posted 11 Jul 2019, 00:35 by Cherelle Augustine   [ updated 11 Jul 2019, 02:52 ]

NIHR Applied Research Collaboration Northwest London Awarded £9m Funding

We are pleased to announce that the NIHR Applied Research Collaboration Northwest London, NIHR ARC NWL, has officially been granted £9 Million of the £135 million research fund as a local collaborative programme in healthcare improvement, to tackle the biggest healthcare challenges of this generation. 

NIHR CLAHRC NWL team at Collaborative Event June 2019

The NHS is joining forces with some of the country’s best universities, leading innovators and local authorities to solve some of the biggest issues facing health and social care over the next five years. The new ARC funding and support is for applied health and care research and to support implementation of research into practice, making tangible improvements for patients, the public and to health and care services.

“As the population grows and demand on the NHS increases, it is paramount we develop the next generation of technologies and improve the way we work to ensure the NHS continues to offer world-leading care.

“The UK has a proud history of cutting edge health research and by supporting the great minds in health and social care, this funding has the potential to unlock solutions to some of the biggest challenges facing healthcare and revolutionise the way patients access treatments in the future.” - Health Minister Nicola Blackwood.

Fifteen partnerships across England, made up of NHS organisations, social care services, leading academics, innovators, and local authorities, have been awarded funding through the National Institute for Health Research (NIHR) for ground-breaking new projects that will address the increasing demands on the NHS and give patients greater independence and choice about how they manage their healthcare.

“The NHS in NW London faces major challenges. The new NIHR Applied Research Collaboration will bring together health and care organisations, universities, local government, and patient and public groups in NW London together to help develop and evaluate interventions to meet these challenges. 

This will include new models of working such as integrated care and new informatics resources that will provide better information on the health of our local population. We are very excited about the opportunities the programme will build and grateful to all our partners for their support.” - Azeem Majeed, NIHR ARC NWL Director.

The NIHR ARC NWL’s new programme that will start October 2019 will be hosted by Chelsea and Westminster NHS Foundation Trust with Imperial College London as the main academic partner. The NIHR ARC NWL will undertake high-quality applied health and care research and work across local health and care systems to close the second translational gap by supporting implementation of research and will work collectively with ARCs in other parts of England to ensure national impact. The ARC programme aims to address a number of key challenges including: the need to increase applied health and care research, increase research in public health and primary care, the challenges of an ageing society, the disease clusters of multimorbidity and the increasing demands placed on our health and care system. 

Our programme will be conducted via four research themes and three cross-cutting themes with the overarching goal is to build sustainable infrastructure for a continual improvement in health behaviours and population health, and a reduction in health inequalities for the people of north west London.

The Child Population Health, Multimorbidity, and Digital Health themes aim to address local and national priorities, exploiting the strengths of committed healthcare professionals, academics and patients. These themes aim to achieve major population health impact, learning from and contributing to international experience.

The fourth research theme, Innovation and Evaluation, will contribute to northwest London infrastructure, capitalising on world-class discovery science in the Imperial AHSC. This will drive the rapid spread of innovations in prevention, early diagnosis and better, targeted treatments, to benefit patients, including frugal innovations from low- and middle-income countries, sharing learning within and beyond the local area.

The four research themes will be supported by three crosscutting themes: Information and Intelligence; Patient, Public, Community Engagement and Involvement; and Collaborative Learning and Capacity Building. They will produce generalisable research on how to maximise the efficiency of health improvement programmes and support high quality services.

Underpinning this work will be significant investments in informatics capability in NW London. This includes information from the Whole Systems Integrated Care (WSIC) Programme, which was established to facilitate better co-ordinated care, particularly for patients with complex health needs.

The primary care, acute, mental health, community and adult social care data for 2.2 million people contained within it will drive the evaluation of patient journeys through the health and care system in north west London.

“This investment by the Government is excellent news, not only to Chelsea and Westminster NHS Trust as a host organisation, but to our partners, our patients and our staff. The funding presents a real opportunity for collaborative working, making a difference to our patients locally and nationally. As we strive to be the best Foundation Trust we can be, we know that we must invest in new models of care, built around the strongest evidence base. 

