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Publication Delivering a national de-adoption programme: a documentary analysis of local commissioning policy compliance with England's Evidence-based Interventions programme (EBI)(Springer Nature, 2025-07-29) Conefrey, Carmel; Farrar, Nicola; Coyle, Maeve; Bell, Mike; Blazeby, Jane; Burton, Christopher; Donovan, Jenny; Gibson, Andy; Glynn, Joel; Jones, Tim; McNair, Angus; Morley, Josie; Owen-Smith, Amanda; Rule, Ellen; Thornton, Gail; Tucker, Victoria; Williams, Iestyn; Hollingworth, William; Rooshenas, Leila; Rule, Ellen; Admin and ClericalBackground: In 2019 the English National Health Service (NHS) launched a national de-adoption programme to stop or limit access to surgical procedures considered to have little, or uncertain, evidence of benefit to justify their risks and/or costs: the Evidence-Based Interventions (EBI) programme. Central to the programme was the publication of guidance detailing clinical recommendations targeting 17 surgical procedures: four to be stopped and 13 to be restricted to patients satisfying specific criteria. Local commissioning organisations, NHS bodies responsible for purchasing surgical services, were instructed to reflect national EBI recommendations in their local commissioning policies. This study (which is part of the NIHR OLIVIA study, an evaluation of the EBI programme) assessed local commissioning policy compliance with EBI recommendations and identified funding mechanisms employed locally to promote enforcement. Methods: A documentary analysis was conducted on a purposive sample of local commissioning policies for each of the 17 EBI surgical procedures. Local policies were compared to EBI recommendations and any differences were categorised against an established five category framework for capturing differences in local policies. Funding mechanisms were also recorded. Data were analysed using descriptive statistics supported by written summaries to describe the nature of discrepancies between local and national recommendations. Results: Three hundred six local commissioning policies were analysed. 72% (44/61) of procedures to be stopped and 43% (106/245) of restricted access policies matched EBI recommendations. Concordance rates varied by surgical procedures. Where local policies for the 13 restricted access procedures differed, variations were most commonly categorised as differences in diagnostic approach followed by differences in specification of symptom severity and disease progression. The funding mechanism most frequently stated for the stopped procedures was ‘Individual Funding Request’ (74%, 45/61), whilst for restricted access procedures, policies relied on ‘Criteria Based Access’ (48%, 117/245) followed by ‘Prior Approval’ (33%, 80/245). Conclusion: This study, to our knowledge, is the first to explore variation between local and national de-adoption policies. With under half of local commissioning policies matching national EBI recommendations, reliance on the take up of national de-adoption policy is inadequate. More support is needed for local commissioners to reflect national guidance. Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-13012-0.Publication Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study(Taylor and Francis Group, 2025-06-25) Shrikrishna, Dinesh; Steer, John; Bostock, Beverley; Dickinson, Scott; Piwko, Alicia; Ramalingam, Sivatharshini; Saggu, Ravijyot; Stonham, Carol Ann; Storey, Robert; Taylor, Clare; Thakkar, Raj; Gale, Chris; Bostock, Beverley; Stonham, Carol Ann; Additional Clinical Services; Medical and DentalChronic obstructive pulmonary disease (COPD) is linked to increased mortality and morbidity, especially in patients with coexisting cardiovascular disease. These patients face heightened cardiopulmonary risk, which escalates further after acute exacerbations of COPD. While there is some guidance on the management of acute exacerbations of COPD, there is a lack of specific strategies for addressing cardiopulmonary risk in COPD. This program of work aimed to establish UK consensus statements and a clinical pathway for managing cardiopulmonary risk in patients with COPD, synthesizing evidence and expert input through a modified Delphi approach. A multidisciplinary Taskforce conducted a systematic review, focusing on the UK and addressing questions relating to the healthcare burden of acute exacerbations of COPD (AECOPDs), the link between AECOPDs and cardiopulmonary events, the management of cardiopulmonary risk in patients with COPD, and the guidelines and interventions implemented to optimize COPD management. The evidence identified was summarized and used to synthesize preliminary consensus statements reflecting the current situation and recommendations for action. Following iterative voting rounds, consensus was reached on 18 statements. Further to this, a clinical pathway framework to support the recognition and management of cardiopulmonary risk in patients with COPD using the consensus statements was formulated. AECOPDs were identified as a substantial healthcare burden in the UK, contributing to high mortality, frequent healthcare interactions, and elevated costs. These exacerbations were associated