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Keep moving to manage pain

Published and last updated by Simon Ellery
Clinician working with woman with back pain

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Musculoskeletal (MSK) conditions such as osteoarthritis and chronic low back pain affect over 18 million people across the UK. These conditions can cause pain and functional limitations, as well as impact on our mental health, which can make ordinary, everyday activities a struggle and prevent us from being able to work or remain independent. Sally Irwin, a Project Manager for the Joint Pain Advice service in the Health Innovation Network, considers the benefits of simple self-management strategies, such as being active, in preventing and managing what can be a life-changing condition.

People often have the view that they can’t do much about the symptoms of osteoarthritis and chronic low back pain. However, there are tools and techniques that people can use to help manage pain and reduce the impact that these conditions can have, and resources available on how to do this. Keeping moving, a healthy lifestyle and self-management strategies such as learning how to pace yourself by planning and prioritising activities are all helpful.

Those with osteoarthritis and chronic back pain often worry being active will increase their pain and may cause more damage. Conversely, keeping moving can help to manage pain, improve mobility and strengthen muscles and bones. Remaining active can bring many benefits, but we know that putting this into practice and changing our habits and behaviours is not easy. It takes time and effort to do and maintain.

Unfortunately, the current Covid -19 pandemic means many people have less opportunity to be active and socialise as they spend more time at home. Similarly, changes to work environments, such as working from home, may be affecting MSK health.

Many MSK organisations have provided useful web-based information and support, including helplines, online groups and peer support. But for some, all of this information can be overwhelming. It can be difficult to know where to start, how to navigate the options available and how to make them relevant to their lives and what matters to them.

One option to support individuals experiencing hip or knee osteoarthritis or chronic low back pain is Joint Pain Advice (JPA). JPA is a service that provides people with an opportunity to have a conversation about their experience and how it impacts them, as well as relevant self-management options.

The Joint Pain Advice (JPA) model of care was developed by the Health Innovation Network as a result of an identified need for accessible, personalised and understandable information, and practical advice and support about how to self-manage the impact of chronic knee and hip pain (often labelled osteoarthritis) and chronic low back pain.

JPA supports individuals to understand and better self-manage their chronic knee and hip and low back pain.

It puts the National Institute for Health and Care Excellence (NICE) guidelines for the management of osteoarthritis and low back pain into practice, using education and self-management strategies for a patient-centred, holistic approach and focusing on increased physical activity and managing weight where appropriate.

The model can easily be incorporated into existing services with minimal disruption and adapted to local contexts. Its flexibility means it can be delivered by a wide range of healthcare and non-healthcare professionals, and it sits comfortably within community, clinical and workplace settings.

The HIN co-ordinates and delivers training for professionals wanting to deliver Joint Pain Advice, which is offered nationally but with a focus on south London. This evaluation shows improvements in pain, physical function, physical activity and mental wellbeing through JPA. Whilst this is based on face-to-face appointments, the approach can easily be delivered virtually where this is not possible.

JPA is a simple and effective way to support individuals experiencing knee and hip osteoarthritis and chronic low back pain to manage the impact that the condition can have on their lives.

If you are interested in finding out more information about Joint Pain Advice, please email hin.jointpainadvice@nhs.net. The JPA training is delivered free of charge to south London organisations.

Sally Irwin is a Project Manager for the Joint Pain Advice service in the Health Innovation Network.

We know we need genuine public involvement in healthcare. Why are we still getting it wrong?

Published and last updated by Rita Mogaiji

We know we need genuine public involvement in healthcare. Why are we still getting it wrong?

Andrew Walker, Deputy Clinical Director MSK and Evaluation Lead, Health Innovation Network reflects on a recent patient and public involvement and engagement process and the need for a relentless focus on true engagement.

Healthcare in the NHS has come a long way from the paternalistic, prescriptive model and principles upon which it was founded in post-war Britain.

The aspiration for greater and better patient and public involvement and engagement (PPIE) is at the heart of today’s NHS. There are multiple, high profile policy documents that reiterate its importance and the need to continue to focus on increasing patients’ voice to improve care. We now have lay member representation on the boards of NHS trusts and clinical commission groups and embedded into how research is prioritised (such as James Lind Alliance), designed and approved (such as INVOLVE and NHS Research Ethics Committees). There is also an increasing wealth of resources and guides from organisations such as INVOLVE and The King’s Fund to help us do PPIE well and in a meaningful way.

