Publication - Report

Realistic Medicine - Feedback Report

Published: 13 Dec 2016

Feedback from the Chief Medical Officer for Scotland's Annual Report 2014/15

34 page PDF

423.4 kB

34 page PDF

423.4 kB

Realistic Medicine - Feedback Report
Annex C

34 page PDF

423.4 kB

Annex C

Realistic Medicine Activity Currently Underway

This is a snapshot of activity that is currently underway on Realistic Medicine across the country which was obtained from sharing the draft feedback report with key stakeholders. It is clear there is a huge amount of activity underway - this is not intended to be a summary of all Realistic Medicine activity in Scotland but merely a snapshot. Should you wish to find out more about any particular contribution please contact the CMO (; telephone 0131 244 2379) and we would be happy to share contacts for you to collaborate and learn further from those championing Realistic Medicine in their areas.

Who? What are they doing already? What offered to do?
Public Health Service Improvement Interest Group
  • House of Care Collaboration in Lothian
  • Fife Shine Project (improving conversations between care providers and people)
  • Redesign of brain injury rehabilitation in NHS Lanarkshire
  • NHS Highland Healthy Weight Pathway
  • New QFIT test for Bowel Screening
NHS Highland
  • Awareness raising
  • Directed work - Area Clinical Forum taken responsibility for themes of RM
  • Clinical meetings looking at variation
  • Promotion of the themes of RM
  • Senior clinician on Board to lead communications
  • Board objectives aligned with the themes
  • International learning applied - Choosing Wisely Canada
Directors of Public Health ( DPH), Ayrshire and Arran
  • House of care collaboration in Lothian
  • Fife Shine Project (changing conversation between staff and patients)
  • Redesign of brain injury rehabilitation service in NHS Lanarkshire
  • NHS Healthy Weight Pathway
  • New QFIT test for Bowel Screening

CEO NHS Lanarkshire
  • Acute: Virtual Intelligence Group ( VIG) linked to RM to find evidence with improvement leadership
  • HSCPs: Recenty published "Achieving Excellence" referencing RM, Project with GPs around risk and public health and planning care for oncology patients
  • Primary/ secondary: considered RM at 3 hopsital / GP interace groups with Prescribing and Efficiency programme established
  • Hospital Anticipatory Care Planning led by Robin Taylor (for roll out across Scotland)
CEO NHS Lothian
  • Considering application of RM in primary and secondary environments including management of risk and shared decision making in oncology
For Scotland and wider community:
  • Insights into concerns among clinical community that might impede spread of RM
  • Proactive measures to support spread of RM
CEO NHS Tayside
  • RM one of seven transformation workstreams in Five Year Transformation
  • Engaging clinical colleagues locally through development work
  • Working with NHS Lothian - aimed at building coalition of willing and RM champions around their RM/ Choosing Wisely Programme
  • Discovering tool utilised for benchmarking
  • Transformation programme focused on medicine management, optimising demand for disagnostic interventions, managing demand for clinical interventions, optimising patient stays and recalls and care pathways
  • RM Clinical Reference Group/ Champions
  • Development programme to embed RM
  • Work with HENS on evidence
  • Considering wider campaign with clinicians and patients
  • RM approach in palliative care
  • Professionalism through Promoting Professionalism for Medical Students and Doctors Programme and considering how with SAMD support can include RM
  • Communication - Developed with Academy of Medical Royal Colleges a framework for generic professional capabilities
  • Consent - embarking on a review of our consent guidance with RM team
Healthcare Improvement Scotland
  • Supporting person centred care, empowering and enabling citizens to have meaningful say
  • Providing strong and comprehensive assessments of quality of health and social care in Scotland
  • Supporting redesign of health and social care service
  • Improving analysis and assessment of inappropriate variation
  • Providing independent external assessment of the sustainability of service provision
  • Play part in raising quality of health and social care
  • Supporting leadership in NHS
  • Actively developing Effective Care Programme ( ECaP)
Scottish Ambulance Service Following RM approach with:
  • Care of Frail Elderly Patients
  • Care of patients following stroke
  • Out of Hospital Cardiac Arrest
  • Care of patients with mental health crisis
  • Paramedics in support of primary care services
  • Towards 2020 - Taking Care to the Patient maps onto Realistic Medicine and will consider detail in development of evidence based pathways, working with HSCPs to develop alternatives to transport to hospital and decision support in field, workforce development and data to drive innovation.
NHS GGC RM being addressed in:
  • Advanced nurse practitioners
  • Chronic disease management
  • Primary Care
  • Holistic needs and care planning - test of change
  • Improving the cancer journey and application of tools to life changing conditions
  • Local health literacy action plan
  • Adopting Getting to Know me and What Matters to Me
  • Better monitoring of variation including CDM programme uptake this year
  • Workforce development
  • Better user of technology enabled care to involve patients in decision making
  • Multi-disciplinary approach to RM
  • Tests of change in maternity and diabetes to other areas
DPH NHS Lanarkshire
  • Contributing to work programme on RM with a specialty registrar in PH supported by CPHM and working with Assoc MD and Director Acute Services at evidence for RM
  • Skills and expertise in critical appraisal. Population perspectives as well as individual
DPH Western Isles
  • Patient Centred Pathways Programme
  • Varicose Vein Treatment- reviewing referral guidelines
  • Biologics and biosimilars- evaluation of dose reductions in existing patients and biosimilars for new patients
  • Anticipatory Care Planning
  • Ophthalmology - releasing consultant to perform cataracts with specialist nursing role enhanced

