Welcome to the NIHR CLAHRC Community e-newsletter 

Spread and sustainability issue

Welcome to the community e-newsletter for the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) bringing you the latest news and interesting developments from across the nine collaborations and the health service research community.

This edition looks at the work the CLAHRCs are doing on spread and sustainability. The CLAHRCs are funded by the NIHR and form part of the NIHR infrastructure.

The South Yorkshire Cohort at the CLAHRC for South Yorkshire (SY)
The South Yorkshire Cohort (SYC) is an innovative population-based research facility that enables the rapid and cheap identification and recruitment of patients to applied health research in chronic conditions, self management, health inequalities and public health. To date, 41 GP practices in Sheffield, Rotherham, Doncaster and Barnsley have invited patients to participate in the SYC and information from 27,802 people has been collected using postal and online ‘Health Questionnaires’. Of these, 22,715 adults gave their consent to be contacted again by the SYC research team, providing a valuable research platform/facility for researchers. From 2014, the Cohort will be expanding throughout the Yorkshire and Humber region and rebranded as the ‘Yorkshire Health Study’. Find out more or contact Dr Clare Relton at
Uptake of a locally developed maternity triage system may improve outcomes and experiences for mothers and babies
Although mainstream in UK Accident and Emergency departments, no triage system which identifies clinical urgency on attendance has been implemented in maternity care, yet perinatal audits consistently identify failure to recognise and react to risk at the time of admission as a cause of adverse events. Dr Nina Johns (Delivery Suite lead Obstetrician), Dr Sara Kenyon and other CLAHRC for Birmingham and Black Country researchers have developed and piloted a maternity triage system at Birmingham Women’s Hospital (BWH). The system, which is based on four categories of urgency for symptom based algorithms for identification and immediate care of women admitted, was implemented at BWH in April 2013. Over 70 midwives have been trained using a package developed by the collaborative group. An evaluation of the system is underway to look at the impact on waiting times, as well as outcomes for mothers and babies, and to capture the midwives and women’s views on the service. Find out more.
A subsequent project is planned under the CLAHRC West Midlands initiative to spread the adoption of the triage system in three further Maternity Units prior to seeking funds for a definitive evaluation of the system. We hope that the implementation of this system will increase the number of women seen in a timely manner based on clinical need and thus improve maternal and neonatal outcomes and experiences.
Sustaining the improvement of heart failure care in Greater Manchester
The Greater Manchester Heart Failure Investigation Tool (GM-HFIT) is a programme of work designed to improve the quality of NHS primary care services for people with heart failure. Following on from the success of the initial work in NHS Manchester Clinical Commissioning Groups (CCGs) for North, South and Central, the CLAHRC for Greater Manchester (GM) team has spread the project to an additional 28 GP practices in NHS Bury CCG and 12 practices in NHS Wigan Borough CCG. The project consists of a series of key interlinked activities, including heart failure register verification and case-finding, an audit of heart failure management, feedback meetings, clinical education sessions, facilitation support and a final re-audit exercise. A series of additional measures have been put in place to ensure that any positive outcomes achieved are maintained and built upon in the long-term. This includes the development of an electronic clinical heart failure review template and guidelines to support the delivery of evidence-based six monthly reviews a key requirement of the National Institute for Health and Care Excellence (NICE) chronic heart failure guidelines, and a heart failure review checklist. In addition, a rolling programme of education for primary care clinicians will be delivered by local Heart Failure Specialist Nurses.
Improving diagnosis of Chronic Kidney Disease
Approximately six per cent of the UK population has Chronic Kidney Disease (CKD) and are at risk of progressive renal failure and premature cardiovascular disease with an estimated 900,000 people with CKD undiagnosed. Early detection and appropriate management can reduce this risk and improve long term outcomes. Projects to improve care for CKD patients by both the CLAHRC for Greater Manchester (GM) and the CLAHRC for Leicestershire, Northamptonshire and Rutland (LNR) have led to the creation of
IMPAKT™ - IMproving Patient care and Awareness of Kidney disease progression Together. This is a programme of work taking place in primary care to help identify people with CKD and lead to improved health outcomes for patients. IMPAKT™ is designed specifically for use on GP practice systems and consists of a MIQUEST query based tool which analyses data from your practice. A series of tailored, user friendly improvement reports using your practice data are available from the My IMPAKT™ section of this website to help you improve the care of your CKD patients. The tool has been successfully implemented across Leicestershire and Northamptonshire and other parts of England and Wales are keen to start using the service.