There are many examples of when PPIE has been done well, but there are still many occasions when we still fall short. Recently, I was involved in a PPIE process and I wanted to share my experience of how we fell short, despite best intentions.

Background to the process

In 2017, NHS England and NIHR published ‘12 actions to support and apply research in the NHS’, which tasked AHSNs to set out local NHS research and innovation priorities. Collectively, the AHSN Network, NIHR and NHS England commissioned ComRes to undertake a Local Survey of Innovation and Research Needs by engaging with key senior stakeholders nationally and locally. Published in June 2019, the report identified a number of priorities across workforce, mental health, digital technology and more. As part of an on-going engagement to explore and refine local priorities, the Health Innovation Network and CLAHRC south London jointly held a Patient Public Engagement event on with service users from across south London.

There were 10 participants with a mix of gender, ethnicity, age and physical/mental conditions. Dr Jane Stafford (South London ARC Associate Director of Operations) and I presented the background to the Survey, AHSNs and CLAHRC/ARCs. The session was facilitated by a PPI expert.

PPI perspectives on the priorities

In terms of the contents of the report, participants felt it was a useful start and broadly concurred with the priorities. However, they felt that some priorities did not resonate with them as patients (e.g. workforce) and illustrated the disconnect between what professionals working within the system perceived as local priorities and service users’ needs. The group wanted a greater focus on research and innovation that addresses the health inequalities and health needs of underrepresented service users. Participants were passionate in expressing a need to implement and deliver interventions and services that meet the needs of people from different ethnic backgrounds (e.g. Southwark has the largest African diaspora of all London boroughs) and excluded/marginalised groups (such as those experiencing homelessness). Participants also felt there was not enough focus within the priorities about improving patient experience, patient choice or personal budgets.

A feeling of ‘rubber stamping’

What I had not expected was the group’s strong criticisms about the process that had been used to identify local priorities. I had seen the session with PPI members as a step in the process of engagement. Whereas, they perceived it more as ‘rubber stamping’ a report that had already defined the local priorities. Specifically, they questioned why there hadn’t been public/patient involvement from the outset. Rightly, participants felt this would have improved the balance of priorities and made the survey more inclusive and comprehensive, and their involvement more meaningful. As I listened, the penny dropped and I thought ‘you’re right, we did it again!’

We highlighted that the survey report provided a sample of stakeholder perspectives and was a starting point for discussion and their input as valid and important as what was in the report. However, the group’s perception was that the timing and scale of PPI in the process gave greater status to stakeholders’ priorities. It also meant that whilst they broadly agreed with the priorities, they felt disconnected with some and couldn’t always see themselves or things that were important to them in the survey.

Being bolder and getting it right

For me, this process was a valuable reminder of the power words gain when committed to paper and how we can always improve our engagement with service users. The experience has renewed my personal commitment to this and to support others to do the same.

We need to be bolder in challenging colleagues and ourselves when we see PPIE is not being done appropriately or a process could be improved. For me, it comes back to the INVOLVE core principles for PPI of respect, transparency and responsiveness. If we can’t clearly demonstrate we’re addressing these principles – no matter the pressure – we need to stop and re-think our approach.

Health and social care are complex, dynamic systems where not one person or group can understand the whole system. It’s only by engaging with people from across the system (public and professionals) and by sharing our perspectives and knowledge that we can bring about system change.

This calls for a more radical shift where we cede power to patients and start to co-design and co-produce health and social care. But to get it right, this approach must also be backed up a commitment to provide adequate time, resources and political will and leadership – across the whole system.

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Save every life

Published and last updated by Rahel Gerezgiher

Save every life

Aileen Jackson, our Head of Mental Health, reflects on her involvement in a new national digital suicide prevention resource funded by the Department of Health and Social Care

Having spent the last few decades working extensively in the health and social care sector, I have seen first-hand the effect that use of certain language can have in particularly sensitive situations. The language used to describe suicide is often regarded as wholly negative and this was brought to light again at our recent stakeholder engagement workshop, where I was challenged on the term ‘zero suicide’.

The man who posed the challenge, like some people with enduring mental illness, lives with suicide ideation. He felt that the ambition of ‘zero suicide’ furthers the stigmatization he already experiences. The harmful thoughts he explained are very much part of his mental illness and, as such, won’t just go away.