Our long term plans are focused on working with partners to support the population in and out of hospital; to ensure they have access to the right care, in the right place, at the right time. But to do this we must understand more about the population, about their care needs and how they want their healthcare system to work for them.  

As a centre for innovation we need to continue to embrace new technology and share best practice with our colleagues and partners internally and externally. Being a part of this collaboration will enable us to meet the changing needs of the population we serve, in a realistic timescale. We look forward to working with each of the partners across the network and being a part of such vital research.” - Lesley Watts, Chief Executive Officer (CEO) Chelsea and Westminster NHS Foundation Trust.

Building on the success of the NIHR Collaboration for Leadership in Applied Health Research and Care Northwest London, NIHR CLAHRC NWL.

Over the last 10 years the NIHR CLAHRC programme has expanded from nine to thirteen CLAHRCs across England, with NIHR CLAHRC NWL being the first London funded CLAHRC in October 2008. The £135 million fund towards the fifteen ARCs now proudly covers the whole of England in a bid to equip the NHS for the future and deliver commitments in Long Term Plan.

                CLAHRC 2008 - 2013

CLAHRC 2014 - 2019

ARC 2019 - 2023

A major ongoing success story of the this CLAHRC is a programme to improve services for people with sickle cell disease, a chronic, previously life-limiting condition that affects red blood cells. 

In partnership with the Sickle Cell Society and the Picker Institute Europe, the team developed the first patient reported experience measure (PREM) for people with sickle cell and conducted the largest-ever survey of people with the condition. Over 700 people, or around 1 in 13 with sickle cell in the UK, were involved, leading to a validated survey that supports hospitals and healthcare to improve services for patients.

“As the outgoing Director for NIHR CLAHRC Northwest London, I am pleased that northwest London have again secured funding directed towards closing the translational gap and building capacity across the sector as part of the ARC programme.” – Professor Derek Bell, NIHR CLAHRC NWL Director.


posted 18 Jun 2019, 09:02 by Derryn Lovett   [ updated 10 Jul 2019, 13:50 by Cherelle Augustine ]

World Sickle Cell Day
Wednesday 19th June 2019

NIHR CLAHRC NWL has been working with the Sickle Cell Society for several years in collaboration with Picker to integrate Patient Reported Experience Measures (PREMs) to support improving services. Click here for more information about this work.

The 19th June is World Sickle Cell Day, a United Nation’s recognised day to raise funds for and awareness of sickle cell at a national and international level.


posted 30 Apr 2019, 06:13 by Cherelle Augustine   [ updated 10 Jul 2019, 13:50 ]

Building Capacity in Quality Improvement Using Bite-Sized eLearning

NIHR CLAHRC NWL offers an alternative way to build capacity in individuals via an eLearning resource called QI4U (Quality Improvement for You). Quality Improvement (QI) methods in healthcare are normally delivered through classroom-based education. This traditional way of training creates an abundance of barriers such as financial outlay, geographical spread of learners, suitable time and venues for hosting training sessions etc. for educating multi-professional groups who need to work together on a single improvement project.

QI4U is a flexible eLearning resource that has engaging bite-sized content that fits learning around the schedule of the learner. Developed by QI experts, with an international reputation for leading QI work and education in healthcare, there are currently 8 modules filled with interactive activities, downloadable templates and videos to support a journey of QI exploration while having the peace of mind of repeated access to the learning content and additional support from expert instructors.

QI in Bite-Sizes


Visit our blog to learn more about QI4U and bite-sized eLearning opportunities.


posted 30 Apr 2019, 06:03 by Cherelle Augustine

Building future leaders: Integrating Quality Improvement in a Public Health Masters Programme

The 2018/2019 ‘Quality Improvement in Healthcare’ module led by Dr Tom Woodcock and Dr Mable Nakubulwa forms part of the Health Services and Systems stream on the Master of Public Health (MPH) at Imperial College London. This 10-week long module has been developed by the Collaboration for Leadership in Applied Health Research and Care North West London(CLAHRC NWL) team, whose work involves facilitating the translation research evidence into practice to benefit patients within the NHS and social care environment.

