With approaches to patient care changing all the time, there has never been a better time to offer a dynamic glossary for the terms we commonly use.
The UK’s respiratory health sector is increasingly diverse and, whilst many HCPs still work in traditional settings, others are involved in project-based matrix teams.
These may be led by an Academic Health Science Network, where colleagues come from beyond the traditional healthcare system, or involve other stakeholders.
Whilst this is the very point of collaborative partnerships, it doesn’t always make it easy for colleagues to hit the ground running on a shared project.
This Jargon buster will evolve over time and we welcome your ideas to help keep it up to date with the most commonly used terms whilst introducing new ones.
AHSNs bring together expertise from across education, clinical research, informatics, charities, health and social care to support integrated delivery of health services. These organisations facilitate knowledge and best practice sharing; driving change and improvements in patient safety and quality of care. NHS England has established 15 AHSNs; each with responsibility for improving services to meet local needs and inequalities. AHSNs aim to put research and innovation in to practice through collaborations between industry and healthcare providers, service redesign and medicines optimisation.
The AAR is an independent review commissioned by Government to identify ways to speed up patient access to medical innovation. The review draws on input from over 600 experts within the NHS, patient and carer organisations, research institutions and industry. It focuses on provision of drugs, diagnostics, medical devices and digital health resources. The AAR was launched in March 2015. An interim report was published in October 2015 and a series of reports focusing on different pathways have subsequently been published. Publication of the final AAR report was delayed due to the recent EU referendum. Final publication is expected by the end of 2016.
ACOs are at the heart of the NHS England place-based systems of care programme. ACOs take many different forms including groups of GP practices (General Practice super-partnerships), acute and primary care providers, and chains of hospitals working with local primary care practitioners and nursing homes. ACOs are responsible for a population-based budget. Further financial incentives are aligned with quality and outcome metrics linked with patient safety and preventative care. Shared-savings programmes enable savings to be split across the ACO.
Hospital AMU teams provide rapid assessment, investigation and treatment for patients admitted urgently via out-patient services, the Accident and Emergency Department or GP referral. Following treatment on the AMU, patients with either be discharged or transferred to appropriate in-patient facilities. Common conditions treated within AMUs include asthma exacerbations, chest infection and other respiratory conditions, heart problems and acute illness in the elderly. Following discharge, AMUs should provide a summary to the patient’s GP, providing details of investigations and treatment including medication on discharge, and recommendations for aftercare.
Acute trusts are responsible for the management, efficiency and improvement of hospital (and some community) services. These services include specialised clinical services as well as support services, e.g. physiotherapy, podiatry, speech and language therapy, counselling and scientific services such as diagnostics. Acute trusts may also be regional or national centres for more specialised care or provide training through university partnerships.
Academic Health and Science Networks (AHSNs) across NHS England have identified over 100 different programmes of activity that should be prioritised in order to improve patient services. These include service redesign, health outcomes and economic growth opportunities. AHSN priorities have been collated in a matrix document, available via the NHS England website.
ALLIANCE Scotland is the national third sector health and social care intermediary for Scotland. It brings together over 500 organisations and 1,000 individuals. It works in partnership with the Scottish Government and national health and social care bodies to ensure the opinions of people with long-term conditions are incorporated within policy and practice.
APMS contracts are used to commission primary care medical services from GP practices or any other provider of services including commercial providers, not-for-profit organisations, voluntary and community sector organisations and NHS trusts. These contracts aim to increase capacity and offer more choice.
Ambulance trusts manage ambulance services, providing a range of other urgent and planned healthcare and transport services. In some cases, ambulance services may instead be managed by a foundation trust.
ACS conditions are chronic illnesses in which hospitalisation may be avoided through proactive disease management. Medical and lifestyle approaches such as vaccinations, self-management plans and effective use of medicines may prevent acute exacerbations and reduce hospital admissions. ACS conditions include congestive heart failure, diabetes, asthma, epilepsy and hypertension.
The Atlas of Solutions in Healthcare is an online tool developed by NHS England’s 15 Academic Health Science Networks (AHSNs). The tool showcases innovative programmes that have improved standards of care and delivered NHS efficiencies. It aims to share examples of best practice and facilitate innovation across health and care services. Each example meets one or more of the priorities identified within the Five Year Forward View. Local contacts are also included so that other service providers can follow up for advice and further information.
The NHS England Atlas of Variation provides an analysis of publicly available data regarding healthcare investment, activity and outcomes across the national population. Areas of health inequality and variation are highlighted, alongside the potential costs to society and the individual patient. A series of Atlases have now been published, and the most recent document can be downloaded directly from the Right Care website.
The BPT aims to reduce variation in clinical care and to encourage delivery of evidence- based, high quality and cost-effective care. Payments made under this scheme will reflect the cost of best practice or recommended approaches to diagnosis and management of conditions rather than standard or usual care. This model is designed to incentivise best practice, which may be more or less expensive than usual care but should result in better patient outcomes in the majority of cases.
The BPT for COPD aims to improve the care provided to COPD patients immediately following emergency hospitalisation. Payments will be made based on recommended best practice and the scheme will be monitored via the national COPD audit programme. Patients must receive specialist input within 24 hours of hospital admission for an exacerbation and a discharge care bundle (including appropriate provision of inhaler technique training, medicines review, self-management plan, smoking cessation advice and pulmonary rehabilitation) should be provided. NHS Improvement have provided an update of plans regarding the BPT online.
National payments and reimbursement for the treatment of pleural effusion have been defined in line with recognised best practice. These BPT payments encourage out-patient management of undiagnosed pleural effusion with the aim of avoiding hospital admissions.
The CQRS digital system helps GP practices to track, monitor, and report achievements against the Quality and Outcomes Framework (QOF), Enhanced Services (ES) and vaccination programmes. Further information regarding the digital systems used in General Practice can be found on the NHS digital website.
