The support of HInM enabled the success of the programme to be realised. Evidence of direct impact of workforce education interventions on healthcare is virtually non-existent. The expertise in the AHSN facilitated capture of vital outcome data to address this gap.
Professor Mini Singh , Director DECIDE® Education Programme
Overview

The DECIDE® Education Programme is a Continuing Professional Development model for qualified health workers. It underpins NHS workforce transformation priorities by operating across health, innovation and education organisations to enhance clinical decisions. DECIDE® provides healthcare clinicians with flexible, relevant education that directly translates into practice whilst ensuring the health system has an effective workforce education tool.

The DECIDE® Education Programme integrates pedagogy, implementation science and NHS policies to provide better value healthcare1. The programme delivers a tailored, population-based approach adaptable to any area of clinical education by targeting behaviours that influence a patient’s journey.

The DECIDE® Education Programme has proven impact in the real world. With support from Health Innovation Manchester (HInM), it was piloted in Greater Manchester (GM) in 2019-2020 to tackle inconsistency in regional primary care dermatology practice across four Clinical Commissioning Groups (CCGs) serving a population of 669,523 individuals. Application of DECIDE’s value-based education IMPACT model (Figure 1) has led to system savings of £212,212 in 12 months. Equivalent to savings of £21 million across England (based on number of CCGs in 2020). Delivery of precision education through a system-wide collaboration resulted in reductions in inappropriate referrals and prescribing, widespread practice change and improvement in quality of referrals.

1. Gray, M., 2017. Value based healthcare. BMJ 356:437

Challenge/problem identified

Dermatology was chosen as the pilot for the DECIDE® Education Programme. Detailed analysis of geographical source of referral revealed variation in dermatology referrals and prescribing practices between localities in GM affecting patient experience, health outcomes and access to secondary care dermatology services. An audit of 352 referrals from three GM CCGs to secondary care carried out in 2016/172 identified:

  • growth in demand in two-week wait referrals (20-23%, year on year, 2015-2017 Salford Dermatology Centre; increased expenditure of £537,833)
  • 24% were diagnoses that could be managed in primary care
  • delay in skin cancer diagnosis (20% of melanomas and 17% Squamous Cell Carcinoma were incidental findings in secondary care)
  • £276,368 expenditure across all 10 GM localities for ineffective medications (2017).

With specialist workforce shortages and the high demand on NHS services, it was imperative to look towards integrative education and service models to provide sustainable solutions and alleviate pressure on secondary care services.

2. Cohen O and Singh M, 2017, presented at Dermatology Centre, Salford Royal Foundation Trust, Salford, UK

Actions taken

Professor Mini Singh, Professor of Medical Education, created the innovative DECIDE® Education programme to deliver the right education for the right clinician at the right time with the aim of transforming clinical practice. This programme empowers first contact clinicians to increase competence in clinical practice through change in decision-making behaviours.

The ask of Health Innovation Manchester (HInM) from the Director of the DECIDE® Education Programme was to:

  • support and initiate the Greater Manchester rollout of the DECIDE®-Dermatology Module
  • conduct a health economic analysis and evaluation of the programme in each locality
  • manage the project and initiate patient focus groups
  • support research administrative processes e.g. research ethics.

Since becoming involved with HInM, the DECIDE® Education programme has grown significantly educating 243 GP practices (49% Greater Manchester Practices).

Impacts/outcomes

49% of GP practices in Greater Manchester (7/10 localities) participated in the DECIDE® Dermatology Module between November 2019 and February 2021. Impact data was obtained from four localities prior to the start of the COVID-19 pandemic. The patient benefit is demonstrated in the resource and efficiency savings outlined below

1. Significant improvement in referral and prescribing practice

(Derived from 12-month comparative data pre and post completion of DECIDE® by participants).

  • Across all referral types a 25.2% reduction in demand for dermatology referrals. Equivalent to a 39.7 percentage point reduction on the proportionate growth in referrals from the previous year (1700 less referrals, 12 less clinics / week in secondary care).
  • There was a consistent 40% reduction in inappropriate prescribing of medications.
  • The fiscal benefits from the above equated to savings of £212,212 across the system in the first 12 months alone.

2. Improved Quality of Referrals

  • Patients from the DECIDE® practices had >6x the odds of those in the non-DECIDE practices of receiving a logical differential diagnosis. This demonstrates that DECIDE® participants applied improved knowledge and decision making skills to increase diagnostic accuracy (189 referrals).

3. Change in decision-making in clinical practice

  • Thematic qualitative analysis of 70 post-attendance clinic consultations demonstrated significant change in clinicians’ decision-making resulting in widespread practice change.
  • The DECIDE®-Dermatology Module empowered community clinicians to improve clinical decision-making, strengthen professional relationships with patients and directly influence service pathways.

Benefits for Patients

Educating community health professionals to improve competence in their decision-making this:

  • enhances patient experience
  • leads to a speedier diagnosis
  • gives peace of mind during consultation
  • offers the patient appropriate advice about what to look out for in the future (health promotion and selfcare).

DECIDE® was shortlisted for Primary Care or Community Service Redesign Initiative at the 2020 HSJ Value Awards.

Start and end dates
  • DECIDE-Dermatology Module: Dec 2019 – Dec 2020
  • DECIDE Respiratory Module: Start Sept 2021
Contacts

Project contact for further information:

Cath Barrow, Senior Programme Development Lead, Health Innovation Manchester

E: cath.barrow@healthinnovationmanchester.com

Media contact for further information:

Lucy Williams, Communications Manager, Health Innovation Manchester

E: Lucy.Williams@healthinnovationmanchester.com