Introduced in 2017 under the leadership of Dr Catherine French and Dr Julie Reed, the module introduces students to the complexities of improving healthcare, supporting them to develop an understanding of Quality Improvement and of how academic research can impact on the reality of health and care. This is achieved through delivery of co-produced lectures, simulated project workshops and individual and group assessments. The module draws on academic literature and research in QI, which are comprehensively illustrated with real life practical examples (including through simulation workshops run by Dr Paul Sullivan) to aid students’ learning. The module also includes an external visit to meet quality improvement teams working in healthcare, and a Q&A session with Lesley Watts, Chief Executive of Chelsea and Westminster Hospital NHS Foundation Trust. This exposure to the reality of working for improvement in healthcare systems is valued by the students.

 “[By] applying theories and taught material in lectures to the group projects week by week … we’re actually consolidating the theory by practice” (student mid-module feedback).

Over the years, CLAHRC NWL has supported and supervised a number of MPH individual research projects, some of which have resulted in publications. Many students have gone on to work in QI practice and/or research, taking with them the skills and knowledge from the MPH as they contribute to efforts to improve healthcare for populations across the globe.

Why is it important for MPH students to learn about QI? Unlike more traditional courses, the teaching and training offered is an integrated QI curriculum involving a mix of lectures, classroom discussions and project-based learning. The design of the module has two unique features intended to support students in developing a rigorous and pragmatic approach to address the challenges of improving health and care for populations.

Firstly, it draws on internationally acclaimed research conducted by CLAHRC NWL, culminating in the framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence). The lectures are structured around SHIFT-Evidence to provide a sound grounding in the scientific basis for practice of QI in healthcare systems. Secondly, the module focuses on building capacity and capability of MPH students in the use of QI methodologies through project simulation workshops. The 8-week project simulations are designed to facilitate the development of key transferable skills and methodologies in QI. Students work in groups to evaluate QI concepts for their relevancy and effectiveness in their simulated project, drawing on the published evidence on best practice and current quality of care. By the end of the module, students are expected to be able to demonstrate good understanding of key principles and techniques related to QI in health care. This is assessed through a group presentation – an applied project based assessment that complements a more traditional theory-based essay – requiring students to apply what they have learnt. Working in groups facilitated by a member of the CLAHRC NWL team, students are expected to develop: a shared aim and programme theory (action effect diagram) for a QI simulated project, a stakeholder engagement plan, process map, measures as well as simulated tests of change (plan-do-study-act cycles). Students are assessed on how well they are able to demonstrate what problem(s) they are trying to solve in their simulated project, what they hoped to achieve, what their change ideas are, how they will know a change was an improvement and how their change ideas developed.

Working in groups during the workshops promotes a setting where collaboration is valued for producing better results, teaching students valuable life-long skills that are important in the professional workplace. We believe that using group work and collaborative learning in the classroom instils students with skills valued by employers and businesses, including but not limited to – leadership skills, oral and verbal communication skills, teamwork, problem solving, autonomous working, and listening skills. Evidence-based QI theory is complex, and teaching concepts relating to applied settings can be challenging especially to students that have limited or no exposure to working in healthcare settings. During the workshops, content is broken down into smaller more digestible practical components, enabling students to tackle larger and more complex problems as well as providing an opportunity for them to apply what they have learned in a collaborative setting. Given that there are intended outcomes for each workshop, students are encouraged to plan and manage their time more effectively. This mirrors the realities of working with a team to deliver improvement in healthcare. The skills developed and adapted during the simulation project work can be applied in the workplace to effect real change in service delivery. The final assessment of the module is for students to produce a theory-based QI report. The students are expected to review existing accounts of improvement in their chosen area, using a theoretical framework as a ‘lens’. Specifically, students are expected to choose an analytical framework and use it to critically explore in a specific clinical problem (e.g. sepsis), patient group (e.g. people with learning disabilities), or setting (e.g. A&E). In combination with the group project, this gives students the opportunity to demonstrate their understanding of QI research and evidence, and QI applied methodologies applied in healthcare.

Selected student experiences from MPH QI training

Aysel Rahimli


“My project focused around using the concepts of “hard core” and “soft periphery” elements of internet delivered-cognitive behavioural therapy, for its implementation in a range of contexts. I was able to explore the intervention using 3 definitions of those concepts (Medical Research Council, Denis et al., (2008) and Greenhalgh (2004)), comparing and contrasting them. From this, I was able to present the complexity and importance of dismantling complex interventions, and how the concepts can be used to help adaptations of the intervention. Having done the project with CLAHRC NWL, I learnt significant research skills, specifically qualitative research analysis, as well as the practical implications of quality improvement and implementation science within healthcare. Attending the CLAHRC NWL Summer Collaborative Learning Event was one of the highlights of this experience.”