IMPAKT™ in Greater Manchester
IMPAKT™ has been rolled-out across five Greater Manchester CCGs in four projects facilitated by the CLAHRC for GM, as part of a CKD quality improvement programme. This programme has involved local Practice Nurses in facilitating improvements in neighbouring surgeries, which has helped to identify an additional 2,370 CKD patients on registers at 50 primary care practices in Greater Manchester in facilitated projects. These teams have also been provided with advice on implementing care in line with NICE CKD guidelines. Resources have been developed using evidence gained from implementation sites, and refined and updated from feedback to make them as user-friendly as possible for clinicians accessing them through the website. The availability of these evidence-informed resources help make the improvements made in practices more sustainable, and increase the potential for spreading improvements locally with a model of lighter facilitation, and beyond Greater Manchester without facilitation from the CLAHRC for GM team.
Expanded Newborn Screening project in South Yorkshire
Newborn babies in the UK are currently screened for five conditions shortly after birth. The Expanded Newborn Screening project at the CLAHRC for SY is evaluating whether another five conditions should be added. During the 12 month evaluation period more than 430,000 babies were born and offered screening for these five additional conditions across the six project sites.  Over the next few months the National Screening Committee will decide whether to role these conditions out nationally. Find out more, view films on the project or contact Dr Katherine Jeays-Ward,
Home Oxygen Pathway work in Rotherham and Doncaster
Prior to the pathway, patients were frequently being prescribed home oxygen by non-specialists for example by GPs or community nurses, and frequently not having their needs reassessed. This collaboration of commissioners, medicines management teams and hospital clinicians aimed to reduce non-specialist prescribing of home oxygen, reduce waste, and improve quality by ensuring appropriate prescribing, patient review and provision of education by specialists. This resulted in a cost saving of £87,000 in 2011/12. Find out more. More examples of spread and sustainability at the CLAHRC for SY can be found in their most recent newsletter Impacts and Sustainability.
Sustainability and Spread at the CLAHRC for North West London
One of the key issues raised in quality improvement adaptation is ensuring sustainability and spread of the methods introduced. The CLAHRC for North West London (NWL) carried out a formative evaluation of using the NHS Institute for Innovation Sustainability Model (Doyle et al., Implementation Science, 2013). The study explored the willingness of project teams to engage with the Sustainability Model and raised key issues about the practical use of the model in the real world. Importantly, it was noted that having separate ‘implementation’ and ‘sustainability’ phases was unhelpful, and could potentially undermine the viability of a project within an operational team.

The Web Improvement Support for Healthcare (WISH) tool, developed for the CLARHC for NWL in partnership with Imperial College Department of Computing and Department of Primary Care and Public Health, has allowed quality improvement monitoring and intelligence gathering across many projects. Notably, several project teams have continued their usage of WISH outside of the projects due to benefits brought by the software. A manuscript on WISH has recently been accepted for publication (Curcin et al., Journal of Biomedical Informatics, in press). Effective medicine management is very important for patient safety. ‘My Medication Passport’, a patient-led initiative to improve communication and empower patients, has successfully spun out of the CLAHRC for NWL to national take-up. Issued more than 25,500 times across England and Scotland, there is now a mobile phone app and has wide sector and industrial partnerships. Demand has spread to an order placed from the USA, and was part of the BMJ-award winning Improving Prescribing for the Elderly project. Find out more.

DESMOND diabetes education spreads its wings
The Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) suite of diabetes education packages for people with diabetes has spread its wings outside the UK. Already widely used across the NHS in England, Scotland, Wales and the Republic of Ireland it is now being used in Australia. With the support of the CLAHRC for LNR DESMOND has expanded its portfolio of activities to include people with ongoing diabetes, specific courses for people from black and minority ethnic communities. Also by working with the local community a course aimed at helping people with diabetes who fast during Ramadan has also been developed. This is being widely used across England in areas with large Muslim communities.

Rolling out the Community Physical Health Co-ordinator model across Manchester
The Schizophrenia Commission (2012) recently stressed that ‘the neglect of physical health cannot be allowed to continue’. The CLAHRC for GM ‘Improving the physical health of people with Severe and enduring Mental Illness (SMI)’ project aims to address this. The pilot project initially worked with one Community Mental Health Team (CMHT) from Manchester Mental Health and Social Care Trust (MMHSCT), introducing Community Physical Health Co-ordinators (CPHCs) to liaise with GP practices at regular multi-disciplinary team (MDT) meetings. Their role involved leading discussions around the physical health management of people with SMI, currently under the care of the CMHT. This model of working proved to be highly successful, with all participants agreeing that care is becoming ‘more co-ordinated’ and increasing number of service users accessing GP practices and receiving the appropriate cardio-metabolic tests and reviews.
The pilot project evaluation report, including a section on the key ingredients required for spreading the model, is now available, along with a more practical CPHC and MDT guidance document. Following the success of the initial work, this model is now being rolled out to all CMHTs across MMHSCT, to span North, Central and South Manchester CCGs.

Further information
Further information on the nine CLAHRCs, including links to their own web resources, is available on the NIHR website at This newsletter is produced by the CLAHRC Partnership Programme based at Universities UK on behalf of the CLAHRC community- see  If you have any ideas or suggestions for the newsletter, please contact Jenny Hawkins at