View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

Project Impact:​

• 75 min of GP time saved per patient​
• 630 extra GP appointments available​
• £21,735 of clinical time avoided​
• Improved patient care​
• 44% reduction in Gabapentin prescribing

Patient Story:

When I turn in bed, I wake in pain, so I get up because I’m fully awake regardless of if I’ve only been sleeping for 45 mins or a couple of hours. I sit up in bed and I get shooting pains. My cheeks flush with anger and I curse and swear at the pain as if it’s a living entity. I hesitate before I move as I know it’s going to hurt like hell. I count in my head 1.2.3 {insert curse word here} as almost every motion has its own personal “hurt”. My neck, both shoulders, both knees & lower back all in varying degrees of pain and all have various swear words associated, from the mildest for my left shoulder, to the vilest for my back. I get up, make a cup of tea, and stay up, generally all night until I feel absolutely exhausted and go back to bed.

It’s exhausting, depressing, hopeless, frustrating, makes me feel completely inadequate because I can’t do the simplest of tasks. The worse it gets, the less I do & the less I do, the worse it gets. I psych myself up for days sometimes, just to go to the shop for essentials, often running out of milk, bread etc. but I manage without until I can go. Mental health plays a big part in this too, so it’s not just the pain preventing me from doing things. I dread going out because I know before I get home, I’ll be in awful pain. Some of the pain is sharp enough to sicken me, some is minor, some medium, but all combined is almost too much to put up with. I have massive walls to climb before I manage a moderate exercise regime and start losing weight, which I’m almost certain will help with at least some of the pain. I am trying to control the pain rather than letting it control me, but I’m losing the fight at the moment.

Does M and the service make a difference? When we 1st spoke, I was very guarded and wary of M, thinking this was just another do gooder, nosey busybody trying to save the NHS money and leave me in pain with no meds. Well, I soon realised that I couldn’t have been more wrong. It takes a long time for me to trust someone, especially someone I have never met. But I knew very quickly that the practitioner had my very best interests at heart, and she was going to help. Not only does she make sure I am on the right medication and proper dosage for my physical issues, but she also takes the time to talk in general and to ensure I’m in the best place mentally.

I cannot stress how important the service and help that M gives to me is. We are working together to try and reduce my medication currently, and also improving my mental health. Through M’s persuasion I started speaking to MIND and I’m trying to change & improve my way of life. I hardly leave my home at the moment because of pain and mental health, but I am making small changes to improve things. This is all thanks to the service.

Project Outcomes:

• A new service was introduced in two South Powys locations for patients with persistent pain, improving their quality of life.​
• There has been a significant impact on prescribing culture, leading to an average 42% reduction in Gabapentin and Tramadol prescriptions, associated costs and improved patient safety.​
• Our service has saved GP time, and improved the patient experience, increasing the quality of care.

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

The Values Programme Online:

Following consultation with service users and staff, we developed an online protocol to deliver a therapy based on Acceptance and Commitment Therapy for Psychosis (ACTp). This was a 4 session intervention delivered for two hours per session for four consecutive weeks.

Project Aims and Objectives:

Our primary aim was to increase access to evidence-based therapy for young people with psychosis. This informed our three project objectives:

1. To increase the amount of young people with psychosis attending group therapy.
2. To explore the acceptability of delivering group therapy online to young people with psychosis.
3. To explore the feasibility (with respect to the service) of delivering group therapy online to young people with psychosis.

Increasing Access:

The Values Programme Online appears to be an effective method of increasing uptake of group therapy amongst young people with psychosis.

The graph below (Figure 2.0) demonstrates a significant improvement in uptake as represented as a percentage of the EIP service caseload.

The graph demonstrates a stepped increase in percentage uptake once the Values Programme Online was introduced.

Acceptability:

Semi-structured interviews with service users helped us to explore the acceptability of this approach.

Service-users reflected that participating in the group online felt ‘comfortable’ and reduced a sense of anxiety that could otherwise interfere with group attendance. These experiences indicated that online group therapy was acceptable to our service users.

Feasibility:

Clinicians who delivered the therapy found the protocol useful and enjoyed delivering the group.

Delivering therapy online reduced costs associated with travelling and saved on clinician time. In addition, travelling costs to service-users were also negated.

Co-produced reflections:

Although online delivery was acceptable to service users, some expressed a desire for a hybrid approach.

Most service users reported a willingness to travel 20 minutes for a ‘Goldilocks’ distance (please see figure 3.0) to attend a supplementary face-to-face session.

However, given the average distance from service user location (based on postcodes) to a central location, this would not be practical for the majority.

Conclusions:

The Values Programme Online  appears to be an acceptable and feasible method of increasing access to group-based therapy for young people with psychosis.

It may be that a hybrid approach combining face to face and online modalities may increase acceptability to a broader range of service users. Incorporating this approach warrants further exploration in the future.