Jayne Yap

“I am now working as a project manager for national initiatives driving clinical quality and improving care in Singapore’s Ministry of Health where I come from. Looking back, it was my summer project, which gave me my first taste of quality improvement work in healthcare, and I found myself considering job prospects in this field. My summer project was a quantitative evaluation of an intervention to improve the diagnosis and management of patients with atrial fibrillation (AF) in primary care. I chose this project because, as an ongoing intervention, it had real and immediate impact in improving care for AF patients. I gained a greater understanding and appreciation of data-driven research to support quality improvement, which is also a big part of my work now. I received amazing support and guidance from my supervisors, Dr Tom Woodcock and Yewande Adeleke, and their team at CLAHRC. Working with them was truly enriching”.

Heather Humphreys


“Over the summer Professor Julie ReedStuart Green, and the team at CLAHRC NWL gave me invaluable guidance and fantastic research experience while working on my dissertation for my MPH from Imperial College. They helped me design my research project to determine constituent factors of Type 1 context that would fit within MUSIQ v2.0 for generation of a complete framework for objective analysis of qualitative quality improvement data. The goal of the study was to examine four representative interventions within one hospital to explore and define the factors of type 1 context in terms of the themes and interactions between project, setting, and QI context. At the end of the project, we defined fourteen contextual factors that, in conjunction with the existing framework, resulted in 50 descriptive categories that can be used for quality improvement design, implementation, and evaluation. I’m really pleased to have had this opportunity to work with CLARHC NWL in designing and following through with my own project with expert supervision and guidance. I’m grateful for the opportunity to have attended seminars, conferences, and presentations as a result of my attachment. The experience gained was fantastic and will be of great use in my further career.”

Monica Valenza

“I have really enjoyed my time at CLAHRC NWL and I am very grateful to have done my MPH dissertation with the team Lead by Professor Julie Reed and supervised by Stuart Green. The topic the title of the thesis was “Exploring the ‘hard core’ and ‘soft periphery’ of  quality improvement complex interventions: An integrative review of surgical site infections care bundles, and aimed to operationalise the theory of ‘hard core’ and ‘soft periphery’ and aimed investigate beyond the discussion of generalised success factors provided by previous studies answering, ‘is this intervention effective?’ to exploring how a balance between theory and what occurs in practice is required to elucidate the relations between the dynamic features of a Quality Improvement (QI) intervention, its implementation and the context. Completion of the thesis concluded that characterising the Hard core and Soft periphery of QI intervention allows to understand how a complex intervention can be adapted to mitigate or exploit system characteristics thus ultimately determine the acceptance of an implementation effort in routine care. I strongly recommend anyone who is interested in QI research, to work with CLAHRC NWL, as they are very supportive, they were always happy to include me in their writing days meetings so I had the opportunity to talk about my research with everyone not only my supervisors and Professor Julie Reed, so I gathered valuable advice from all the team members present.”

Neil Stillman


“Starting the Master of Public Health (MPH) degree at Imperial College in October 2015, I remember most looking forward to the lectures on quality improvement. At the time, we had introductory sessions from Professor Julie Reed and Rachel Matthews from NIHR CLAHRC NWL on improvement methodology and patient and public involvement, respectively, as part of an improving health services module – this brief exposure to improvement was enough for me to know that this was something I would like to pursue further. Luckily, I had the opportunity to complete my dissertation with Professor Reed and colleagues at CLAHRC NWL where I explored the spread of a successful quality improvement project across acute care settings.

Following the completion of my summer project, I had the opportunity to present alongside Professor Reed at the 34th international conference of the International Society for Quality in Healthcare (ISQua). We outlined the value of applying the concept of ‘hard core’ and ‘soft periphery’ to complex clinical interventions to support shared learning between QI initiatives. Working with CLAHRC NWL, it has been great to see how such research may be applied in practice to help support the rollout of several clinical interventions including medications management, heart failure and paediatric allergies.