The Caldicott Standards are based on the Data Protection Act 1998 and provide the principles that should be used for collection and storage of personal information and data within health services, including councils and social care services. The standards are defined as 6 key principles:
A care bundle is a set of 3-5 evidence-based interventions that significantly improve patient outcomes. Multidisciplinary teams work to deliver the best possible care supported by evidence-based research and practices, with a focus on improving patient care. All of the interventions must be performed within a defined process or algorithm and time frame by one healthcare team.
Care pathways are documented plans setting out a patient’s care provision. These plans are sometimes referred to as clinical pathways, critical pathways or case management plans. They map out the multidisciplinary care a patient should expect across organisational boundaries. They also provide a consistent template for documentation of care that supports ongoing auditing and recording of best practice.
The CQC are the independent regulator of health and social care in England. They monitor, inspect and regulate services to ensure that they meet defined standards for quality and safety. Where services do not meet the required standards, the CQC may issue a warning notice that requests improvement within a defined time period, they may restrict admissions to services, issue fixed penalty notices, suspend/cancel a provider’s registration or prosecute providers. Inspection reports are published via the CQC website including details of where improvements should be made to bring services in line with quality standards.
In February 2016, Lord Carter published his independent review of operational productivity and performance in English NHS acute hospitals. The review assessed productivity and efficiency in English non-specialist acute hospitals and concluded that around £5 billion may be saved by addressing ‘unwarranted variation’ across services. The report makes 15 recommendations designed to tackle this issue and help trusts improve their performance.
Following the UK’s decision to leave the European Union (EU), a group of 29 organisations representing health and social care staff and employers formed a group to support sustained delivery of care during the transition process. With approximately 144,000 EU nationals working within the health and social care sector, the BREXIT decision has potential implications for these services in the UK. The group includes organisations such as the Royal College of Nursing, the National Association of Primary Care, NHS Confederation and the New NHS Alliance.
NHS England has a statutory duty to conduct an annual assessment of every Clinical Commissioning Group (CCG). The CCG Improvement and Assessment Framework focuses on six key areas of care (cancer, dementia, diabetes, mental health, learning disabilities and maternity care) and an additional 29 performance areas, including new care models, and efficiency. The framework will provide a focal point for joint work and will also incorporate information taken from local Sustainability and Transformation Plans (STPs).
Choose and Book was an online booking system, used at the point of referral from primary care, that allowed patients to select the hospital, date and time of their hospital or clinic appointment. The system also allowed patients to independently manage their ongoing appointments. The Choose and Book system has been replaced by the NHS e-referral service.
CAS/CATS facilities are intermediate services that enable patients to be assessed, diagnosed and often treated by healthcare professionals who have a higher level of training and specialist clinical expertise in a particular area than would normally be available in primary care. Patients are usually referred to CAS/CATS services by their GP. These services may be staffed by GPs with a Special Interest (GPwSIs), other healthcare practitioners (e.g. physiotherapists) or multidisciplinary teams (e.g. Community Mental Health Teams or secondary care clinicians), and may be based in primary care, secondary care or independent provider settings.
CCGs are the independent commissioning organisations that took over many of the responsibilities previously held by Primary Care Trusts in 2013. They are designed to put GPs at the heart of NHS decision making and are responsible for the planning and commissioning of local healthcare services. CCG membership consist of all the GP practices within the locality. They are led by a governing body made up of GPs, nurses, secondary care consultants and lay members and are responsible for around 60% of the national NHS budget.
Clinical senates are advisory groups that support clinical commissioning groups (CCGs). Senates are made up of experts from across health and social care settings as well as patients and members of the public. There are 12 senates across England that offer local CCGs strategic advice and insight regarding the communities they represent.
The CMU is part of the Medicine, Pharmacy and Industry Group within the Department of Health, which supports supply and procurement of medicines across England. The CMU team have specialist knowledge and expertise in managing the contractual process concerning the purchase of medicines to ensure that the NHS obtains the best value from suppliers.
Commissioning is the process of planning, purchasing and monitoring services with the aim of obtaining optimal value for high quality services. Within the NHS, this is an extremely complex process as service planning is required to meet the diverse needs of local populations in an environment with restricted funding. Most of the NHS commissioning budget is now managed locally by clinical commissioning groups (CCGs), but NHS England still commissions some specialised services at a national level.
The CQUIN payments framework is designed to incentivise local commissioners to drive improvements in service quality and transformational change with the aim of achieving better patient outcomes. The 2016/2017 CQUIN framework is influenced by the Five Year Forward View and aligned with the Sustainability and Transformation Plans (STPs) that will guide health and social care services in the coming year. New indicators have been included around the health and wellbeing of NHS staff with the aim of supporting a sustainable workforce.
CSUs provide non-clinical support services to enable clinical commissioners to focus on delivery of patient care. Nine CSUs, based across England, help CCGs to achieve efficiencies and savings so that more money can be reinvested in frontline clinical care. CSUs offer a wide range of specialist services including contract management and negotiation, service redesign support, financial management, human resources advice, healthcare procurement and non-clinical purchasing and patient engagement.
CHCs are independent statutory organisations that represent the interests of patients across Wales. CHCs provide the link between healthcare commissioners/providers and service users. They inspect NHS premises and provide recommendations for improvement, consult with local Health Boards and provide patient advocacy services.
Community health trusts may be part of a foundation trust or function independently of a hospital trust. They manage delivery of community-based services such as district nursing, health visitors, school nursing, NHS walk-in centres and home-based rehabilitation.
Continuing care (or fully funded care) is NHS-funded care that is provided within the community setting. Continuing care may be delivered within the patient’s home or care home. Eligibility for CCG funding is based upon a number of factors including the patient’s behaviour, cognition and ability to communicate as well as psychological and mobility requirements, breathing difficulties and symptom control through medication and other therapies.
