Deploy case studies

As innovations develop into real world solutions and services, the role of the West of England AHSN shifts to identifying and supporting those with the greatest potential to improve health and care across our region.

Through our ‘evidence into practice’ approach, we select innovations with a proven clinical evidence base to spread more widely across our local systems. Our role is that of a facilitator or guide encouraging adoption and spread, using quality improvement approaches to continue testing, learning, adapting and refining.

Adoption of innovation is rarely a straight road. Even with credible evaluation and strong clinical evidence, it is not always simple to implement a new solution or service. We work closely with healthcare providers to help them adapt their care pathways and practices to adopt innovative medical devices, diagnostics and technologies.

Here are some case studies exploring our work at the ‘Deploy’ phase of our innovation pipeline from 2022-23:

Evidence into practice

Implementing a unique care bundle for premature babies

Since April 2020 we have worked in partnership with the South West AHSN and South West Neonatal Operational Delivery Network on the rollout of our award-winning PERIPrem care bundle, co-designed with parents and clinicians, to improve the outcomes for premature babies. It is now in use in all 12 maternity trusts across the South West region.

The bundle consists of 11 perinatal interventions, including delayed cord clamping, early breast milk and administration of magnesium sulphate. These have been shown to have a positive impact on brain
injury and mortality rates amongst babies born prematurely.

Quality improvement (QI) methodology was at the heart of implementation, alongside coaching and forging new ways of working. Clinicians from obstetrics, midwifery, and neonatal care joined together as a perinatal community to drive forward and revolutionise care for preterm babies.

To date at least 1,989 babies in the South West have been cared for using the PERIPrem bundle. Modelling indicates that if PERIPrem were adopted nationally, the lifetime health and social care costs avoided by the NHS resulting from severe brain injury for very preterm babies would be in the region of £290 to £370 million per year.

The National Neonatal Audit Programme’s latest report showed units across the South West achieved on average the highest rate of delayed cord clamping at 68.1% (against a national average of 43%). Evidence shows that delayed cord clamping reduces death in preterm babies by nearly a third.

On average, South West units also achieved the second highest rates of maternal early breast milk, the second lowest rates of necrotising enterocolitis (NEC) and the third lowest rates of mortality to discharge for babies born at less than 28 weeks across England.

PERIPrem Cymru launched in Wales early in 2023, and we have supported its adoption and spread through sharing and adapting materials developed during the initial project. NHS Wales Executive have commissioned us to provide programme management and clinical leadership support during the initial set-up phases of PERIPrem Cymru.

Find out more about PERIPrem.

Supporting diagnosis of ADHD

Along with AHSNs across the country, we have continued to implement objective testing using the
QbTest tool to support diagnosis of attention deficit hyperactivity disorder (ADHD) and reduce waiting
times through our Focus ADHD programme. Diagnosis of ADHD can take significant time and resources, with an average 18-month wait for accurate diagnosis.

We have supported six children and adolescent mental health services (CAMHS) or community paediatric services in the West to implement QbTest. In our region, 428 patients were assessed in 2022/23 using the QbTest, and a total of 715 patients since the start of the programme.

Together with the South West AHSN we host a community of practice, exploring innovation needs on the children and young people’s neurodiversity pathway. The online community is open to commissioners and service leads in children and young people’s mental health, as well as those working in community paediatric services, supporting ADHD assessment.

Read more about SHarED here.

The SHarED project has propelled our work to support some of the most vulnerable, marginalised patient groups in ociety, who access EDs frequently for a variety of reasons. Working with teams from all over the West of England, we’ve educated staff and supported patients to work towards safer patient care and an improved experience for patients and staff. It’s a fantastic example of cultural change across the whole patch."

Rebecca Thorpe ED Consultant, University Hospitals Bristol and Weston NHS Foundation Trust

Supporting national spread and adoption

Polypharmacy: getting the balance right

In England, NHS primary care dispenses over one billion prescription items every year. As more people live longer with multiple long-term health conditions, the number of medicines they take often increases. Whilst we know that medicines can bring many benefits, we also see that this can create a significant burden for the person trying to manage multiple medicine regimes, and in some cases it can cause harm.

Problematic polypharmacy adds a cost to the healthcare system and diminishes quality care for the patient. Most of this is entirely preventable.

On behalf of the AHSN Network and commissioned by NHS England, in 2022/23 we have coordinated rollout of the national polypharmacy programme. AHSNs have set up 34 clinical, multi-stakeholder communities of practice, supporting local systems and primary care to identify patients who take multiple medications and are at potential risk of harm, and to support better conversations about medicines.

1,270 health and care professionals have attended our popular webinar series for support in using data from the NHSBSA Polypharmacy Prescribing Comparators to understand risks and identify and prioritise patients for shared decision-making structured medication reviews.

Regional and national polypharmacy action learning sets are upskilling the primary care workforce to be more confident about stopping unnecessary medicines.