After the MPH programme, I spent some time working at the Royal College of Psychiatrists’ Centre for Quality Improvement on the NICE/NHS England commissioned Achieving Better Access to Mental Health Services programme team. The insights gained during my project with CLAHRC NWL into the complexity of quality improvement proved useful in developing a quality assessment and improvement programme to improve health service delivery and patient experience for individuals across England presenting in a mental health crisis who require urgent and emergency mental health care.

Taking up a full-time position with CLAHRC NWL in November 2017, I’ve had the chance to return to Imperial through a recently introduced CLAHRC NWL led module (Quality Improvement in Healthcare) on the MPH, where I deliver a session on spreading improvement. It has been fantastic to watch the MPH programme evolve to take account of the changing healthcare landscape – towards greater integration and multidisciplinary working – and the need to improve quality while also delivering better value care. Being involved in facilitating an innovative group quality improvement simulation project over ten weeks demonstrates how CLAHRC NWL, in collaboration with Imperial, is well-placed to ensure that MPH students are equipped with skills responsive to employer needs.”

Below are some of the projects that CLAHRC NWL has supported and supervised over the years.

Dr Jose Mercano: Social Deprivation and Common Mental Disorders – The Case of the Westminster IAPT Service

Sonar Parmar: Influence of Quality and Outcomes Framework on diabetic foot admissions in North West London

Abdul-Azeez Osi-Efa: COPD prescribing and outcomes in North West London

Dr Luís de Sousa: Evaluation of the implementation and impact of a quality improvement project for inpatient management of acute diabetic foot disease

Tahania Ahmad: An evaluation of a COPD Care Bundle to improve outcomes and reduce variation in care

Monica Valenza: Exploring the ‘hard core’ and ‘soft periphery’ of complex interventions: A review of surgical site infections care bundles

Neil Stillman: Exploring the Spread of a Successful Improvement Project. “It’s complicated”: a qualitative study of the spread of a medicines review intervention across acute hospitals in London

Jayne Yap: Improving Diagnosis and Management of Atrial Fibrillation in Hounslow: An Evaluation of a Quality Improvement Initiative in Primary Care

James Redmore: Social Return on investment for DIMPLE project

Valencia Lim: Paediatric reattendance at ED. (Mitch Blair main supervisor)

Carolyn Sharpe: Alcohol Licencing in Southwark. (Richard Pinder main supervisor)

Talia Boshari: Alcohol and violence in Southwark. (Richard Pinder main supervisor)

Yasmin Bou Karim: Exploring the relationship between annual cycles in healthcare and their impact on the ability of Quality Improvement projects to make progress towards achieving their improvement goals

Heather Humphreys: When the Dust Settles: Determining the Factors that Constitute Type 1 Context

Aysel Rahimli: A Realist Review: Application of ‘Hard Core’ and ‘Soft Periphery’ Concepts for Implementation of Internet – Delivered Cognitive Behavioural Therapy

Lucy Miller: Roll out and organisational readiness: The spread of a heart failure care bundle in Northwest London

Juan (Sebastian) Dennis-Beron: Perceived Context and its Role in Quality Improvement Initiatives


Thank you to the authors: Dr Mable Nakubulwa, Stuart Green,  and Dr Tom Woodcock 

Thank you editors: Yewande Adeleke and Linda Eftychiou 


posted 11 Mar 2019, 06:52 by Cherelle Augustine   [ updated 25 Mar 2019, 04:53 by Derryn Lovett ]

This Sickle Cell Life

Your expertise needed to support young people!

We invite you as an expert in your field to join young people on April 2nd at an innovative and interactive event to help shape services of the future. The Royal College of Paediatrics and Child Health (RCPCH) is working with the London School of Hygiene and Tropical Medicine (LSHTM) on a project to transform understanding, awareness and knowledge about a the UK's most common inherited genetic disorder that has a huge impact on young people as they transition to adulthood and adult healthcare services in London and across the UK. We believe that in order to start the journey to creating lasting change, children, young people, families, patients, specialists, and stakeholders from a wide range of sectors such as yours need to be involved. 


On April 2nd 2019 from 10am – 4pm, we will be running “This Sickle Cell Life”, sharing findings from the 3 year research programme conducted by LSHTM. We will then invite attendees with and without Sickle Cell / Thalassemia experience, to help co-produce a range of useful materials that can be used by your colleagues, peers and your sector to better understand how to support young people and families living with these conditions now and into adulthood. 