View the project poster Cohort 8 from the Bevan Exemplar Showcase

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

In 2021 cancer caused ~25% of all UK childhood deaths (Children’s Cancers | Cancer Research UK). Current genetic testing for childhood cancers in Wales can include multiple genetic tests and invasive procedures.

Whole Genome Sequencing (WGS)  – DNA sequencing method for whole genome analysis. One test can detect a variety of genomic abnormalities including tumour and familial (cancer predisposition genes) abnormalities through paired testing of tumour and germline DNA (Figure 1). (Nakawaga et al., 2015).

There is evidence that WGS provides more accurate diagnosis, prognosis and access to more treatment options for childhood cancer than current standard of care genetic tests (Trotman et al., 2022).

Graphical demonstration of WGS capability to detect tumour (somatic) and germline variants through paired testing of tumour and germline DNA.

Project Aims:

• Validate a whole genome sequencing (WGS) pipeline for paediatric oncology patients at diagnosis, relapse, progression or where all standard of care treatment options are exhausted (<25years)
• Develop a clinical and laboratory pathway that utilises a PCR free WGS testing method for paediatric oncology samples and matched germline samples.

Project Outcomes:

Procedures in place for sample referral, patient consent, laboratory receipt, sample storage, sample culturing, DNA extraction and sequencing from required samples for WGS for paediatric oncology patients.

• 44/45 sets of patient samples passed DNA extraction quality control parameters for WGS.
• 25/27 sequencing runs met quality parameters (One run repeated twice).
• 10/12 sequencing runs met initial bioinformatics quality parameters (One run repeated twice).

All SNVs (single nucleotide variants) with greater than 5% VAF (Variant allele frequency) detected in the cancer cell line using TSO500 DNA in house cancer NGS panel were also detected using WGS.

Cancer cell line sample: Venn diagram comparison of variants detected using TSO500 in house cancer DNA NGS panel and WGS.

Project Impact:

An in house WGS service for paediatric oncology patients is possible. DNA extracted from paediatric oncology samples is of sufficient quality for initiation of WGS.

First line WGS testing for paediatric oncology patients could replace the majority of separate standard of care genetic tests and provide greater chance of more accurate diagnosis, treatment and prognosis in the first instance. This could prevent repetitive genetic testing and limit sampling procedures experienced by children.

A paediatric oncology WGS service would be utilised by approximately 80 Welsh patients per year.

Genomics Partnership Wales – Patient and Public sounding board feedback – The sounding board were generally positive about using WGS technology for cancer patients and the patient benefit it could bring.

‘Information is power’

Watch the Cohort 8 Bevan Exemplar Showcase Presentation

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

Project Outcomes:

Thirty-three medical staff across various specialties and disciplines attended the programme, including Consultants, Specialty Doctors, Junior Doctors and Physician Associates.

Of the participants who provided feedback:

• 100% felt that their knowledge and skills have improved.
• 100% felt the changed practice had a positive impact for patient/family/carers.
• 100% would recommend the programme to their peers.

Feedback:

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

Project Aims and Objectives:

With significant delays in accessing an Orthopaedic review (over a year to see an Orthopaedic surgeon) the aim of the new pathway is to:

• Improve access to specialist advice and application of an offloading knee brace.
• Reduce the waiting time for an Orthopaedic review.
• Reduce the number of inappropriate referrals to Orthopaedics.
• Authorise prescribing of offloading knee braces.
• Improve patient outcomes and satisfaction.

Project Outcomes:

A revised process for the provision of offloading braces, implementing earlier decision-making in the form of a virtual MDT through a piloted initiative. This streamlined the previous approach, with reduced waiting times for patients, fewer appointments and reduced associated costs with improved use of resources.

Project Impact:

In total, 11 patients were involved in the 6/12 pilot pathway. The implementation of a virtual MDT reduced the time taken from having an initial consultation in CMATS to receiving an Orthopaedic opinion from 12 months to an average wait of 1.6 months (Range: 1/7 to 3/12).

Despite issues with booking appointments for the fitting of braces in ESP Orthopaedic clinics, for those patients who were booked according to the pilot protocol, the average wait from being discussed at the MDT and recommended for a knee brace, to being seen in the ESP Orthopaedic clinic for the fitting of a knee brace was 3.9 months. Patients reported statistically significant reductions in pain outcome measures  and Oxford Knee Scores following fitting of the brace.

Conclusions:

The implementation of a virtual knee MDT supports earlier decision-making and improves more timely access to offloading knee braces for patients diagnosed with unicompartmental knee OA.

This also has implications for Orthopaedic waiting lists, improving conversion rates, making better use of resources and improving patient outcomes.

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase

View the project poster and slides from the Cohort 8 Bevan Exemplar Showcase