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10 steps to a networked care model


Methodology

To help and to reinforce our aim to provide a replicable model, we have developed a methodology to:

  • guide prospective partners through the process.
  • enable standardisation of approach.
  • use consistent documentation.
  • evidence decision making.
  • enable replication at pace.

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While this is primarily intended for developing a single speciality networked care model, it could be applied to other forms of service development. It is designed to enable organisations to move through a structured process from when a (host) trust starts to consider alternative service delivery models through developing a partnership, mobilisation and service transition. It is supported by practical tools (templates) which can be downloaded and adapted for you to use within your own organisation.

We have provided a partnership programme plan which is linked to the 10 steps methodology as template 8 and you may choose to use this from step 1 through to transition.

Step 1:

Identify service concerns or other reason for review

It is important, regardless of the reason for the service review, that as far as is possible, the host trust (the organisation currently providing the service directly or indirectly) gathers sufficient information to make an informed decision at each key stage.

We have provided a template for you to capture some initial scoping information template 1. We have also provided a scoring template. The scoring document is a way of quantifying the information collected into a simple evidence-based format to help make decisions. At this stage consider whether it would be better to collect more detailed information to save time later. The template 3a and template 3b provide this more detailed approach.

  • As far as is possible clear baselines will be needed so that the success of any decision and future performance can be judged.
  • Measurement against national and local quality standards will enable you to assess current performance. Sample metrics are provided to help you to do this.
  • The local sustainability and transformation planning group and commissioners should be involved from the start so that time is not wasted on a solution which is not supported.

 

Agreeing a specialty review image

Step 2:

Agreeing a specialty review

As this toolkit is primarily aimed at developing single speciality networked care, the scoring template encourages a specialist review. The absence of local clinical expertise to lead and mentor a smaller specialty can be a symptom of service failure or risk of failure. It can also make it difficult for hospital management to make informed choices about a service’s future.

There are times when it can be beneficial for an organisation to commission an independent, expert review of the service to understand what it currently looks like and provide a gap analysis for what is needed to create longer-term sustainability.

  • Metrics are helpful but do not tell the whole story.
  • An external review by a small multidisciplinary specialty team, with a specific remit and questions to answer, can help the organisation to consider options.
  • Options could include continuing with the service and trying to bridge the gap or seeking a partnership with a specialty provider.
  • The information gathered will be useful whether you go into partnership or not, as the basis for future improvement, whatever the model.
  • A review can help develop a service specification if there is a decision to use a procurement process.
  • The review team can be different from the eventual partner but if you have a partner in mind it is prudent to use it so that the review can serve as due diligence if you proceed.

All steps in the methodology are designed to provide assurance that a robust process has been followed.

Step 3:

Planning the review visit

This is potentially the start of building a relationship with a prospective partner.

  • Contact the specialty provider. Be clear about who is best to provide this expert review.
  • Steps to planning the discussion (telecom or short visit from speciality provider):
    • Discuss the overarching question or concern for review – be clear about your concerns or objectives.
    • Agree the key questions which need to be answered as part of the report so that the expected outputs are clear to both parties. This should include whether the host trust wants any specific recommendations about future management of the service.
    • Agree information required before the visit.
    • Agree the visit date(s).

Template 4 is a template for the review agreement.Planning the review visit image

Having agreed the review, the specialty review team will need you to send more detailed information than may have been collected at step 1. This is why we suggest using template 3 at that early stage. Send detailed information to the specialty review team template 3a (Excel) and template 3b (Word). Please note that some information may not be able to be shared at this stage due to commercial or potential TUPE regulations. However if the partner has already been identified, it may be helpful to consider accelerating the process to include agreeing the memorandum of understanding and data sharing agreements (step 5).

  • The review team will also gather information about the local health economy and other providers unless the host trust can provide this.
  • The more information the host trust can gather, the more comprehensive the overall review report will be. The host trust should start gathering financial detail but it may not be shared at this stage with the review team unless this is the prospective partner.

 

Step 4:

Review visit methodology

The onus now shifts to the specialty provider review team responsible for both the review visit methodology and report structure. But it is important to ensure that the host trust is clear about the process.

We have provided a template that can be used for planning the review visit template 5 although local circumstances will vary so it can be adapted accordingly. The specialty team will need access to all relevant clinical areas in order to carry out an effective review. The team will want to spend as much time as possible with frontline staff and patients and will need planned interview slots for key local service leaders.

At the end of the visit the review team clinical lead will share with the service clinical lead and manager any clinical concerns needing urgent attention. Some positive feedback on something observed which deserves special mention can help to leave things on a positive note. No further discussion should be entered into until all the team members can assimilate their findings.

Review visit methodology photo

Step 5:

Review visit report and feedback meetingReview visit report and feedback meeting photo

The review team should share its findings and recommendations in a formal written report and at a face-to-face meeting with the host trust. Template 6 is a framework for the report and information to be collected during the review although, again, this will vary according to local circumstances.

The host trust should now be in a position to decide how to proceed.