with cardiopulmonary events such as myocardial infarction and stroke. Most UK guidelines have focused on the respiratory management of COPD exacerbations, but lack strategies to specifically address cardiopulmonary risk, highlighting the need for integration of care. This consensus program has identified gaps in management, as well as a need to optimize care and reduce the cost of COPD management through the development of new UK policies and clinical guidance.Publication Virtual wards for people with frailty: what works, for whom, how and why—a rapid realist review(Oxford University Press, 2024-03-01) Westby, Maggie; Ijaz, Sharia; Savovic, Jelena; McLeod, Hugh; Dawson, Sarah; Welsh, Tomas; Le Roux, Hein; Walsh, Nicola; Bradley, Natasha; Le Roux, Hein; Medical and DentalBackground: Virtual wards (VWs) deliver multidisciplinary care at home to people with frailty who are at high risk of a crisis or in crisis, aiming to mitigate the risk of acute hospital admission. Different VW models exist, and evidence of effectiveness is inconsistent. Aim: We conducted a rapid realist review to identify different VW models and to develop explanations for how and why VWs could deliver effective frailty management. Methods: We searched published and grey literature to identify evidence on multidisciplinary VWs. Information on how and why VWs might 'work' was extracted and synthesised into context-mechanism-outcome configurations with input from clinicians and patient/public contributors. Results: We included 17 peer-reviewed and 11 grey literature documents. VWs could be short-term and acute (1-21 days), or longer-term and preventative (typically 3-7 months). Effective VW operation requires common standards agreements, information sharing processes, an appropriate multidisciplinary team that plans patient care remotely, and good co-ordination. VWs may enable delivery of frailty interventions through appropriate selection of patients, comprehensive assessment including medication review, integrated case management and proactive care. Important components for patients and caregivers are good communication with the VW, their experience of care at home, and feeling involved, safe and empowered to manage their condition. Conclusions: Insights gained from this review could inform implementation or evaluation of VWs for frailty. A combination of acute and longer-term VWs may be needed within a whole system approach. Proactive care is recommended to avoid frailty-related crises.Publication Use and acceptability of an asthma diagnosis clinical decision support system for primary care clinicians: an observational mixed methods study(Nature Research, 2024-11-27) Daines, Luke; Canny, Anne; Donaghy, Eddie; Murray, Victoria; Campbell, Leo; Stonham, Carol; Milne, Heather; Price, David; Buchner, Mark; Nelson, Lesley; Mair, Frances; Sheikh, Aziz; Bush, Andrew; McKinstry, Brian; Pinnock, Hilary; Stonham, Carol; Nursing and Midwifery RegisteredThere is uncertainty about how best to diagnose asthma, especially in primary care where mis-diagnosis is common. To address this, we developed a clinical decision support system (CDSS) for asthma diagnosis in children and young people (aged 5-25 years). This study explored the feasibility and acceptability of the CDSS in UK primary care. We recruited general practices from England and Scotland. The CDSS was available for use during routine consultations for six months. We analysed CDSS usage and, toward the end of the study, undertook qualitative interviews with clinicians who had used the CDSS. Within the 10 practices who completed the study, the CDSS was used by 75 out of 94 clinicians. 11 clinicians from 8 practices were interviewed. The CDSS was acceptable to participants who particularly commented on the ease of use and auto-population of information from the patient record. Barriers to use included the inability to record findings directly into the patient notes and a sense that, whilst possibly useful for trainees and junior colleagues, the CDSS would not necessarily lead to a change in their own practice. The CDSS was generally well received by primary care clinicians, though participants felt it would be most useful for trainees and less experienced colleagues.Publication Co-developing and unlocking Integrated Proactive Neighbourhood Teams in Gloucestershire to improve care for people living with frailty(Ubiquity Press, 2025-04-09) Barnes, Bronwyn; Barnes, Bronwyn; Admin and ClericalIn Gloucestershire we are rightly proud of our strong track record in collaborative working across organisations in the wider health, care and wellbeing system. We are committed to the delivery of Integrated Neighbourhood Teams building on integrated care. Across our partnerships we strive to continuously improve the care and outcomes for our people. However we are not without our challenges. While life expectancy continues to improve for the most affluent 10%, it has either stalled or fallen for the most deprived 10%. An ageing population means there’s a growing demand and pressure on the system to remain sustainable. The Working as One transformation Programme endeavours “to deliver quality, integrated care for the people of Gloucestershire to support