CEO NHS Borders
  • Transformed existing Quality and Efficiency Programme - with RM subheading - leadership and clinical group meet every few months. The group looking at variation, patient participation
  • Poster in waiting rooms to ask the patient to think ahead for the questions they should ask doctors
  • Creating and effective organisational vehicle for delivery of RM
  • Support with empowering patient
  • Ongoing commitment to RM and focused and accessible CMO Annual Report
NHS D and G MD
  • Appointment of Associate Medical Director
  • Clincial Effectiveness Group
  • RM promoted through GP clusters - to address variation more effectively
  • Identifcation of Data Analyst
  • Project manager to support the work of Assoc Medical Director into RM and reporting to Healthcare Governance Group
  • Sharing ideas with other Boards including demand optimisation Group
  • Six key themes resonate with RM - person centred (working with Patient Opinion/ Voice and Good Conversations and initiatives to improve communications with gypsy/travellers), leadership (mandatory training review), variation in practice (consultants agree to reduce number of minor surgical procedures that add no value and updating clinical strategy), informed consent (including updating consent forms, good examples in Learning Disability), managing risk (around older patients), supporting improvement (including through Hospital Huddles)

NHS Forth Valley
  • Polypharmacy reviews
  • Reduction in step 2 opiods by GP practices
  • Macmillan to employ consultant for improving end of life decision making
  • Data about acute admissions - leading to practice change
  • Variation in ward based practice through IHO work
  • Mental health in Falkirk - involved stopping activity not supported by evidence base
  • Clear pathways in day case and 23 days surgery to reduce variation
  • Innovative practice around GP practices
  • Diabetic foot care to reduce variation
  • ALFY and patient based plans
  • Prevention and self-management prioritised in new healthcare strategy
  • Supporting consultants to lead innovation projects in dermatology and diabetes
  • Developing enhance skills for staff to have conversations around ITU referrals and ceiling of care
  • Leadership from MDs to support GM in their work with doctors at all stages of career
NES Safety and improvement :
  • Quality improvement work
  • Patient Safety
  • Patient Safety Training
  • Patient Safety Tools
  • Enhanced SEA
  • Structured handover, Adverse Event, Trigger Review Method, Patient Stories
  • Healthcare Associated Infections
  • Primary Care Safety and Improvement resources
  • Human Factors Training
  • Sharing Intelligence for Health and Care Leadership and Management
  • Scottish Clinical Leadership Fellow Programme
  • Advance Communication skills in both undergraduate and postgraduate training
  • Promoting need for reflection and staff wellbeing
  • Enabling doctors to cope with uncertainty
  • Communicating
  • Supporting self-management
  • Practice based small learning groups
NSS Medical Director
  • Practical implementation and delivery
NHS D and G Director of Med Education
  • Human factor courses
  • Trainees to take part on Qi projects to reduce variation
  • RM summary documents to all trainees at generic induction and emphasised importance of shared decision making
  • FY doctors have session on what matters to me and RM early in year
  • Consultation skills courses advertising- people may choose CPD to improve shared decision making
  • Enthusiastic support
NHS Grampian DME
  • Presented RM to ENT Scotland at 2016 summer meeting
  • Investigate evidence base of routine nasal surgery, review local neck ultrasound protocols to address rising numbers of incidental thyroid findings picked up
  • Enthusiasm to promote this concept with ENT Surgery and strive for a critical analysis of procedures of limited benefit to patients (eg snoring surgery)
  • Continue to engage with Primary Care colleagues to ensure appropriate referrals
Dean of Medicine University of Dundee
  • Introduction of RM into the curriculum around reducing harm, managing risk, building a personalised approach to care modules
Principal and Head of School of Medicine, Univ of Glasgow
  • Acknowledging RM importance and tie in with Professionalism teaching
University of St Andrews
  • Commitment to patient safety
  • Introduction of communication skills in curriculum
  • Graduate Entry Medical degree to take students in 2018 with training in community for complex patients.
  • Teaching and training around good communication
  • Mentoring doctors
  • Addressing unwarranted variation embedded in work with SIGN etc
  • Body of clinical expertise to support RM
  • Welcome SG policy to support RM
  • Recognise challenge professional workload represents
  • Innovation, leadership and improvement should be recognised by employers
  • Invite to speak at College
State hospital
  • Supporting patients in work around shared decision making, reducing haram and waste, variation, innovation, education.
  • Lessons from Forensic Network to apply to RM
  • Founding member of Links worker programme
  • Strategy and support for GP clusters to reduce variation
  • Supporting efforts to reduce waste including Spend to Save in RCGP Scotland's A Blueprint for General Practice
  • Combining expertise for collaborative work.
  • Core Values publication on patient/ doctor relationships
  • Quality work based on GP clusters to better manage clinical risk
  • Leadership for Innovation programme
NHS Grampian
  • Grampian's Clinical Strategy with links to Realistic Medicine is out for consultation

Golden Jubilee
  • Leading in enhanced recovery after surgery
  • Systematic review of treatment consent procedures
  • Developing clinical outcomes frameworks
  • Examples of service redesign via Strategic Projects Group and Quality Bid Process
  • Exploring pilots with SAMD and DOFs on clinical treatment sets
  • Leadership framework implementation - universal Human Factors and QI awareness training