The DSU provides research and training support on behalf of the National Institute for Health and Care Excellence (NICE) to support technology appraisals. The DSU is a collaboration between the Universities of Sheffield, York and Leicester. Additional members are also based at the University of Bristol, London School of Hygiene and Tropical Medicine and Brunel University.
The Department of Health (Health-NI) is responsible for the delivery of health and social wellbeing services for Northern Ireland. The Department oversees policy and legislation focused in three broad areas: health and social care, public health and public safety. Until May 2016, the Department was called the Department of Health, Social Services and Public Safety.
‘Devo Manc’ is the short-hand term used to describe the devolution agreement allowing transition of certain responsibilities from central government to Greater Manchester’s local councils. Devolution will enable local government to take control of funding and delivery of key community services including transport, housing, skills and training, health and social care.
Enhanced services (ES) are provided in addition to essential services that are required under core GMS contracts in primary care. The aim of ES provision is to avoid unplanned hospital admissions and reduce demand on secondary care while offering more local services that provide value for money and are aligned with local needs. These services are commissioned using the CCG budget. Chronic obstructive pulmonary disease (COPD) is often managed through enhanced local services.
Enhanced services (ES) are provided in addition to essential services that are required under core GMS contracts in primary care. The aim of ES provision is to avoid unplanned hospital admissions and reduce demand on secondary care while offering more local services that provide value for money and are aligned with local needs. These services are commissioned using the CCG budget. Chronic obstructive pulmonary disease (COPD) is often managed through enhanced local services.
The NHS e-referral service is a national electronic referral tool that enables clinicians and patients to book out-patient referral appointments online. This service aims to speed up referral to treatment time and offer greater choice of hospital or specialist options as well as making cost savings and reducing administration resource supporting this process.
Essential services are those that primary care providers are required to deliver for registered patients in line with the GMS contract. There are 7 additional services that practices can choose to opt out of: cervical cytology, child health surveillance, maternity medical services, contraceptive services, minor surgery, childhood immunisations and pre-school boosters and vaccinations and immunisations.
EPPs are self-management programmes that are offered to patients who have long-term medical conditions, e.g. asthma and diabetes, to improve understanding of their disease and management of their condition. EPP courses usually run over a 6-week period and empower patients to take control of their condition, working in partnership with their healthcare professional(s) and achieving a better quality of life. The courses cover areas such as goal setting, fitness and exercise, breathing techniques, healthy eating and communication skills.
Published in October 2014, the Five Year Forward View sets out a clear direction for the NHS in England and provides context regarding the changes that are required to support a sustainable health service. It was developed by NHS England, NHS Improvement (Monitor and the NHS Trust Development Authority), Health Education England (HEE), The National Institute for Health and Care Excellence (NICE), Public Health England (PHE) and the Care Quality Commission (CQC). The Forward View recommends that commissioners and practitioners form partnerships with local communities, local authorities and employers through development of Sustainability Transformation Plans (STPs). The document highlights critical areas of public health that must be prioritised and the need for greater provision of care at the local level.
Foundation trusts are independent healthcare organisations that have the freedom to manage their own budget and strategic direction. They are able to raise funds via public and private sector arrangements, and they are accountable to a board of governors, which usually include representatives from the communities that they serve. Most hospitals and secondary care services in England are managed by these trusts. In some cases, ambulance services are also managed by the foundation trust.
The Freedom of Information Act 2000 provides access to information held by public bodies. Since the introduction of the Act, public authorities have been required to publish certain information concerning their activities and financial dealings, and members of the public can request information from these organisations. Public organisations covered by the Act include Government departments, local authorities, NHS, state schools and the police forces. The Act does not automatically give people access to their own personal data, e.g. health records, but people are able to request this information in line with the Data Protection Act 1998.
The Future Hospital Programme was developed with the aim of improving care by bringing specialist services closer to the patient - whether they are in hospital or in the community. The Royal College of Physicians has created the Future Hospitals Partner Network to oversee this work with the aim of sharing and nurturing innovative practice. The programme focuses on areas such as patient experience, timely access to effective care, transfer of care arrangements, communication and tailoring services to individual patient needs.
The GMS contract is the agreement between General Practices and NHS England for delivery of primary care services. The General Practitioners Committee (GPC) negotiates the contract with NHS England on behalf of the British Medical Association (BMA). The GMS contract was first introduced in 2003 and covers the costs of running a General Practice, the quality and outcomes framework (QOF) and enhanced services (ES).
The General Practice chronic disease population profiles have been produced by NHS Wales to help practices and groups of practices (or GP clusters) with their development plans. The profiles provide information on key indicators that are appropriate for local populations. Details of geographic spread, age, gender, deprivation and access to primary care are provided alongside information regarding chronic diseases that have a high impact on services including chronic obstructive pulmonary disease (COPD), asthma, coronary heart disease, epilepsy, hypertension and diabetes.
The General Practice Forward View, published in April 2016, provides a national plan for the transformation of General Practice. The plan was developed by NHS England, Health Education England and Royal College of GPs. It contains practical advice on growth and development of staff, efficiencies in workload and technology to help redesign primary care services. To support the plan, NHS England have promised an investment of £2.4 billion a year by 2020/21, which will be supplemented by a one off five-year £500 million national sustainability and transformation package.
As primary care colleagues seek more innovative ways to manage growing demand for local services, multiple practices spanning more than one CCG are joining forces to form organisations known as super-partnerships or super-practices. Managed by a board of GPs from across the constituent practices, each practice maintains autonomy concerning service delivery and CQC inspections etc. However, a number of expensive managerial and administrative tasks can be streamlined via the organisation, including accountancy and follow-up regarding payments, to make efficiencies and the best use of resources within the partnership.
