Dear Colleague

Purpose

This HDL invites proposals for pilot Managed Clinical Networks (MCNs) in Palliative Care and sets out the main issues which should be considered in developing proposals and the timetable for their submission to the Scottish Executive Health Department.

Action

Proposals should be submitted to Mr J N Leadbeater, Planning and Performance Management Directorate, 2(E)N, St. Andrew's House, Regent Road, EDINBURGH, EH1 3DG by no later than Tuesday 31 October 2000.

Additional copies of this HDL may be obtained from Mrs Michelle Williamson. Tel: 0131 244 2946.

Yours sincerely

SIR DAVID CARTER
Chief Medical Officer and Acting Head of Department

29 August 2000
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MANAGED CLINICAL NETWORKS IN PALLIATIVE CARE

The Managed Clinical Network (MCN) concept was set out in the report of the Acute Services Review published in June 1998, and has been well received throughout the NHS in Scotland. Proposals for pilot MCNs in Palliative Care are now invited and this letter sets out the main issues which should be considered in developing proposals and the timetable for their submission to the Scottish Executive Health Department.

The Acute Services Group, which is responsible for guiding the implementation of the recommendations of the Acute Services Review, has developed guidance setting out the principles underlying MCNs and providing a procedure for their creation and dissolution. These are set out in Management Executive Letter (MEL)(1999)10, copies of which are available from the Department or from Scottish Health on the Web (SHOW), which can be found at www.show.scot.nhs.uk

'Managed Clinical Networks' are defined as linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.

Palliative care has been recognised as particularly suitable for an MCN approach because it is delivered in a broad range of care settings by a wide spectrum of health care professionals, and requires good communication and co-operation across all the agencies and professions involved. It is also an area where there are significant issues of patient care which still require to be addressed. There is clear evidence that the management of pain is variable, and it is proposed that improvement in the management of pain should be the first priority of the pilot Networks.

The Scottish Executive Health Department has therefore encouraged the Scottish Partnership Agency for Palliative and Cancer Care to develop proposals for a Managed Clinical Network in palliative care, with particular reference to pain relief. The Agency established a Working Party to look at this, and a copy of the report which it produced is attached. This sets out a framework for the operation of such a Network. The report has been considered and accepted by the Acute Services Group, which suggested that, in addition to MCNs focussing initially on cancer pain relief, the Department would also be interested in looking at MCNs which aim to meet the palliative care needs of people with chronic and progressive conditions other than cancer. Proposals for pilot Networks are therefore now invited.

The proposals should be submitted in outline form, but those preparing them should bear in mind that in considering them, the Department will be looking for the following:

• Evidence of support for the proposal from the local Primary Care Trust, LHCCs, Acute Trust, Health Board, community pharmacists and local hospice or specialist palliative care service, and of a collaborative approach involving other planning partners, including voluntary agencies. There should also be evidence of compatibility with Health Improvement Programmes and Trust Implementation Plans;
  
  
• Clarity about the aims and objectives of the proposed Network, including the extent to which its primary focus will be on cancer or on the needs of people with other chronic and progressive conditions;
  
  
• Consideration of the most appropriate catchment area for the MCN, bearing in mind their basis in primary care, the population to be served, the natural community concerned, the number of LHCCs involved and the distribution of hospices;
  
  
• Different approaches in rural and urban settings;
  
  
• Proposed membership of the Network;
  
  
• For MCNs focussing on palliative cancer care:
  • Proposed links with regional cancer MCNs;
  • A commitment to implementation of the SIGN Guideline on the Control of Pain in Patients with Cancer;
    
    
• An indication of how the project will be evaluated. Thought should be given to the achievements expected in the period and the way in which these can be measured. The evaluation should indicate what baseline information is needed and how it will be collected.

Pilots should run over a total period of 2 years including set-up time and evaluation. The Department would expect reports from the pilots to be submitted by the end of December 2002.

While the administrative, IM&T and clinical governance support for the pilots would be expected to come from within the structure of Primary Care Trusts or LHCCs, some funding may be available for evaluation of the pilots. Those developing proposals should also bear in mind the possible applicability of the funding of £225,000 which has been allocated to each Trust in Scotland specifically to catalyse and facilitate service re-design and the development of Managed Clinical Networks.

The Scottish Partnership Agency for Palliative and Cancer Care has agreed to help assess the bids. A short list of the most promising proposals will then be put to the Acute Services Group, which will then take the final decision about the proposals it wishes to support. Those submitting successful bids may be asked to provide more detailed proposals. In order to consider these bids at the meeting of the Group on 11 December, proposals should be submitted to Mr J N Leadbeater, Planning and Performance Management Directorate, 2E(N), St Andrew's House, Edinburgh EH1 3DG by Tuesday 31 October 2000.