Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. Evidence based innovation
Dr Robert Varnam
Head of general practice development, NHS England
robert.varnam@nhs.net @robertvarnam

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The founding principles of UK primary care are admired the world over, and rightly so.
General practice is a jewel in the crown of this country.
Right now, general practice feels in a bad place. Constrained, hemmed-in and, to
some, marginalised.
Whatever the state of things in your part of the country, in general, I think it’s fair to say
that, at the very least, general practice is currently constrained from delivering its full
potential.
We need to see increases in funding, a growth in the workforce, and improvements to
premises. Without those, existing services may not be sustainable.
Overview
 Common pitfalls
 The GP Access Fund experience
 Five top tips

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1. Common pitfalls

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Call to Action on General Practice
“What needs to be done to promote, support and sustain the adoption of effective
innovations?”
a) Finding innovation
b) Implementing change
c) Unease about innovators & innovations
d) Concern about causality
bit.ly/c2aGP

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Call to Action on General Practice
“What needs to be done to promote, support and sustain the adoption of effective
innovations?”
a) Finding innovation
b) Implementing change
c) Unease about innovators & innovations
d) Concern about causality
bit.ly/c2aGP

6. w ww.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“What needs to be done to promote, support and sustain the adoption of effective
innovations?”
a) Finding innovation
b) Implementing change
c) Unease about innovators & innovations
d) Concern about causality
NHS Change Model
bit.ly/c2aGP

7. w ww.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“What needs to be done to promote, support and sustain the adoption of effective
innovations?”
a) Finding innovation
b) Implementing change
c) Unease about innovators & innovations
d) Concern about causality
bit.ly/c2aGP

8. w ww.england.nhs.uk #Expo15NHS @robertvarnam
Unease about innovators & innovations
The innovators
• Whacky / unappealing
• Too brainy
• Too creative
• Too hard working
Admirable but not me

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Unease about innovators & innovations
The innovations
• Experimental / unfinished / risky
• Too niche
• Too context-specific
Interesting but not for me

10. w ww.england.nhs.uk #Expo15NHS @robertvarnam
Call to Action on General Practice
“What needs to be done to promote, support and sustain the adoption of effective
innovations?”
a) Finding innovation
b) Implementing change
c) Unease about innovators & innovations
d) Concern about causality
bit.ly/c2aGP

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The innovation itself is not enough

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2. GP Access Fund

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About the GP Access Fund
Aim: “to help improve access to general practice and stimulate innovative ways of
providing primary care services”
• Wave one: Apr 2014
• £50m
• Wave two: Apr 2015
• £100m
Applications from practices covering nearly 2/3 of the population of England

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About the GP Access Fund
57 schemes
~100 ‘federations’
2500 providers
18m patients
Wave one: Apr 2014
Wave two: Apr 2015

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An example of this in practice at the
moment is the Prime Minister’s GP Access
Fund. Now covering a significant
proportion of the country, practices in this
are implementing quite wide-ranging
redesign of their services, acknowledging
that extended hours are only one part of
good access. The practices participating in
this programme are already beginning to
implement many of the transformational
changes envisaged by the Five Year
Forward View. This is generating valuable
learning about the specific changes
required, including the ways in which the
system can make progress easier and
more sustainable.
Innovations being tested

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Schemes' initial plans for measurement
Three broad approaches:
a) External academic unit
b) Project manager time set aside
c) No detailed plan Wave one: 4/20 schemes had dedicated
budget for measurement

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Inputs from innovation support programme
• Webinars
• Workshops
• Advice from evaluation team
• Coaching from NHS IQ
• Team reviews
• Direct conversations
… modest success

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The biggest data challenge of all …
Wave one: 19/20 schemes required help. 4 had existing BI systems
Dec 14: guide published, application preparation webinars
Apr 15: welcome pack
Wave two: 37/37 have requested help
General practice
activity data

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An exception…

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Some of the NHS is ill-prepared to
measure innovation in everyday care,
and some of our baselines are weak.

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a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

22. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

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a) Budget & plan for measurement
It doesn’t just happen

24. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

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Innovations’
efficacy
Schemes’
efficacyFunding
Cost-effectiveness
b) Know your logic model
Patient
satisfaction
Staff
assessment
OOH
attendance
A&E
attendance
New extended
hours
appointments
Additional
contact
modes
Other access
innovations
Changes in
care model

26. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

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Innovations’
efficacy
Schemes’
efficacyFunding
Cost-effectiveness
c) Measure to inspire and inform
Patient
satisfaction
Staff
assessment
OOH
attendance
A&E
attendance
New extended
hours
appointments
Additional
contact
modes
Other access
innovations
Changes in
care model
Why
should I
commit to
this?
How might
this work
for us?

28. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

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d) Measure in realtime
If you’re moving forward, why only look backwards?

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Using periodic averages
105
55
0
20
40
60
80
100
120
Sample A Sample B1st three
month
period
2nd three
month
period
Start Data
vacuum
This is our traditional approach. It is familiar but serves innovation
leaders very poorly.
How do youkeep
people motivated in
thisperiod?
Averagespreventyou
learning from variation

31. Statistical Process Control charts allow you to measure very frequently,
and draw statistically sound conclusions about any change.
97.3%
C.I.
Changeintroduced
here
Rapid confirmation that thechangewasa
statistically significant improvement
This kind of analysis can be produced by a wide variety of software.

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d) Measure in realtime
Benefits for innovators:
 Keep staff motivated & curious
 Refine the innovation more rapidly
 Gather convincing evidence for others in shorter timescale
 Test multiple changes (eg phasing / multiple sites)
1 2 3 4
1
2
3

33. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

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e) Show it can work elsewhere
• Describe and measure your context (well enough for others to understand
& compare)
• Test in multiple different contexts
• Yourself
• First followers

35. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere
3. Five top tips

36. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere

37. w ww.england.nhs.uk #Expo15NHS @robertvarnam#Expo15NHS @robertvarnam
Using data as part of a change strategy
bit.ly/PMCFlessons1
Choosing metrics for innovation
vimeo.com/111923411
Using retrospective case control
bit.ly/NuffieldRetroCaseControl
Logic models
wikipedia.org/wiki/Logic_model
Scaling up innovation
ow.ly/RBxYt
SPC guides
bit.ly/SPCguide1 & bit.ly/SPCguide2
#Expo15NHS @robertvarnam
john_taylor@nhs.net
robert.varnam@nhs.net
a) Budget & plan for measurement
b) Know your logic model
c) Measure to inspire and inform
d) Measure in realtime
e) Show it can work elsewhere