National engagement and research on suicide prevention

The workshop in question was part of a national engagement and research project I was involved in as part of my role at the Health Innovation Network. The project, commissioned by the Zero Suicide Alliance (ZSA), was designed to find out what professionals need to know about preventing suicide and what information is already available online to assist them. The purpose of both tasks was to inform a new digital suicide prevention resource funded by the Department of Health and Social Care.

Worldwide close to 800,000 people took their own lives in 2018, and suicide is the second leading cause of death among 15 to 29-year-olds and still the biggest killer for men under 50. Every week, 12 Londoners lose their life to suicide. It does not take much imagination to work out how many others are affected by each life lost. Zero Suicide is an ambition being adopted around the UK and the world, and the Major of London announced his support for Zero Suicide in September on World Suicide Prevention Day.

The stakeholder engagement took several forms, workshops, telephone interviews and a digital survey, which gathered nearly 1,000 responses in just six short weeks.

What we are learning

The project has taught us several things. Firstly, it showed us how passionate people working in this field are about knowing more about suicide prevention. People want to be trained, to know how digital apps and research are contributing to this area of mental health, and what best practice is out there and ready to share. Perhaps most simply of all, people want to be able to know what to say if someone they encounter is suicidal.

Our research also demonstrated there are plenty of good quality national and international examples out there to support and equip professionals to build their suicide prevention toolbox. The responses demonstrated there is a need for a national suicide prevention ‘go to’ digital resource to inform and support the full range of professionals; NHS, police, fire, social care, unions, private and third sector that work so tirelessly to prevent suicide.

On a personal level, I learnt that many of us have first-hand experience of suicide, which we seldom speak about. All the learning from our project has been provided to ZSA and is informing the content and design of a new digital resource, which will be made invariably stronger by the open, honest and brave contributions that everyone involved throughout the process has made.

To learn more about this project please email hin.southlondon@nhs.net.

A thank you

Thank you to all of you who contributed so openly, you inspired us to complete this work on your behalf. Thank you to the man who had the courage to challenge us at that first workshop. You opened my mind to the life that you and your peers live, you stayed and joined in despite your anger and upset. I believe by the end you were uplifted, like me, by the sheer number of professionals in the room from all different services that wanted to understand more about how they can be better equipped to prevent suicide. By engaging with the topic, sharing your experience and your viewpoint, you helped us to ensure the experience of others like you is captured and considered.

And thank you to those colleagues who bravely shared their personal experiences of suicide. I hope you have been helped through hearing some of the other sad stories of loss, which were presented so eloquently and courageously at our workshops around the country.

Suicide touches the lives of so many of us in some way, either through relatives or friends, or through living with suicidal ideation as part of a mental illness. What we’re not always able to do is talk about it. I believe if the Zero Suicide ambition helps even more people affected to find the words and forums to talk about it, is an ambition worth pursuing.

Help us to achieve our Zero Suicide ambition

The Health Innovation Network has joined with the ZSA in its support of the Major of London’s Zero Suicide campaign. You can learn more about preventing suicide through free Save a Life training.

The aim of Save a Life is to #See #Say #Signpost

  • Identify when someone is presenting with suicidal thoughts/behaviour
  • Be able to speak out in a supportive manner
  • Empower them to signpost the individual to the correct services or support.

Take 20 mins now to Save a Life, access the training here.

Acknowledgements and further information

Thank you to King’s Health Partners for supporting our suicide prevention engagement work and to the Zero Suicide Alliance for the opportunity to contribute to the design and content of the new national digital suicide prevention resource.

This piece was originally published on 10 October 2019 on kingshealthpartners.org

Topol Review highlights potential of digital technologies to address the big healthcare challenges

Published and last updated by Rahel Gerezgiher

Topol Review highlights potential of digital technologies to address the big healthcare challenges

Written by Anna King, Commercial Director at Health Innovation Network.

It is not often that an independent review for a UK Secretary of State gets held up for a book launch, but such is the case when you ask a world-eminent, California-based cardiologist to review the changes required in the NHS healthcare workforce to ensure preparation for the technological future.

Dr Eric Topol, probably best known for his book, The Patient will see you now, published his long awaited The Topol Review: Preparing the healthcare workforce to deliver the digital future last month. The report highlights how digital healthcare technologies have the potential to address the big healthcare challenges as well as tackle increasing costs. The report observes that innovation will “increasingly shift the balance of care in the NHS towards more centralised highly specialised care and decentralised less specialist care”. This shift in the pattern of need and services is aligned with much of the HIN’s work and our focus on out-of-hospital care. Flatteringly, Topol also supports the ambition that the UK has the potential to become a world leader in such healthcare innovations. This is particularly exciting to hear given the work the HIN has been doing locally with DigitalHealth.London building upon local strengths in clinical care, research, education and business to boost London as a world leader in digital health.