GPwSIs are GPs with expertise in a specific area of medicine, e.g. respiratory medicine. They are often involved in service development as well as clinical care. Since 2009, GPwSIs have been required to be accredited in line with a competency framework to ensure levels of knowledge and skills are maintained. The Royal College of General Practitioners (RCGP) provides specific frameworks, designed to help practitioners and accreditors understand the knowledge and skills required.
The GIRFT report was published in 2012 by Professor Timothy Briggs (Medical Director and Consultant Orthopaedic Surgeon, Royal National Orthopaedic Trust, Middlesex). The report provided direction concerning approaches to cost-effective quality improvements in orthopaedic care. This was the first time quality, productivity and efficiency performance metrics had been collated in a single dashboard. The report highlighted the need for appropriate patient pathways and referral systems that ensure patients are seen by the right specialist at the right time, efficient approaches to treatment in secondary care that focus on improving patient outcomes and reducing complications from the first appointment and patient follow-up. In 2016, the Carter Review recommended that the GIRFT initiative should be extended to other NHS services to tackle unwarranted variation and improve efficiency. This work is now led and by the Faculty of Improvement.
The GP Cluster Network Development Domain is a framework that enables practices in Wales to collaborate and operate as a local network or cluster to improve coordination of care and integration of health and social care services within each Health Board. Practices will participate in at least 4 cluster network meetings per year to track progress against the plan. Local Health Boards will respond to issues raised by the cluster and an annual Cluster Network Report will publish details of achievements against objectives.
Six HSC trusts oversee delivery of integrated health and social care services across Northern Ireland. Five trusts manage hospital, health centre, residential home, day centre and other associated health and social care services. The sixth trust oversees the Northern Ireland Ambulance Service.
The Health and Social Care Improvement Network aims to provide opportunities for collaborative approaches and joint working initiatives that drive health improvement across Wales. The network draws together organisations across a range of sectors with common objectives concerning the improvement of health and social care services for people living in Wales.
Health and Wellbeing Boards are statutory organisations that work at the local level to link health providers with colleagues in local authorities, public health teams, social care and related services to provide a more joined-up approach to healthcare in England. According to the Kings Fund, there are currently 130 Health and Wellbeing Boards across England, most of which are hosted by local authorities. These organisations prioritise provision of funding and resource in line with the local population requirements and health inequalities.
Health Boards in Scotland and Wales are responsible for provision of healthcare services. In Scotland, 14 local Health Boards oversee delivery of healthcare, supported by 7 national Health Boards. In Wales, 7 local Health Boards plan, secure and deliver healthcare services, supported by 3 NHS Trusts. Practices and practice networks (or clusters) feed in to Health Boards to ensure that services are delivered in line with local health priorities.
HEE sits within the Department of Health (DH) and has responsibility for workforce planning as well as commissioning and provision of education for NHS staff. HEE aims to improve consistency and standards of education at a national level. They recruit doctors and dentists in to training and provide funding and education for a range of multidisciplinary roles across the NHS.
Healthcare Improvement Scotland is part of NHS Scotland and oversees national healthcare improvement programmes. The organisation focuses on empowering people to manage their own care, inspection of services and review of provider services in line with evidence-based clinical standards and guidelines.
The HQIP is an independent organisation led by the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices (the coalition of health and social care charities in England). The organisation aims to improve quality of care, with a particular focus on increasing the impact of clinical audit. HQIP commissions, manages and supports national and local clinical audit programmes on behalf of NHS England and other healthcare organisations. HQIP also provides educational programmes and facilitates best practice sharing.
HRGs are often described as ‘currency’ for acute health services in England. HRGs are a set of standardised groupings used to define treatments for related health conditions that use similar levels of healthcare resource. HRGs allow organisations to compare services and are used to support reimbursement and payment by results (PbR). They are also used for benchmarking and standardising commissioning across regions and nationally.
HES is a database containing details of all admissions, out-patient appointments and accident and emergency visits at NHS hospitals in England. This information is used to enable hospitals to be paid for the care they deliver. The data can also be analysed to highlight areas of concern in specific populations, e.g. asthma-related hospital admissions.
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a set of codes that are defined by the World Health Organization (WHO). This system enables consistent global coding of disease diagnoses, symptoms, social factors and causes of injury or diseases. All in-patient admissions and appointments that result in diagnoses must be recorded and coded appropriately in line with the ICD system.
An ICER is a statistic used to summarise the cost-effectiveness of a healthcare intervention. The difference in cost between two potential interventions is divided by the difference in their effect; demonstrated through clinical trials or other research.
(cost of treatment A) - (cost of treatment B)
clinical success with treatment A - clinical success with treatment B
This approach is used in health economic analysis to work out the cost per quality-adjusted life year (QALY) to determine whether a treatment is considered cost-effective.
ISTCs are private sector treatment centres that are commissioned by NHS organisations in England to provide healthcare services that are free for at the point of access for patients. ISTCs usually provide routine elective (non-emergency) surgery and diagnostic services.
Information governance is the legal framework governing the use of personal confidential data. The law allows personal data to be shared between those offering care directly to patients. However, secondary use of data for activities such as services review, commissioning of services and public health planning must not include information that may identify individual patients unless specific consent has been provided by the patient themselves.
INHALE is an online tool providing data concerning respiratory disease. INHALE is a Public Health England initiative that collates data from the Quality and Outcomes Framework (QOF), Hospital Episode Statistics (HES), the Public Health Outcomes Framework (PHOF) and NHS Comparators. Data regarding indicators, prevention, diagnosis, management, outcomes and cost are provided for each CCG to offer a single data source from which a better understanding of local health needs and variation can be obtained.
PrescQIPP provide inhaler technique assessment tools via their website to enable GPs, nurses and pharmacists to offer respiratory patients consistent and high quality advice on how to use their inhaler effectively to obtain the correct amount of medicine and reduce wastage. These tools aim to improve management of asthma and COPD while addressing medicines optimisation.
