The document summarizes three joint working projects between the Greater Manchester Clinical Commissioning Strategic Clinical Network and Senate (GMCCSN) and pharmaceutical companies. The first project with Boehringer Ingelheim to map atrial fibrillation services was successful with a detailed agreement and shared goals. The deep vein thrombosis project with Bayer Healthcare did not proceed as a joint working due to historical suspicions. The door-to-balloon time project engaged Company A and Company B but was not truly joint working due to NHS reconfiguration and competition between companies. Overall results were varied, with success more likely when all partners agreed to pooled resources, clear plans, transparency, and shared patient-focused outcomes.

1. Joint Working - Varied Success!
Amanda J Schofield
Quality Improvement Lead
Greater Manchester, Lancashire
& South Cumbria Strategic
Clinical Network & Senate
26.06.13

2. NHS | Presentation to [XXXX Company] | [Type Date]2
Overview
• A brief overview of each project
• What went well
• Barriers
• Key points for future project

3. GMCCSN Joint Working Proposals
1.Mapping the provision of Anticoagulation Services
for patients with Atrial Fibrillation (AF) across
Greater Manchester (GM) – Boehringer Ingelheim
(July 2010 – 2011)
2.The Management of Patients with Deep Vein
Thrombosis in GM – Bayer Healthcare (February
2013 - Present)
3.Door In Door Out Project – Company A &
Company B (January 2013 – Present)
3 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

4. 1. GMCCSN, GMMMG & Boehringer Ingelheim
Initiation
• Government directive on Atrial Fibrillation and
stroke prevention
• New Oral Anticoagulants – Licensed
• Commissioned by GM Association of PCT’s
• Three way partnership
• Open and Transparent
4 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

5. GMCCSN, GMMMG & Boehringer Ingelheim
Key Points
• Detailed joint working agreement
• Shared vision
• Shared project management
• Knowledge sharing
• Pooling of resources
• Outcomes were patient focused
5 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

6. GMCCSN, GMMMG & Boehringer Ingelheim
Project Aims
• Examine care pathways for patients with AF
• Understand the provision of anticoagulation services
• Achieve the best outcomes for patients in terms of clinical
efficacy and cost effectiveness
• A controlled introduction from a financial and new clinical
intervention perspective
6 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

7. GMCCSN, GMMMG & Boehringer Ingelheim
Deliverables
• GM algorithms
• Care pathway
• GRASP AF implementation
• Most effective prescribing for AF patients
7 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

8. 2. GMCCSN & Bayer Healthcare
Initiation
• GMMMG and GM commissioners agreement for GMCCSN
to look at the clinical pathway for Venous Thromboembolim
(specifically DVT)
• Extensive clinical support to evaluate the protocol and
guidance
• New oral anticoagulation therapy licensed for DVT
• New NICE guidance released in June 2012
8 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

9. GMCCSN & Bayer Healthcare
Key Points
• Detailed Joint working agreement drafted
• Shared vision
• Shared project management
• Pooling of resources
• Knowledge sharing
• Outcome patient focused
9 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

10. GMCCSN & Bayer Healthcare
Project Aims
• To improve and standardise the management of patients
with a DVT across Greater Manchester
• The development of a new protocol and pathway to manage
patients with suspected DVT within Greater Manchester
• The development of a structured, consistent and organised
approach in the management of DVT
• Improve patient outcomes
10 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

11. GMCCSN & Bayer Healthcare
Outcome
• Not a joint working project
• Unanimous decision from project steering group members
• Historical suspicion
• Bayer Healthcare invite
• Standardised protocol development continues
• Collaborative GMMMG prescribing guidance
11 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

12. 3.GMCCSN & Company A and Company B
Initiation
• Call to Balloon Time – national guidance 150 minutes
• A GM pathway flow problem had been indentified
• Project mandated by GMCCSN Cardiac Board
• Door – In – Door – Out (DIDO) steering group
• GMCCSN approached by company A to work jointly
• Advice from GMMMG to approach Company B
NHS | Presentation to [XXXX Company] | [Type Date]12

13. GMCCSN & Company A and Company B
Key Points
• Joint working agreements drafted
• Clinical engagement and agreement from the beginning
• Agreement patient outcome focused
• Individual companies input
• Pooling of resources
• NHS reconfiguration
NHS | Presentation to [XXXX Company] | [Type Date]13

14. GMCCSN & Company A and Company B
Project Aims
• Ensure that all patients receive effective yet extremely
prompt assessment and referral from their local ED to the
heart attack centre for their treatment.
• Target DIDO time of 30 minutes across GM.
14 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

15. GMCCSN & Company A and Company B
Outcome
• Not a joint working project
• GM treatment pathway - competition
• Company B supporting training and sponsorship
• Openness and transparency
• NHS reconfiguration
• Communication
• Time
15 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

16. Varied Success
• Patient focused
• Governance
• Shared benefits
• Pooled resources
• Engagement
• NHS Reconfiguration
• Communication
• A Competitive market
16 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

17. What does success look like?
• Have a clear understanding from beginning
• All cards on the table
• Detailed plans
• Communication (internal/external)
• Leadership
• Decision makers – who are they?
• Trust
• Commitment
17 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13

18. Key Differences
NHS England GM Lancs & South Cumbria SCN & Senate 26/06/1318
Key differentiators
POOLING of resources by NHS/pharmaceutical company(ies)
Detailed joint working agreement
Outcomes (for patients, NHS, company(ies)) clearly articulated and measured
Details of arrangements made public

19. Contact information:
Name: Amanda Schofield
Job title: Quality Improvement Lead
Company: Greater Manchester, Lancashire and South
Cumbria SCN and Senate
Email: a.schofield1@nhs.net
Tel: 07795127368
19 NHS England GM Lancs & South Cumbria SCN & Senate 26/06/13