The event will be interactive and workshop based, with young people, young patients, workers and decision makers from a range of backgrounds and disciplines. Attendees will have the chance to learn about what young patients need from services such as health, education, leisure and social care services to support their journey with Sickle Cell / Thalassemia whilst sharing their sector expertise to help develop messages and achieve hopes and wishes.


It is important to the success of the project to have your insight as part of the day and we really hope you or a colleague will be able to join us.


If you would like to find out more about the project, please check the Sickle Cell Life twitter or the Sickle Cell Life projectpage . I have also attached a team flyer for the Children and Young People’s Engagement Team at the RCPCH who lead the RCPCH&Us Network to ensure that children and young people are actively involved in shaping healthcare and policy across the UK.


To confirm your attendance or suggest a colleague, please contact Emma Sparrow at RCPCH via and_us@rcpch.ac.uk by March 11th.


posted 24 Jan 2019, 03:27 by Cherelle Augustine   [ updated 21 Feb 2019, 03:00 by Derryn Lovett ]

& Early Years

J.O. Warner OBE MD FRCP FRCPCH FMedSci, academic lead for our Early Years theme and Professor of Paediatrics Imperial College.

"The NHS Long-term plan published in January 2019 emphasises the need to move towards the creation of “Integrated Care Systems” involving coordination between multiple agencies including; primary and specialist care, physical and mental health services, and health with social care. NIHR CLAHRC Northwest London’s Early Years theme’s research over the last 10 years has developed and implemented integrated care pathways for children with allergic disease and sickle-cell disease. Working with patients and carers we have developed disease specific Patient Reported Experience Measures (PREMs) which have been used to guide quality improvement initiatives.

The plan also focuses on early life often now known as the first 1000 days from conception to 2 years of age. While the main emphasis in the long-term plan is on mental health this period of early life offers many opportunities for prevention and early intervention to influence long term health outcomes and need for medical care. Our early year’s theme aims to “Promote a healthy start for lifelong health and wellbeing.”  We are researching health education programmes for expectant parents to improve immunisation up-take; breast feeding; recognition and home management of minor illness. Other studies are improving management of pregnancies of unknown origin; involving parents in the management of their infants while in neonatal intensive care; trialling interventions for maternal anxiety in pregnancy and strategies to improve pathways of management for preschool children with common acute problems."


posted 7 Jan 2019, 07:54 by Derryn Lovett   [ updated 21 Feb 2019, 03:02 ]


The NHS Long Term Plan builds upon all the quality improvement work that continues to be developed by individuals working across the health and social care sector.

Professor Derek Bell OBE, Director of NIHR CLAHRC Northwest London, remarked:

“I welcome the NHS Long Term Plan’s balanced portfolio of service improvement that reflects the needs of the population and 
individuals. The focus on prevention and mental health is also welcome. NIHR CLAHRC Northwest London has been working on many of the areas highlighted in the NHS plan including:
  • Improving rapid access to heart failure nurses so that more patients with heart failure, who are not on a cardiology ward, will receive specialist care and advice: Development of the Heart Failure Project
  • Improving early diagnosis in the community: testing for Atrial Fibrillation Screening Project
  • Improving Mental Health Services: SHINE Project (improving the physical health of people with serve mental illness)
  • Supporting patients with alcohol dependence in hospital: Alcohol Care Bundle Project
  • Supporting parents whose babies are on the neonatal unit: Better Use of Data to improve parent Satisfaction (BUDS) project (to improve communication between parents and healthcare professionals in neonatal units)."


posted 7 Jan 2019, 06:09 by Derryn Lovett   [ updated 21 Feb 2019, 03:01 ]

& Breathlessness

With today's release of the NHS Long Term Plan we'd like to give you some of the thoughts from our team.

