collaboration of Clinical Commissioning Groups (CCGs) the PRSB is developing the digital care and support planning standard to ensure that care plans can be effectively shared between patients, carers and all health and care professionals involved in the person’s care.

In order to ensure that headings reflect the people’s information needs, we are working with health, social care workers and patients to draft the standard. Next month we will be holding a workshop in London to discuss suggested headings and information structures, so that we can develop a standard that improves care and efficiency for patients and their families, as well as care professionals. For more information go to www.theprsb.org/projects.

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Successful teams have the functional skills to lead a task, benefit from diversity, and are led in a way that creates time and space for reflection; the ability to take stock periodically, of the task and of the way in which the team is engaged in delivering it. Your stakeholder analysis [HYPERLINK] should help you assemble the most appropriate team and identify how the team interacts and relates to other stakeholders like sponsors, services users, etc.

The variation in the size, both in terms of population served and numbers of constituent organisations, and of complexity, between Integrated Care Systems, precludes the possibility of any prescriptive guidance on the way in which this team is assembled.

Engeström’s expansive learning cycle of learning actions explains how there are 7 stages of learning actions;

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests. 
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history. 

 

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning. 

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”