the best possible physical and mental health outcomes, enabling them to lead the most happy and healthy lifestyles”. One improvement cycle of the Prevention workstream of Working as One is the development of Integrated Proactive Neighbourhoods; Integrated Neighbourhood Teams focussed on proactive frailty. We know there are over 73,000 people in Gloucestershire over the age of 65 coded as frail within our GP clinical systems. If and when people in this age group attend our acute hospital emergency department, they are more likely to spend longer there than those aged under 65, and more likely than the younger age group for that attendance to lead to an admission. We are keen to prevent attendances where reasonably avoidable and where people can be proactively supported to remain in their own homes and communities. We know a patchwork of interventions has developed for different cohorts of people living with frailty. This programme enables us; a system comprising teams of teams around specific populations; to collectively work better together to improve the health and care outcomes for our populations. It is an opportunity to systematise adoption of the most impactful evidence based interventions for people across our county by cohort and individual need and positively impact the wider system. We acknowledge that, whilst transformative in many respects, this is also an evolutionary change that builds on examples of already successful integrated working practices. We’re phasing our approach across fifteen neighbourhoods in Gloucestershire to collectively run improvement and change cycles. Importantly whilst system and senior strategic colleagues can provide the structure, conditions for change and permissions for this new way of working, it is the local health and care professionals, our vibrant voluntary and community sector and people in communities who hold the key to delivering locally appropriate adaptations of the model to meet local people’s needs in a meaningful and sustainable way. Our work links most to pillars 1,2,3 and 6 of integrated care. Our key next step is convening a series of workshops to enable local teams the time and space to co-develop the integrated working in their neighbourhoods. With the support of our systemwide Improvement Community and strategic leaders, local teams will be enabled and empowered to work with people to continuously develop and iterate integrated care for, and with the people we serve.Publication CSP2023: 254 - Improving pathways for patients with acquired brain injury and spinal cord injury through in-depth case review and facilitated workshop(Elsevier, 2024-06-18) Sabapathy, Srikesavan; Jago, Nicky; Gray, Debbie; Sabapathy, Srikesavan; Jago, Nicky; Gray, Debbie; Allied Health Professional; Admin and ClericalNo abstract availablePublication Exacerbating the burden of cardiovascular disease: how can we address cardiopulmonary risk in individuals with chronic obstructive pulmonary disease?(Oxford University Press, 2023-10-13) Shrikrishna, Dinesh; Taylor, Clare; Stonham, Carol; Gale, Chris; Stonham, Carol; Nursing and Midwifery RegisteredNo abstract availablePublication Clinician views on how clinical decision support systems can help diagnose asthma in primary care: a qualitative study(Taylor and Francis, 2023-11-11) Daines, Luke; Donaghy, Eddie; Canny, Anne; Murray, Victoria; Campbell, Leo; Stonham, Carol; Bush, Andrew; McKinstry, Brian; Milne, Heather; Price, David; Sheikh, Aziz; Pinnock, Hilary; Stonham, Carol; Nursing and Midwifery RegisteredObjective: Asthma can be difficult to diagnose in primary care. Clinical decision support systems (CDSS) can assist clinicians when making diagnostic decisions, but the perspectives of intended users need to be incorporated into the software if the CDSS is to be clinically useful. Therefore, we aimed to understand health professional views on the value of an asthma diagnosis CDSS and the barriers and facilitators for use in UK primary care. Methods: We recruited doctors and nurses working in UK primary care who had experience of assessing respiratory symptoms and diagnosing asthma. Qualitative interviews were used to explore clinicians' experiences of making a diagnosis of asthma and understand views on a CDSS to support asthma diagnosis. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. Results: 16 clinicians (nine doctors, seven nurses) including 13 participants with over 10 years experience, contributed interviews. Participants saw the potential for a CDSS to support asthma diagnosis in primary care by structuring consultations, identifying relevant information from health records, and having visuals to communicate findings to patients. Being evidence based, regularly updated, integrated with software, quick and easy to use were considered important for a CDSS to be successfully implemented. Experienced clinicians were unsure a CDSS would help their routine practice, particularly in straightforward diagnostic scenarios, but thought a CDSS would be useful for trainees or less experienced colleagues. Conclusions: To be adopted into clinical practice, clinicians were clear that a CDSS must be validated, integrated with existing software, and quick and easy to use.