Professor Martin Cowieacademic lead for our Breathlessness theme, who's work on our Atrial Fibrillation and Heart Failure projects, will have a large part to play in developing and leading this long term plan.
@ProfMartinCowie, Imperial College London Profile

“The NHS long term plan identifies where the biggest wins can be made right along the care pathway: identifying people at high risk of cardiovascular events such as stroke or heart attack, giving GPs better access to the key diagnostic tests to speed up diagnosis and appropriate care, improving access to specialists when patients are admitted to hospital with heart failure, and increasing access to rehabilitation to improve quality of life after heart attack or heart failure. Now that the key areas have been identified, local services need to focus on these issues to deliver improved care and experience of care for those living in England. NW London CLAHRC has been active in all of these areas, and the new national plan adds impetus to its work”.


posted 1 Nov 2018, 09:23 by Cherelle Augustine

Hand and Wrist Virtual Fracture Clinic Pathway

Most common fracture presentation to A&E departments, UK

Hand and wrist fractures are the most common fracture presentation to accident and emergency departments within the UK. Complications following both simple and complex hand and wrist fractures can have devastating consequences. The British Orthopaedic Association recommends initial assessment in a fracture clinic should take place within 72 hours and any surgery should be performed within one week. It was the experience of Raymond Anakwe (Consultant Trauma & Orthopaedic Surgeon) of Imperial College Healthcare NHS Trust (ICHNT) that adult patients presenting with hand and wrist fractures, experienced delays in: attending fracture clinics; operative treatment; and in referral to rehabilitation. This resulted in extended recovery times, sub-optimal outcomes, an increased number of hospital visits, and overall poorer patient and staff experience.

An initial retrospective clinical audit, showed that 31% (13/42) patients waited over 15 days and another 28% (12/42) patients waited between 8-14 days for surgery following fracture. Further analysis of these delayed patients showed that the most frequent reasons for delay is delay in initial clinical review at fracture clinic.

Introduction of a new pathway

The Hand and Wrist Virtual Fracture Clinic planned to ensure prompt access for patients with fractures to receive expert review within 72 hours, to achieve better patient outcomes, improve quality of care and improve efficiency of the system. In the pre-intervention clinical review model, 100% of patients were referred from A&E to the Hand Clinic for a face-to-face consultation with an orthopaedic consultant (average 10 days from referral to expert review, audit 2016).


A new pathway (See Table 1), incorporating implementation of e-referral and virtual review software was implemented to reduce the time between presentation and expert review. This led to accelerated triage of patients to one of three destinations: fracture clinic, hand therapy and direct discharge after initial presentation via Urgent care centres or ICHT A&Es.

A series of interventions were implemented:

  • On-line referral system replacing paper referral 
  • Text message / email system providing supportive information about injury, pathway and Virtual Fracture Clinic contact details 
  • Telephone support clinic 
  • Follow-up phone call to discharged patients responding to questions / providing specific advice 
  • Patient information leaflets developed and uploaded onto a public website 
  • Education sessions delivered to healthcare professionals working in four of the five affiliated referral sources


Following the introduction of the Hand and Wrist Virtual Fracture Clinic, 2,449 patients were referred to the service: 60% of patients (1,451) were referred to the Hand Clinic; 22% of patients (549) were discharged with information on how to self-manage their injury; and 18% (449) were directly triaged to hand therapy. The time to expert review reduced from an average of 10 days to an average of 1 day.

The tariff for face-to-face initial hand (fracture) clinic consultation is costed at £151 per patient. For this project, 2449 patients were referred to Virtual Fracture Clinic. In the traditional pathway, all these patients would have been referred to the hand (fracture) clinic incurring a cost of £369,799. With the introduction of the Virtual Fracture Clinic Pathway, only 1451 patients were referred for a hand (fracture) clinic consultation costing £219,101 and resulting in a potential cost saving of £150,698 (setup and running costs not included).


posted 8 Aug 2018, 08:31 by Cherelle Augustine

How interventions are spread: CLAHRC NWL PhD Student Sophie Spitters Wins second prize at the Research as Art Summer Showcase

The Imperial College London Graduate School organised their annual Summer Showcase on Friday 13th July 2018. The showcase aims to celebrate research undertaken by PhD students at Imperial and invites staff, students and visitors to find out more about their work via a poster and a research as art exhibition. Sophie Spitters, joined the research as an art exhibition, showcasing her NIHR CLAHRC NWL research, and won second prize. 

Her art installation, titled How interventions are spread’, aimed to communicate the reality of spreading healthcare improvement interventions, which often does not follow the expected trajectory. Read more about Sophie's experience in our blog

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