We are also working with patients and the public to drive regional testing and evaluation of initiatives to change public perceptions of prescriptions, encouraging patients to be open about their medicine concerns and expectations. In partnership with AGE UK and other local voluntary groups, 142 patients have taken part in focus groups to test public-facing materials.

Early intervention for eating disorders

All AHSNs are supporting the spread and adoption of FREED (First-episode Rapid Early intervention for Eating Disorders). Developed by a team of researchers at South London and Maudsley NHS Foundation Trust and King’s College London, this is an evidence-based, specialist care package for 16 to 25-year-olds with a first-episode eating disorder of less than three years in duration.

We have continued to work with Avon and Wiltshire Partnership Mental Health NHS Trust and Gloucestershire Health and Care Services NHS Foundation Trust to introduce the FREED model and support the recruitment of FREED Champions.

Find out more about FREED.

Blood pressure optimisation

The ambition of the national AHSN Network Blood Pressure Optimisation programme is to prevent heart attacks, strokes and vascular dementia in patients with hypertension.

As part of this we have been supporting primary care networks in Bristol, North Somerset and South Gloucestershire and Bath and North East Somerset, Swindon and Wiltshire to implement a care framework for hypertension, developed by UCLPartners. The framework aims to optimise clinical care and self-management, ensuring a systemwide approach to blood pressure optimisation.

We have worked with primary care colleagues to increase the detection of people with hypertension using various approaches, such as practice case finding through patient record searches and involvement of community pharmacists. We are also supporting integrated care boards to reduce health inequalities by targeting 20% of the most deprived populations and other local priority groups by applying NHS England’s Core20PLUS5 framework.

Find out more about our Blood Pressure Optimisation work.

Prioritising a co-production approach has provided valuable learning for local health services in how we support patients. This learning extends beyond blood pressure management to health care in general and has allowed us to maintain a community focus.

Elizabeth Emsley Clinical Teaching Fellow & Project Lead on behalf of Bristol Inner City Primary Care Network

Encouraging uptake of transformative diagnostics and medicines

As part of the national AHSN Network’s support to the Accelerated Access Collaborative (AAC), we are driving the adoption and spread of transformative diagnostics and medicines through the Rapid Uptake Products programme.

FeNO testing in primary care

FeNO devices measure fractional exhaled nitric oxide in the breath of patients, which provides an indication of the level of inflammation in the lungs. This can be used to aid in the diagnosis of asthma and can be carried out by any healthcare professional who has received training. FeNO testing speeds up diagnosis, improves patient experience and reduces secondary care referrals and inappropriate prescribing.

We have supported several local projects as part of the Rapid Uptake Product programme to introduce
FeNO testing into primary care, which completed in summer 2022. This has led to a high uptake of
FeNO testing across our region.

More than 2,500 patients in the West of England have accessed FeNO testing since October 2021, with 143 GP practices now offering the service.

Find out more about our support for FeNO testing here.

Lipid management

Helping prevent cardiovascular disease (CVD) due to high cholesterol, we have supported the increased use of lipid management medicines. This forms part of the Rapid Uptake Products programme, which focuses on three medicines: high intensity statins, ezetimibe and PCSK9 inhibitors. These are usually prescribed in primary care.

We worked with five GP practices across Gloucestershire to identify patients at risk of raised cholesterol who would benefit from a detailed medication review. Between July 2021 and June 2022 635 patient records were reviewed. 516 patients attended a lipids consultation, resulting in changes to treatment plans for 374 of these. Overall 269 patients achieved a measured reduction in cholesterol.

The AHSNs are also leading the AAC’s rollout of Inclisiran, a new drug to lower cholesterol, made accessible to patients through the first NHS ‘population health agreement’.

Since October 2021, we’ve been running a programme of monthly online educational webinars for GPs and healthcare professionals on Inclisiran and lipids optimisation, which has proven incredibly popular. These cover the evidence base and safety data for Inclisiran and practical issues around prescribing and administration. We’ve also arranged educational events for specific primary care networks (PCNs).

Uptake for Inclisiran in the West of England is now way ahead of the rest of the country. 100% of
PCNs in the West have ordered Inclisiran, with over 50% of practices prescribing it to patients to date.

Find out more about our lipid management support here.

Asthma biologics for treating severe asthma

As part of the Rapid Uptake Products programme, people with severe asthma are being offered a newer type of treatment alongside their usual asthma medicines, known as asthma biologics.

Biological therapies can transform the lives of people with asthma by reducing the long-term side effects of other treatments, such as oral steroids, and can also reduce exacerbations and life-threatening attacks.

We have worked with the South West Severe Asthma Network, South West AHSN and acute trusts from Cornwall to Swindon to create a common pathway for managing adult asthma care, streamlining the process of referral to severe asthma centres and improving access to asthma biologic therapy.

By the end of the project in September 2022, 961 patients across the South of England were receiving biologic treatment.

We’ve also worked with Bristol Royal Hospital for Children to develop and embed a robust clinical asthma service for children and young people, including a community pilot involving specialist nursing support from the hospital and six GP practices.

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