Developing a Service Model
This may include developing a new, existing or revising a current service in place.
When developing any service it is important to consider the policy drivers for change and development as described in part 1 of this toolkit. It is important to ask the following:
- Is this what the commissioners want to buy? And does it provide a solution/fit with CCG priorities? If the dietitian’s are driving the proposal then it is essential it is in line with the commissioners’ priorities, such as local PCT / acute Trust / GP commissioning cluster/local authority.
- Does the proposed service being developed meet the specification?
- Is this a clinically effective service that will benefit the commissioners and their patients?
- Is this a public health programme that will reduce health inequalities?
If the purchaser of dietetic services has requested the new service, or a service level agreement document, then ensure there is an agreed, clear definition of the scope of the service.
This will need to include criteria such as: timescale, specific target population and patient population size, criteria for patient referral, diagnosis or level of service, to meet national or local guidelines, if specialist or secondary care: agreement when the patient is handed back to general practice.
It is important to develop a service with the dietetic team, possibly in collaboration with other service providers, patients and commissioners.
Developing a service model with the dietetic team and other professionals
- Define whether a bid is uni-disciplinary or multi-disciplinary? An example of setting up a uni-disciplinary service is where a diabetes dietetic service was organised to ensure that each patient in a specific geographical area received an annual dietetic review.
- If the bid is multi-disciplinary, engage the specialist multi-disciplinary team with the up to date knowledge to design the model. Define how much of the dietetic service is required for the integrated care pathway.
- Ensure approach is based on national guidance such as NICE guidelines, quality standards, or guidelines produced by specialist groups (BAPEN, Diabetes UK)
- Consider innovative and radical ways of working – what is the unique selling point(s) for the service you are offering over a potential competitor?
- Consider skill mix or new ways of working.
- Learn from local colleagues – a shared model can give economies of scale, particularly in the area of training for health professionals.
- Learn from other expert colleagues nationally
Developing a service model with patients
Patient and public involvement is key to changing services for the better. As a provider of nutrition and dietetic services it is important to ensure that the service meets the needs of both the commissioners and the patients. Patients can be involved at a variety of stages:
- Integral to a senior clinicians’ team developing the model from the start. Ask potential service users to examine with you how a service could develop.
- Consult with a draft model and options based on evidence, best practice and local needs and the views of service users.
- All too often patients are only involved at the final stage – what could be learned from earlier input?
- How do you currently use service user feedback to develop and change the service?
The importance of patient stories and case studies to demonstrate the impact of dietetics
Patient stories and patient case studies are extremely important when helping describe the outcomes patients receive as a result of services they have accessed. This information is important and valuable evidence for colleagues buying dietetic services.