The following steps assume the host trust decides on a single speciality networked care provider solution. However the steps and templates can be adapted for other solutions.

Step 6:

Developing a memorandum of understanding (MoU)

Developing a memorandum of understanding (MoU) photoThere will be a period between the decision to work together to see if a mutual solution can be agreed and any final decision and business case. There should be transparency between the two parties to ensure that the best outcome can be achieved:

  • The MoU states the responsibilities, activities, outcomes and lead contacts between the host trust and the specialty provider. It is non-binding and mutually beneficial.
  • There is no agreed formal structure for an MoU but one or more of the parties are likely to have an organisational template it is required to use.
  • The MoU’s purpose is to ensure both sides deliver what is agreed: the host trust to supply information and the specialist team to plan how the new service will address gaps and innovate.
  • The MoU will inform the business case so the host will have to share financial data.
  • Consider involving the commissioners in the MoU as their co-operation and support may be needed.
  • The framework for the agreement needs to be discussed – how the service will be managed, financial agreements and so forth. Are both parties in agreement as to how the service will be managed?

Both parties must sign a data-sharing agreement in respect of sharing any identifiable patient and staff information.

The information governance leads for each partner must be involved in this process to ensure that all safeguards are in place.

Step 7:

Developing the networked care solution

  • The host trust now supplies more detailed information to enable the specialist partner to see if a networked care solution can be developed. The template 3a and template 3b detail will now need to expand to include the financial data to help the specialty provider assess business viability. For example:
    • Activity remuneration: there may be local prices and agreements which the specialist provider will need to understand. The contracting department can provide a full year activity costing.
    • Staff costs: the specialty provider will need to know the grades and spine points in order to accurately cost the existing staff resource. This may still need to be without names and some more sensitive information which cannot be provided until TUPE information can be requested (if a transfer is imminent) or after staff transfer (if they transfer). However the full staff costs should be shared at this stage.
    • The specialty provider will need to make a decision about equipment – will it transfer, is it suitable for transfer and any costs. There is likely to be a need for capital investment so this will be a key part of any business case development.
    • Space: what are the space costs? After staff, revenue costs of space are usually the next highest cost for any new provider.

The partnership arrangement (or contract form) will be key to the specialty provider business case. Our board-level interviews showed some differences in the way organisation executives think about networked care partnerships. Both parties need to be clear from the outset about what they want to get from the partnership and the level of control or autonomy each party expects to have. Key considerations:

  • Joint meetings and two-way information exchanges will help develop solutions.
  • It is essential to bring together key internal stakeholders from both organisations to ensure that agreements are reached and at the right level, for example resuscitation-officer-to-resuscitation-officer; pharmacy-to-pharmacy and so on.
  • Commissioners must be kept informed as the process develops.
  • Performance baselines should be agreed so that success can be measured before and during service transition.

Step 8:

Designing the improved service

The review report, further discussions and information sharing will now enable the specialty partner to develop the revised service plan. We have provided a comprehensive planning checklist template 7a (Excel) and template 7b (Word) which has multiple functions:

  • It can be used instead of templates 1 and 3 as a more comprehensive current service review.
  • It will help the specialty provider to ensure all aspects of the potential service are identified.
  • It will enable both partners to identify the internal stakeholders needed to agree/sign off aspects of the service, for example the resuscitation arrangements.
  • It will become the mobilisation checklist when adapted from the planning phase.
  • It will ensure all staffing, space, equipment resources and costs are identified for the business case.
  • It provides assurance that the service has been planned well.
  • The detail collected at step 3 and updated at step 7 will accelerate the business case detail and mobilisation planning. It will ensure that all activities and costs are captured avoiding problems once the service is being mobilised. Plan for every eventuality, then plan again!

 

Step 9:

Business case

The business plan will need to be developed by the specialty partner for its board-level approval. Depending on the proposed partnership, this may not be straightforward, for example if the host trust wants to retain some financial or managerial interest.

A business case template 8 can be used although most organisations have their own.

Step 10:

Mobilisation and transitionBusiness case photo

We have provided a partnership programme plan template 9 which can be used from step 1 throughout the process. It is a template which will need to be populated in more detail locally.

Critical success factors for mobilisation include:

  • a robust engagement and communication strategy, starting from the decision to develop a business plan to the opening of the new facility.
  • an experienced project leadership and governance structure supported by project management methodology.
  • a project team who research operational requirements and costs thoroughly in order to inform the business case and service level agreement.
  • use of easily-accessible approved templates to improve learning and communicate plans.
  • an agreed stakeholder project group for every new operational service development project ensuring that services are co-created with patients.
  • understanding what success looks like for finances, reputation and market share.
  • robust analysis tracking the impact on clinical outcomes, patient experience, activity and contribution.

“Had someone senior undertaken with total clarity the operational requirements, costs, site requirements and SLA before mobilisation, most issues would probably have been avoided.”

Once the service starts, review the process and see what can be learned. If toolkit methodology and/or toolkit templates are used please let us know how useful they are using the website feedback form or by emailing enquiries@networkedcaretoolkit.org.uk