However, Topol also offers words of caution for those impatient for new digital healthcare technologies to reach their full potential. As he observed, “it can take up to 10 years to realise cost savings, investment in IT systems, hardware, software and connectivity, as well as the training of healthcare staff and the public”.  The potential benefits of genomics moving beyond rare diseases and cancers is a good example of this. Allowing better prevention and management of conditions that could reduce costs and disease burden in the 10 to 20 year timeframe will require the NHS to have completed the “digitisation and integration of health and care records if the full benefits of digital medicine (earlier diagnosis, personalised care and treatment) are going to be realised”.

Whilst much of the report focused on the longer-term revolutionary technologies, there was also an acknowledgement that some data-driven technologies can and are being deployed today. Particularly, those with the aim of improving ease of access or remote monitoring, designed to reduce unplanned hospital admissions and decrease non-attendance rates. This is an area that we see many solutions being developed by the innovators of the NHS Innovation and DigitalHealth.London Accelerator programmes. Companies like Transforming Systems and Dr Doctor use data to improve access and system efficiency, and companies like Lumeon and Health Navigator helping improve individual patient pathways. Topol is also refreshingly realistic about the issues we see many innovators face because of “uneven NHS data quality, gaps in information governance and lack of expertise”. Potential enablers to overcome the barriers to adoption, he suggests, include: an information governance framework, and guidance to support the evaluation, and purchasing of AI products.

In the report, genomics, digital medicine and artificial intelligence were all seen to have a major potential impact on patient care, but it also showed how digital will help improve the lives of the NHS workforce. There was a helpful introduction to a number of emerging technologies, including low-cost sequencing technology, telemedicine, smartphone apps, biosensors for remote diagnosis and monitoring, speech recognition and automated image interpretation, that are seen to be particularly important for the healthcare workers.

Topol also finally puts to rest dated concerns that technology exists to replace people working in healthcare. The report clearly responds to this fear confirming that technology is intended to ‘augment’ healthcare professionals, rather than replace; releasing more time to care for direct patient care. Whilst, some professions will be more affected than others,Topol finds that the ‘impact on patient outcomes should in all cases be positive’.

At the HIN we have been supporting the development of the NHS workforce as a necessary part of the journey to digital transformation. I was pleased that Health Education England’s involvement in the Topol Report means that training and education will be modernised, as it is still very dated both in its methods of delivery and syllabus. However, this education should not focus solely on just educating new NHS staff members – but we should also be digitally upskilling the workforce we have now, and at every level. And herein lies the real complexity of the digital revolution. What Topol finds undeniable is that the roles of healthcare staff will change and new skills will be required, and it is good to see Health Education England responding to this challenge – although, it was shocking to learn that radiologist are still be taught how to develop traditional x-ray films, despite them rarely being used in the NHS!

Learning from previous changes, implementation will require investment in people as well as technology. It bodes well for the exciting wide-ranging programmes of the AHSNs, that support a learning environment, understand the enablers of change and create a culture of innovation. Programmes of ours like the Graduates Into Health Fast Track IM&T programme and the DigitalHealth.London NHS Digital Pioneers programme will play an important role in developing an agile and empowered workforce to facilitate the introduction of the new these new technologies. The report is clear that it is an exciting time for the NHS to benefit and capitalise on technological advances, and the AHSNs are well place to support this. The observation that ‘within 20 years, 90% of all jobs in the NHS will require some element of digital skills, illustrates the need for digital education revolution perfectly, even if it did raise the question what would the 10% be doing!

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About the author
Anna has been Commercial Director at the Health Innovation Network since July 2013. Prior to her current role Anna was the Commercial Programme Director at the London Commercial Support Unit (Commissioning Support for London, NHS London and NHS Trust Development Authority).

Think Diabetes for World Diabetes Day

Published and last updated by Simon Ellery

Think Diabetes for Diabetes Day

HR managers are working in partnership to revolutionize the workplace in a move which could improve employees’ health, save money for the NHS and boost productivity, argues Health Innovation Network Senior Project Manager Linda Briant (pictured below) who is driving forward Think Diabetes.

