Supported by the National Institute for Health and Clinical Excellence

Judges

  • Dr Beverly Malone, general secretary, Royal College of Nursing
  • Professor Ian Gilmore, president, Royal College of Physicians
  • Professor Roy Pounder, emeritus professor of medicine, University of London
  • Dr Gillian Leng, implementation systems director, National Institute for Health and Clinical Excellence

Winner NHS Greater Glasgow and Clyde

The judging panel was highly impressed by the levels of professionalism that have gone into implementing this model in West Renfrewshire

While there had been no significant increase in the prevalence of depression, a condition managed primarily by GPs, the West Renfrewshire area had seen a three-fold rise in antidepressant prescribing over 10 years leading up to 2004, with waiting lists for psychological therapies in secondary care hitting 12 months.

To address the situation by implementing NICE clinical guideline 23, funding was secured from the Centre for Change and Innovation's doing well by people with depression programme.

The service is designed to improve access to evidence-based psychological interventions using a 'stepped collaborative care' approach. And the doing well IT system supports this by allowing all patients to be referred electronically, and providing detailed monitoring of response to treatment.

Depression screening at initial GP assessment is being standardised by using the patient health questionnaire (PHQ). The PHQ score guides interventions offered by the doing well team. Responses can range from 'watchful waiting' for patients with mild depression, to brief cognitive behavioural therapy, antidepressants or inpatient treatment in more severe cases.

Drug costs within the programme have also been reduced - from an average of£18 to£9 a month - following the promotion of local formulary guidance on antidepressants.

The emphasis on patient education and choice has helped doing well achieve its targets in West Renfrewshire with a relatively small multidisciplinary clinical team of 5.2 whole-time equivalents.

More than 900 patients across 14 GP practices have now been seen, with an average contact time of 148 minutes over 4.6 contacts. PHQ scores have also improved, with average indications shifting from 'clinical depression' to 'recovery'.

This successful implementation of NICE guidance is readily transferable to other geographical areas.

Doing well by people with depression, contact elsbeth.campbell@gghb.scot.nhs.uk

Highly commended Blackpool PCT

NICE guidance on falls, published in 2004, was used to inform agreements to reduce accident-related deaths in Blackpool

Implementation of falls guidance in Blackpool - a borough with the second-worst life expectancy for men in England and Wales and similarly poor outcome figures for women - was run in tandem with the national service framework for older people standard 6, with the express aim of targeting the most vulnerable groups and reducing health inequalities.

A multi-agency group performed a needs assessment to examine falls in the over-65s and identify inequalities in incidence and access. This equity profile demonstrated that while existing NICE guidance was being followed, its interpretation into care provision was not meeting the needs of the highest-risk group.

The drive to resolve this disparity to ensure best practice delivery to the most vulnerable was framed in a number of objectives. Multi-agency training raised awareness of all the factors related to falls in older people and accident prevention activities. Medication was reviewed and an exercise programme was developed for high-risk patients and their carers.

A falls community matron co-ordinated falls prevention work in areas of greatest need and, where improvements in risk were achieved, pathways to rehabilitation programmes could be accessed.

Preliminary outcomes have been very encouraging. Both A&E and ambulance services are recording falls and providing information for a comprehensive database of people at high risk. Paramedics proactively refer to the falls prevention service and hospital admission records show fractured neck of femur rates are in decline.

Predict and prevent, contact colette.cassin@blackpoolpct.nhs.uk

Finalist Eastern Wakefield PCT

NICE-ly does it, launched by Eastern Wakefield PCT in March, is a process for ensuring NICE guidance implementation and compliance, and followed a year-long pilot study

The policy was devised as a result of earlier recognition of inconsistencies, inefficiencies and duplication across the area. Organisations were unable to demonstrate guidance as current practice or the financial or clinical implications of implementation.

Implementation is now monitored by a tracking database that ensures timely and consistent evidence-based care is available for patients. And there is now a clear commitment to collaborative working across the organisation's planning groups.

NICE-ly does it, contact laura.elliott@ewpct.nhs.uk

Finalist North East Lincolnshire PCT

Consultation highlighted the psychological barriers to exercise for people who suffer or fear shortness of breath, but an expert patient scheme has helped address this

Working alongside the COPD clinical co-ordinator at community-based services, expert patients (or pulmonary rehabilitation 'buddies') offer peer support and motivation, assist with exercises and lead educational activities. The buddies help patients overcome anxieties and establish pulmonary guidance in line with NICE guidance.

Dramatic physical and psychological improvements have been recorded using standardised assessment tools. The project is an example of best practice that could be easily replicated across the country.

Pulmonary rehabilitation buddies, contact michelle.webb@nelpct.nhs.uk

Finalist Sheffield S&W PCT and Sheffield Teaching Hospitals Foundation Trust - Criteria for the Management of NICE Guidance

Praise from the Healthcare Commission for Sheffield Teaching Hospitals foundation trust's NICE guidance management methodology prompted uptake of the system by organisations across the Sheffield health economy

A city-wide steering group and a powerful database are some of the facets of a variety of models and systems used to co-ordinate the implementation of NICE guidance in Sheffield.

Successful components from the Sheffield system have now been identified as a distinct set of process criteria that remain consistent with national recommendations, allowing the management approach to be transferred and replicated in strategic networks across the UK.

Criteria for the management of NICE guidance, contact deborah.hopkinson@sheffieldsw-pct.nhs.uk