The integrated care model aims to provide a coordinated approach to delivery of healthcare services, drawing on expertise and skills offered by professionals working across different health and social care organisations. Healthcare professionals working in primary care will work alongside colleagues in secondary care or specialist services and social care to deliver services that meet the need of local people, particularly when managing complex and long-term conditions where patients may receive treatment in hospital and community settings.
A JSNA is research conducted by commissioners to enable local health and social care providers to gain an understanding of current and future local health and wellbeing requirements. Data from JSNAs provide the basis for strategic planning of funding and resources to support the local population and address health inequalities.
Knowledge 4 Commissioning is an NHS resource for England that links local commissioners of health services with data and information providers. This service allows access to information sources and evidence, case studies, best practice examples and news concerning commissioning.
Five LCGs oversee commissioning of health and social care services in Northern Ireland. Each LCG is responsible for assessing health and social care needs, planning for routine and emergency care, and delivering care in line with the requirements of their local population.
LPCs are independent organisations that represent all NHS pharmacy contractors within clinical commissioning groups (CCGs) across England. LPCs work closely with CCGs, local authorities and healthcare professionals to support the planning process for local health services. The LPC negotiates with commissioners regarding pharmacy services and advises community pharmacy contractors.
LSPs are organisations that bring together representatives from public, private, voluntary and community sectors to agree on funding allocation and develop a strategic plan to address local health issues. LSPs encourage joint working and community involvement with the aim of using local resources more efficiently.
The LNDG is an expert advisory body that aims to support commissioners and healthcare providers in making decisions about new medicines. The group focusses on medicines that may have a significant clinical or financial impact and works to ensure efficacy, safety and cost-effectiveness evidence is reflected within medicine reviews. To avoid duplication of effort, the LNDG does not consider medicines that have already been assessed by the National Institute of Health and Clinical Excellence (NICE).
Medicines management aims to provide a more cost-effective approach to prescribing in primary care and to reduce the likelihood of medication errors. Medication reviews and audits, IT decision-support tools, pharmacy or nurse-led interventions and transfer of care programmes (following hospital discharge) help to ensure that patients receive the most appropriate and cost-effective medicines.
Medicines optimisation is a patient-focused approach to obtaining optimal benefit and value from medicines. This approach aims to ensure that the right patients get the right choice of medicine, at the right time. To achieve this, healthcare professionals work in partnership with patients to help them take their medicines correctly and safely, avoid taking unnecessary medicines and reduce wastage. Unlike medicines management, medicines optimisation focuses on outcomes and patients rather than process and systems. Interventions such as inhaler technique training help to support the medicines optimisation agenda by ensuring that patients are able to use their inhaler devices correctly and obtain the right amount of medicine to manage their respiratory condition.
Monitor is the sector regulator for health services in England. In April 2016, it became part of NHS Improvement and supports NHS providers to improve quality and consistency of care.
NCEPOD is an independent group that undertakes confidential surveys and research to monitor and improve the standards of NHS care for adults and children. This organisation’s work originally focused on the care of surgical patients, but has evolved to cover more general medicine. Where issues of concern are identified, NCEPOD refers these cases back to the Medical Director of the health trust/Health Board so that appropriate action can be taken. Consultants involved with the case are also notified.
The National COPD Audit Programme aims to highlight variations in service provision and patient care to drive better standards in the management of COPD. The programme will collate data from across primary care, secondary care and pulmonary rehabilitation services to allow comparison of admissions and outcome data.
The National Information Board (NIB) leads on the use of information technology (IT) on behalf of the Department of Health (DH). The NIB aims to provide a consistent approach to the way that information technology is used across healthcare commissioning and provider organisations. The Board also ensures that system-wide frameworks, such as information governance, are adopted and maintained across the system.
NICE is an independent national body, commissioned by the Department of Health (DH), to produce evidence-based guidance, quality standards and performance metrics for health, public health and social care practitioners as well as commissioners. NICE guidance officially applies to England, but many guidance documents and standards are also adhered to in Wales, Scotland and Northern Ireland.
The NIHR works in partnership with health providers, industry and charities to support health research across the UK with the aim of maximising research opportunities in the NHS, driving faster translation of scientific innovation into tangible benefits for patients and establishing the NHS as an internationally recognised centre of research excellence.
National MCNs are networks of healthcare professional and organisations working across NHS services in primary, secondary and tertiary care within Scotland. The networks aim to improve collaborative working to ensure that patients are able to access the right treatments at the right time.
The NPSA leads on initiatives to improve and maintain safe patient care. The agency sits within the Department of Health (DH), but works at ‘arm’s length’ to inform and support healthcare organisations across the UK with the aim of reducing risk to patient safety.
In 2016, a new national register of healthcare professionals certified to perform and/or interpret diagnostic spirometry in adults was launched providing a competency assessment framework for diagnostic spirometry. To attain the necessary competencies for the national register, healthcare professionals must meet the required standards at one of three levels: Foundation (performing tests only), Full (performing tests & interpreting results) and Interpretation Only. The full document can be accessed via the British Thoracic Society website.
The NRLS is led by the National Patient Safety Agency (NPSA). It provides a central database of patient safety incident reports. This information is analysed to identify potential risks and opportunities to put processes in place to improve patient safety.
NSFs are policy documents developed by the Department for Health (DH) that define quality standards for supporting people with particular conditions. NSFs are developed in partnership with health professionals, patients, carers, managers and voluntary organisations. They provide a review of current evidence concerning available treatments as well as strategies for optimal management.
The NSD regularly reviews health services on behalf of NHS Scotland to map out projected trends in services to form a forward plan, assess current policy for service delivery and review achievements of National Managed Clinical Networks (MCNs) to ensure improvements in patient care and cost-effectiveness targets are met.
Never events are preventable serious incidents. Each event has the potential to cause serious patient harm or death. These include wrong site surgery, retained instrument post operation, wrong route administration of chemotherapy. National guidance and safety procedures are in place to prevent these events from happening where possible.