Employees with a diagnosis of both Type 1 and Type 2 diabetes (and carers of people with diabetes) will be supported and encouraged to take time off work to learn about their diabetes. The insight and knowledge gained at these Structured Education sessions will empower individuals to self-manage their condition and improve their long-term health outcomes.

How big a problem is diabetes?
Diabetes costs the NHS more than £10 billion per year and this constitutes roughly 10 per cent of the entire budget. We know that Structured Education is part of the solution. People with diabetes benefit from being able to self-manage their condition and make changes to diet and lifestyle. Structured Education helps them to do this and is clinically proven. It also provides much needed peer support after being diagnosed with a life changing condition. What’s more, it is recommended as a basic and crucial part of care for an individual with diabetes by the National Institute for Health and Care Excellence (NICE), the NHS’s guidance on clinical standards.

Despite this, uptake rates of diabetes education are low and one of the reasons commonly cited is that it is difficult to take time off work. Diabetes is covered by the Equality Act 2010 as a long term condition that has significant impact on individuals’ lives. Employers are therefore obliged to make reasonable adjustments, although these adjustments are not defined. The case for employers adjusting their policies and supporting individuals to attend structured education is overwhelming.

What must change?
The working population in Britain spends roughly a third of their life at work. Yet all too often, the role of employers in creating and maintaining healthy workplaces, or supporting their staff to be healthy, is overlooked.
The workplace is a great setting for reaching people with messages that promote and encourage healthy lifestyles and many businesses are already taking action by promoting healthy initiatives. The benefits to them are higher staff morale and lower rates of sickness absence.
Evidence shows that employers that invest in appropriate workplace health initiatives to support the health and wellbeing of their employees have the potential to see a significant return on investment (1) A review of academic studies shows that the return on investment for some workplace health initiatives can range from £2 for every £1 spent (1:2) to £34 for every £1 spent (1:34) (2).

How is the Health Innovation Network influencing change?
Human resource (HR) professionals, alongside people living with diabetes have worked with the Health Innovation Network to develop and test strategies that could easily be adopted by organisations to support people living with diabetes attend structured education. These include:
1. HR policy and strategy changes to facilitate taking leave to attend courses
2. Structured education delivered in the workplace
3. Healthy lifestyles awareness-raising sessions at work with a focus on diabetes prevention

The learning from this feasibility study is being incorporated into a ‘how to’ guide, which provides examples of good practice, along with recommendations for undertaking this initiative in your workplace.

This guide will be published and available in January 2019.
How can you make change happen for your workforce?
• Sign up to receive a free copy of the ‘how to guide’ for supporting people living with diabetes in the workplace
• Implement the recommendations
• Tell us about the impact
• Grow the UK’s healthy workplace community
If you are an HR professional interested in receiving more information, contact me on linda.briant@nhs.net.
Citing the evidence

Evidence informs us that working age adults and younger people with diabetes are less likely to complete Structured Education, which can result in poor health outcomes.
The All Party Parliamentary Group for Diabetes’ report: Taking control: Supporting people to self-manage their diabetes (March 2015) highlighted that many structured education courses require substantial time off work during the week; and that this is a major disincentive to attendance as people often do not wish to use annual leave for this purpose.
A recommendation from the report states: “The clear benefits to people’s health of attending education courses mean that the Government should give people a legal right to time off work to attend education courses about their diabetes that their healthcare team believe are appropriate to their needs.” (3) NICE recommends that well-designed and well-implemented structured education programmes are likely to be cost-effective for people with diabetes and should be offered to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review.
References:
1 Healthy Work – Evidence into Action 2010 page 46
2 BUPA, Workplace Health – A Worthwhile Investment, 2010
3 Taking Control: Supporting people to self-manage their diabetes, page 20 – APPG Diabetes Report

Older Adults recover well from common mental health conditions

Published and last updated by Rahel Gerezgiher

Older Adults recover well from common mental health conditions

We all need to do more to recognise older adults who may have depression and anxiety; older adults engage well with IAPT (including digital IAPT interventions) and most importantly they recover well, evidence shows that the recovery rate of older adults is better than working age adults. These were the key messages given to a capacity audience at the recent Health Innovation Network’s Improving Older Adults Access to Psychological Therapies (IAPT) event which took place on 19 September. All these points seem relatively simple, so why can’t we quickly fix this problem?