NERVTAG is an expert committee that advises the Department of Health (DH) and Chief Medical Officer (CMO) on the threat posed by new and emerging respiratory viruses. It also provides risk assessments and advice regarding management of these viruses.
The new care model programme is a national initiative across England, which will be led by the 50 local vanguard sites to meet the objectives set out in the Five Year Forward View. Each vanguard site has a particular area of focus. These comprise: integrated primary and acute care systems, multispecialty community providers, enhanced health in care homes, urgent and emergency care, acute care collaborations.
NHS Choices is the official patient-focused website for the NHS in England. It is the UK's largest health website and offers a comprehensive health information service, providing information on health services and healthy lifestyles as well as review of health and social care services across England.
NHS England leads the National Health Service in England. It provides strategic direction at a national level regarding priorities and innovations required to improve the standard of care. In particular, NHS England issues guidance on the commissioning of health services (managed locally by Clinical Commissioning Groups) and oversees GP, pharmacist, and dentist contracts in England.
NHS Improvement oversees delivery of care via foundation trusts and other NHS trusts, as well as independent providers that offer NHS-funded care. NHS improvement supports trusts in meeting their operational and clinical objectives to offer high quality cost-effective care. It is also a regulator that holds trusts to account and provides education, training and resources to support trusts in meeting the recommended standards.
In 2014, NHS Improving Quality (NHS IQ) launched a national pilot programme to improve speed and accuracy of diagnosis for patients experiencing breathlessness. Three pilot sites were selected, each using integrated models of care, and a report was published in April 2016 evaluating different approaches. The report highlighted 12 key recommendations that will feed in to plans that will support the Five Year Forward View.
The NHS Outcomes Framework summarises the indicators that will be used to hold NHS England to account for improvements in health outcomes. The framework focuses on 5 areas of care or ‘domains’, under which key priorities must be met:
Domain 1: Preventing people from dying prematurely
Domain 2: Enhancing quality of life for people with long-term conditions
Domain 3: Helping people to recover from episodes of ill health or following injury
Domain 4: Ensuring that people have a positive experience of care
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm
The NHS Partners Network is the trade association representing independent providers of NHS-funded clinical services, including commercial and third sector organisations.
The NHS Planning Guidance document, published by NHS England, outlines the plan for implementation of the Five Year Forward View. The guidance incorporates recommendations from the Kings Fund regarding place-based approaches to planning and systems of care, Sustainability and Transformation Plans (STPs), local operational plans and national priorities for 2016/17.
The 2020 Vision provides an overview of the Scottish Government’s aspirations for healthcare. The Route Map to the 2020 Vision provides further detail regarding key priorities and areas of focus in order to meet 3 Quality Ambitions for healthcare improvement - safe, effective and person-centred care.
NHS trusts are NHS-funded services providing geographical or specialist services. There are several types of NHS trust in place across the UK. NHS hospital trusts (also called acute trusts and foundation trusts) provide secondary care services, mental health trusts support in-patient and out-patient mental health services, ambulance trusts deliver accident and emergency transport and services, and community health trusts coordinate local care services across primary care, secondary care and community settings.
NICE Pathways are online tools provided by the National Institute of Health and Clinical Excellence (NICE) to enable health, commissioning and social care practitioners to access up to date NICE guidance, quality standards and related information via interactive topic-based diagrams. The pathways provide access to clinical practice guidelines, technology appraisals, interventional procedures, diagnostics and quality standards.
The NICE quality standards set out the priority areas defined by the National Institute for Health and Clinical Excellence (NICE) for quality improvement within health and social care. The quality standards aim to address areas where there is significant variation in quality of care to provide greater consistency across England.
The NICRN supports high quality clinical trials across all Health and Social Care (HSC) Trusts in Northern Ireland. This organisation aims to promote research within Northern Ireland and facilitate partnership working across the network and wider research community. The network manages a portfolio of ongoing studies and assists with processes involved in initiating studies, e.g. ethical and regulatory considerations. They also provide training and education, and additional resources where required.
OPCS4 is the standardised procedural classification used by clinical coders within NHS hospitals and Health and Social Care (HSC) Trusts in Northern Ireland. Each operation, procedure and intervention performed for in-patients, day case surgery and some out-patients has been allocated an OPCS4 code. This coding system supports data collection and planning of healthcare services.
PALS services support patients, relatives and carers in resolving issues or concerns regarding their treatment quickly and efficiently. PALS services are available in most hospitals where they provide a communication channel for patients to direct queries and obtain confidential advice regarding their care.
PLICS data is cost information that is collected at the individual patient level. This approach aims to provide accurate information regarding the use of health resources/funding to allow identification of efficiencies and opportunities for service improvement. PLICS is part of the NHS plan to transform data collection. NHS Improvement aim to make collection of patient-level data mandatory for all health providers by 2020.
In 2006, the Kings Fund developed a tool to support NHS Trusts accurately predict the risk of re-admission to hospital over a 12-month period. Since then, other groups have developed tools using similar approaches, such as those that predict re-admission to hospital on within 30 days.
PbR is the system used to pay acute providers in England for services. There is a fixed national tariff for commissioning of emergency care, elective in-patient treatment, day cases and out-patients. Payments are linked to activity and this system aims to ensure that funding is provided in a fair and consistent manor.
Personalised medicine is an approach that aims to deliver care that is appropriate for a particular individual or group of patients. It allows healthcare practitioners to prescribe treatments, interventions or preventative measures that are tailored to different patient types. Patients may be stratified, based upon their age, level of risk and existing medical conditions to ensure that the care they receive is the right care for them and the best use of healthcare resources.
The Health and Wellbeing Directorate, based within Public Health England (PHE), works with partners within local government, the NHS and education services to deliver evidence-based and educational health improvement programmes that address social factors affecting people’s health.