It seems everyone has a part to play, we should not be treating older adults as a homogeneous group 65 – 100 years old is a large age span and perceptions and needs will be different.

The third sector, housing and social care organisations have significant role in facilitating referrals to IAPT and ensuring older adults are aware that depression and anxiety can be resolved through talking therapies. We should encourage older adults to share their experience of IAPT and we need all to listen. IAPT services need to train their staff to work with this large older adults age range and liaise more closely with their secondary mental health colleagues particularly the memory service who are diagnosing people with dementia.

Finally, our very busy GPs who are often the gateway to supporting referrals to IAPT services. Think always that chronic health conditions go hand in hand with mental health issues, don’t just refer the physical issues, address both mind and body to make sure the older adult is enabled to maximise independence and live a happier life.

Aileen Jackson, Senior Project Manager Healthy Ageing and Mental Health lead, Health Innovation Network

What are we doing to prevent strokes?

Published and last updated by Simon Ellery

A new online tool will help prevent strokes and save lives

An estimated 68,000 people in London are living with undetected AF and at risk of blood clots, stroke, heart failure and other heart-related complications. The Health Innovation Network’s Fay Edwards talks about the launch of an important new tool.

This week together with our partners we launched the Pan-London Atrial Fibrillation (AF) toolkit. The online toolkit is the culmination of a collaboration between the three London Academic Health Science Networks (AHSNs) and the London Clinical Network (LCN).

Visualised in 2016, it is targeted at commissioners and providers who want to find more people with AF (Detect), Treat more people with AF (Protect) and improve the outcomes of those people receiving treatment (Perfect).  The toolkit focuses on each of these three areas and is laid out in a logical order, first setting the scene with an introduction from Tony Rudd (National Clinical Director for Stroke, NHS England) and Matt Kearney (National Clinical director for Cardiovascular Disease Prevention, NHS England) highlighting the unmet need for appropriate anticoagulation and improved detection of AF.

Within each of the three domains there are three “opportunities for improvement” designed to stimulate ideas and focus efforts.  These contain case studies, resources and best practice examples which provide guidance on how to replicate.  With all quality improvement it is vital for teams to understand their ‘current state’ before embarking on the future. The AF improvement cycle (on page 7) encourages teams to consider the quality and performance of their service compared to national standards and highlights the need for them to understand and interpret their own service level data. The AF improvement cycle is a complete and concise methodology which has been developed through the understanding of the critical success factors needed to undertake AF improvement work. It can be applied to any of the three domains and opportunities for improvement.

Complementing the AF improvement cycle is a series of infographics for each London CCG which clearly and pictorially presents data on prevalence, anticoagulation rates, those known to be at risk of stroke and those who have had a stroke in the past year.  These have already proved very powerful in engaging interest and understanding a starting point.  For those teams outside of London, or for data more focused on each domain (Detect, Protect and Correct) there is a useful table of data sources laid out within each of these.

Supporting all of this is the AF business case model.  Designed by Public Health England and the AHSNs this tool uses publically reported data of AF to help organisations identify areas for improvement in the identification management of AF.  It will also quantify the cost and savings associated with addressing these opportunities.

Detect 

Within detect there is a focus on AF Awareness campaigns, the importance of manual pulse rhythm checks and AF detection devices. This includes the Health Innovation Network’s AF detection device review, a detailed report which defines the current technology and software designs available to enhance AF detection. It contains examples of how to use these devices and improve actual prevalence in a variety of settings.

Protect

Within protect there is focus on how to improve anticoagulation, Initiating anticoagulation in community settings, correcting heart rhythm and rate where necessary.

Perfect 

Perfect encourages high quality anticoagulation services which provide patient education, a range of treatment options and support of self-monitoring. It contains the ‘Excellence in Anticoagulation Care’ document from the London Clinical Network – a guide for commissioners and service providers to help deliver high quality anticoagulation services.

A pathway for service review is contained in this section including a checklist to assist commissioners in benchmarking their anticoagulation service or create a service specification.

There are also educational resources for patients and staff n to support self-management and self-monitoring of International Normalisation Ratio (INR) for those prescribed Warfarin.

Mythbusters

Designed to dispel the common myths and misconceptions encountered when prescribing anticoagulation, by providing an evidenced based explanation.

I hope the toolkit will inform clinicians and commissioners in the design of local services to deliver the best patient care and optimum outcomes.

Download the toolkit here.