Public Health England (PHE) centres provide local health improvement, public health and health protection services across England. These centres coordinate and implement PHE strategies (national and local) that are relevant for the population. Local health protection teams, based within the centres assist with specific health protection enquiries, such as reporting infectious diseases.
Place-based systems of care aim to improve health and care through local collaborations and effective management of common resources. This approach requires integrated commissioning of services to make the best use of NHS funding. This concept underpins the development of Sustainability and Transformation Plans (STPs) that aim to deliver the objectives of the Five Year Forward View.
GPs and pharmacists with particular skills or expertise within a specific area of medicine are collectively known as Practitioners with a Special Interest (PwSI). They are required to obtain Royal College of General Practitioners (RCGP) accreditation in line with a competency framework to ensure levels of knowledge and skills are maintained.
PrescQIPP is an NHS-funded community interest company (social enterprise) that helps NHS organisations to improve medicines management and medicines optimisation processes with the aim of providing better patient care. The PrescQIPP website also facilitates sharing of innovation and good practice.
The Asthma Focus bulletin and briefing was developed by PrescQIPP to provide guidance and advice on inhaled treatments for asthma. Additional support materials are provided in the briefing to help practices identify and review at risk patients as well as ensuring that appropriate patients are stepped down on the treatment pathway.
PrescQIPP have developed a number of asthma pathway documents that demonstrate the place of inhaler products within the British Thoracic Society (BTS)/ Scottish Intercollegiate Guidelines Network (SIGN) guidelines for the management of asthma.
Primary care is the first point of contact within NHS services for most people seeking medical treatment and advice. The majority of people access these services via their local GP surgery or walk-in centre, but dentists, pharmacists and optometrists also provide primary care services within their areas of specialism. In addition, the NHS 111 service is considered to be a primary care service.
The PCMD holds individual record level mortality data that is captured during registration of death. Information includes the registered GP/practice and patient details (e.g. age, causes of death, NHS number). The database is managed by NHS Digital and, due to the personal-level of data included in the system, can only be accessed by approved public health, local authority and NHS users requiring mortality data for statistical purposes.
PHE are an agency, based within the Department of Health (DH), with responsibility for delivery of public health/health improvement programmes, addressing health inequalities, and health protection work in England. PHE have 8 local centres across England where they are responsible for delivery of programmes to improve health and wellbeing, based upon local priorities.
The Public Health Outcomes Framework is a data tool that provides an overview of the outcomes and indicators required to understand the current state of public health in England. This data tool presents information regarding life expectancy, the wider determinants of health and wellbeing, health improvement statistics and health protection data.
Quality Accounts are publicly available annual reports concerning the quality of services delivered by NHS providers and independent providers commissioned by NHS England or local Clinical Commissioning Groups (CCGs). Providers publish their reports via the NHS Choices website showing details of patient safety measures, disease management and patient feedback. Clinical teams, managers, patients and patient groups may also contribute to the report and advise on relevant content.
QOF is a General Practice framework, included in the general medical services (GMS) contract, that incentivises practices to provide high quality care for people with long-term conditions. The framework also aims to improve standards of record-keeping including development of disease registers for COPD and asthma.
The Academy of Medical Royal Colleges published Quality Improvement -training for better outcomes in 2016. This research report provided a robust framework to embed quality improvement within daily practice. This information will inform work to reduce the variability between organisations’ capabilities, and ensure that work is coordinated and quality is prioritised at all levels throughout healthcare.
The NHS Scotland Quality Strategy aims to deliver the objectives of the 2020 Vision; providing the highest quality healthcare to the people of Scotland via collaboration and partnership working with NHS, local authorities, third sector, patients, carers and the public.
QIPP was a national, regional and local level programme designed to support clinical teams and NHS organisations to improve the quality of care while making efficiency savings that can be reinvested into the NHS. QIPP objectives sit within Domain 3 of the NHS Outcomes Framework alongside local health and wellbeing strategies. The QIPP programme has now stopped and this work has been passed to Right Care to manage from within NHE England and Public Health England (PHE).
Real-world data and/or real-world evidence are generated through studies conducted outside of traditional randomised clinical trials settings. These studies are design to evaluate effectiveness of treatments or interventions in daily clinical practice. Real-world studies usually take the form of observational research or clinical audits using retrospective data from clinical databases.
Reference costs are collected and published annually by the Department of Health (DH). They provide the average unit cost to the NHS of delivering a broad range of secondary care services. This value is used to set prices for NHS-funded services in England.
RMCs were introduced in England to manage the referral process between primary and secondary care. RMCs receive referrals from primary care and link patients with booking services. These centres help to decide which provider is best suited to deliver the services, e.g. consultant, GP with a specialist interest (GPwSIs), specialist nurse. Some RMCs offer triage services and direct access to diagnostics as well.
The RVPBRU provides national and international laboratory services on behalf of Public Health England (PHE) for a number of bacteria causing respiratory, systemic and vaccine preventable infections including pneumococci and haemophilus influenzae.
The RVU sits within Public Health England (PHE) and provides laboratory services for respiratory virus infections. It also investigates outbreaks of respiratory virus infection and is involved in development of diagnostic tests and vaccine evaluations for respiratory viruses.
Medical revalidation is the process by which clinical staff are approved to continue to practice within the UK. This process ensures that practitioners are up to date with current regulations and practice, and fit to deliver care in the UK. The General Medical Council (GMC) oversees revalidation of doctors and nurses are appraised via the Nursing and Midwifery Council (NMC).
Right Care is an organisation, based within NHS England, that is playing a key role in delivering the Five Year Forward View. Right Care aims to maximise value in healthcare for the patient, the NHS and society. One of Right Care’s key responsibilities is ensuring that the core QIPP programmes continue now that the project has officially been wound up.
SIGN is responsible for developing evidence-based clinical practice guidelines on behalf of Healthcare Improvement Scotland. SIGN guidelines contain recommendations for effective practice and improvement of service quality. Guideline development is overseen by an expert panel and undertaken by multidisciplinary groups that include clinical specialists, nursing, pharmacy and dentistry professions.
The SMC advises Scottish NHS Boards and local commissioning bodies regarding newly licensed prescription only medicines and new formulations or indications for established therapies. The SMC is led by a committee of clinicians and managers from across NHS Scotland as well as representatives from the pharmaceutical industry and public sector.
NHS England have set out their aspiration to provide patient access to seven-day hospital services that meet four priority standards. As part of this process, 10 clinical standards have been identified. NHS England have committed to the rollout of 4 priority clinical standards to 25% of the population by the end of 2017 and to deliver seven-day services to the whole of England by 2020 (with progress made on six other standards), so that patients receive the same standards of care in hospitals, seven days a week.
Shared planning guidance has been published by NHS England to explain how NHS operational planning and commissioning will support Sustainability and Transformation Plans (STPs). This guidance aims to help local health and care commissioners plan for the years ahead. Two year financial plans will be required as part of this process and a 2-year tariff and standard contract will also be applied.
The Single Oversight Framework aims to support healthcare service providers improve standards of care and achieve ‘good’ or ‘outstanding’ rating from the Care Quality Commission (CQC). The framework should also help to identify providers that may benefit from further support in order to improve services.
Commissioning of specialised services (or specialised commissioning) is the process of purchasing services that are provided in relatively few hospitals and accessed by comparatively small numbers of patients. These range from services for long-term conditions, such as renal and specific mental health problems, to services for cystic fibrosis. Some highly specialised services, including those for very rare diseases, are only provided at a very small number of centres across the country. Others, such as chemotherapy services, are provided by most acute hospitals.
The SCOG has been put in place by NHS England to oversee specialised commissioning across England. The group aim to reduce variation and inequalities in specialised commissioning, put processes in place to drive continuous quality improvements and ensure integration of specialised commissioning alongside services commissioned by clinical commissioning groups (CCGs) and local authorities.
SSQDs are monitoring tools that provide an overview of data regarding the quality of services provided by specialised healthcare providers. They enable comparisons to be made between service providers for a defined list of agreed measures. Data are updated quarterly and used by NHS England to monitor the quality and outcomes of services, and identify excellence.
Strategic Clinical Networks aim to provide an integrated approach to improvement of health services for disease areas that have complex patient pathways. The networks include health and social care commissioners, service providers, patients, carers and people from local communities. Current areas of focus for these groups include cardiovascular disease, maternity care and children’s services, mental health, respiratory medicine and cancer.
Strategic commissioning is a new model designed to support Sustainability and Transformation Plans (STPs). This new approach moves away from negotiation and tendering approaches. Instead, commissioning will focus on defining and measuring outcomes, using incentives for delivery of outcomes and longer-term contracts to reduce transactions costs and release resources to invest in innovation and improvement of healthcare services.
The SHMI enables a standard approach to provision of trust-level mortality data in England. SHMI data are published quarterly by NHS Digital. The SHMI is the ratio of the actual number of patients who die following hospitalisation at a particular trust compared with the average figure for England, based on the situation and patient characteristics.
STPs are 5-year plans focusing on local delivery of health and social care services. The plans focus on commissioners and service providers working closely together and pooling budgets to provide more co-ordinated services that are aligned specifically with the needs of the local population. These integrated plans are designed to provide a more practical and locally-relevant approach to patient care and to support the Five Year Forward View.
The SDU is joint funded by NHS England and Public Health England. The SDU helps organisations working in health and social care to reduce emissions, save money and improve the health of people and communities. The SDU focuses on environmental factors such as energy, travel and waste as well as health promotion and the wider determinants of health.
The Sustainable Improvement Team works on behalf of NHS England to help the health and social care system in England to change in a sustainable way. Using best practice examples from across the world, the team designs and tests initiatives to improve services. The objective is to speed up implementation of improvement models, and to identify projects that will have the biggest impact for the healthcare system.
The tariff is the amount that a commissioner will pay for a package of hospital care including out-patient appointments, in-patient care and procedures. The NHS national tariff is proposed by NHS England and NHS Improvement. This comprises a set of prices and rules to help providers and commissioners obtain the best value for their patients.
Tertiary care is usually provided as an in-patient service, following referral from primary care or secondary care, when highly specialised skill, expertise and/or facilities are required. Examples of tertiary care services include cancer management, neurosurgery, plastic surgery, treatment for severe burns and palliative care.
Transfer of care is the movement of a patient from one health care setting to another, e.g. a hospital in to the community. Transfer of care services and toolkits are in place in some areas across the country to support patients who have been discharged from hospital, to minimise the risk of medication and care errors and to ensure patients transfer between health care providers effectively.
Urgent care services are out-of-hours care providers accessed by people with minor injuries or illness who are unable to wait until their GP surgery is open to see a doctor or another healthcare professional. These services aim to reduce the number of non-emergency patients attending accident and emergency (A&E) departments.
A total of 50 local vanguard sites across England have been selected by NHS England to receive funding for the delivery of new care models that will define how care is provided across the country in the future. Each of the sites represents a local partnership comprised of NHS, local authority and independent health and social care organisations. The vanguards have been allocated an area of focus ranging from integration of primary and acute care services through to enhancing health in care homes. The outputs of these projects will be fed in to future planning and innovation models.
As each acute trust provides a diverse range of services, it is difficult compare output measures between trusts. Cost-weighting or WAUs were recommended within the Carter Review as a means of adjusting for variation in service offerings when evaluating trusts and monitoring improvement. One WAU is the equivalent of an elective inpatient admission, based on the cost of providing that treatment (≈£3,500). This approach is also used in other countries including Australia and the United States.