Prevention: The DDES Experience



PEN Winner

Commissioning for personalisation in stroke prevention: The DDES experience

Made up of 42 GP practices covering southern and eastern County Durham unitary authority, Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group has a registered population of 288,000. GPs and a multidisciplinary leadership team of health professionals are fully responsible for the planning and purchasing (commissioning) local health services.
In January 2012, DDES CCG started working with Boehringer Ingelheim Limited (BI) and the social business GCA Limited to co design a prototype stroke prevention commissioning programme for spread across the UK.

The aim of the programme was to explore and deeply understand peoples’ current experiences of stroke prevention so that DDES can improve personalisation of care and commissioned services and develop a set of sensitive measures to track improvement.

This work consisted of 4 stages:

Developing insight and completing need assessment: DDES engaged commissioners, front line caregivers (NHS, social care and voluntary sector), local people with experience of stroke and stroke prevention and their families in 2 events and undertook 10 semi structured interviews with local people and caregivers to map current stories and experiences of stroke prevention and desired ones. This threw up anomalies about how care givers and people/families see the world and a set of improvement challenges around personalisation. Most notable was the contrasting professional/patient and family experience of ‘hearing diagnosis and early support’. DDES data was then benchmarked with National ELC™ insights and then triangulated to provide a comprehensive health needs assessment.

Service specification: the co design process continued with two full day events. The first applied PATH planning. Local people worked with commissioners/caregivers to co design ‘great stroke prevention care in three years time’ and a detailed route map. The second brought stakeholders together to co design solutions to the 12 most critical improvement challenges and develop a three year strategy.

Improvement contract co design: current providers, local people, providers and commissioners co designed an improvement contract framework, including: a shared ‘purpose’ and a set of person centred values to drive commissioning/service delivery; outcome measures that all providers – including voluntary sector, lifestyle services, GP, pharmacy and NHS trust providers – will be held to account for and that can underpin an integrated ‘alliance contract’ for personalised stroke prevention care.

Key improvements:

  • Improving family and personal experience of hearing diagnosis and early signposting peer support ( largely in general practice) to accelerate restoration of peoples’ confidence and ability to reduce their risk and improve their lives independently (what they want);
  • Systematising primary care screening and follow up in high risk people;
  • Commissioning an integrated ‘connection’ experience in the form of an invigorated, more focused network of peer led support groups (mainly voluntary sector) for people with risk factors for hypertension, stroke, including CVD, diabetes, AF and TIA
  • Commissioning personalised exercise programmes that build confidence in the person AND their spouse to keep exercising as they did prior to diagnosis
  • Integrating pharmacy commissioning to deliver ‘confidence about managing my medicines’
  • Educating caregivers so they empathise with people and better understand how stroke prevention impacts on people and family lives

Educating ‘gatekeepers’ (GP receptionists, out of hours, A&E) about stroke symptoms so they accelerate access to diagnosis and treatment.

DDES deeply understands the improvement challenge and can commission the right services and measure the outcomes that matter. The work was endorsed by DDES CCG’s authorisation team.

Learning Points:

  • Stroke prevention, diabetes and cardiovascular disease prevention have much in common. We can rationalise experience led commissioning around these agendas
  • Clinicians grossly underestimate the impact of TIA and AF on people lives. People tell us ‘it feels like you are dying’. Clinicians say, ‘It won’t kill you’. When a clinician has first hand or close family member experience of living with these conditions, their attitude quickly changes and they deliver more empathetic care
  • Peoples’ experience of hearing diagnosis and early support to come to terms with and adjust to a new way of living can either accelerate their ability to self care and prevent stroke or leave them feeling disempowered, anxious, scared, helpless and with no confidence to take action. Confidence is essence of what people need to feel to improve stroke prevention outcomes
  • Peer support and being connected with people who share the same experience is a great comfort and vastly undervalued by health commissioners. In stroke prevention, which largely relies on self care, it is as important as clinical care.
  • Front line care givers and people alike find participation in ELC™ co design events is a learning experience.

Commissioning can be inspiring, fun and educational!

9th Annual Patient Information Conference – Patient Information Forum (PiF)

We are delighted to announce that the 9th Annual Patient Information Conference will take place at the St John’s Hotel, Solihull, on Thursday 1st May 2014.

Registrations are now open and the first Early Bird discount of 20% will until be valid until close of play on 20th December 2013.

The PiF annual conference is all about the fundamental components of delivering high quality health information resources and services, with a look at policy, quality standards and commissioning information. High-level speakers from across voluntary, NHS, and commercial sectors, will bring you up to date with national information strategies, whilst hands-on workshops will develop the core skills behind producing and disseminating quality health information.

Click here to register to attend the conference (remember, if you are a PiF member you must be logged in to the website to see your member-level fee).

This is the conference you must attend in 2014 if you communicate with patients and the public about their health.

Please visit for regular updates.

We hope you can join us!

Patient Information Forum (PiF)

500 Chiswick High Road, London W4 5RG

Mobile: + 44 (0) 7813 143 384






PiF – For Professionals Working in Consumer Health Information

Mobile phone app transforms patient and family feedback

The revolutionary app Talk to.. , developed in partnership with Birmingham Children’s Hospital, allows patients and their families to send messages that go directly to the person in charge of the ward they have visited; so feedback can be addressed in real-time. As part of a hospital’s commitment to openness and transparency, the administration system allows both comments and responses to be published on hospital’s website.

As the first organisation to develop a feedback app of this kind, Birmingham Children’s Hospital found that the system significantly boosts staff morale and increases patient satisfaction.

If you would like to find out more, visit Digital Life Sciences or call 0121 663 0300

CLN Conference

20th November 2013, Manchester

Following the success of the CLN’s re-launch in the North West, we are now expanding the network to a national level – hosting our first national conference on 20th November 2013.

Please find attached details of how to secure a place at the event, including registering your details as a member of CLN. This process is completely free and does not impose any obligations to act; though it will give access to current CLN information including future events/meetings. We also ask that all previous CLN members please re-register their details so we can create an up-to-date mailing list.

For more details please see or email

Better Data for Informed Commissioning

Wednesday 20 November 2013 , London
This conference focuses on delivering better data for informed commissioning to assess and improve outcomes along the patient pathway. Sessions will focus on using information to assess quality, commissioning on facts: the information needed to commission and assure quality, and using information to commission and improve outcomes. National developments and practical case studies will demonstrate how high quality data can be used by commissioners to improve patient outcomes and ensure value at a local level. For further information and to book your place visit or email

A £250 +VAT discounted rate* is available to PEN members quote: HCUK250PEN when booking.
(This rate applies to new bookings only* and cannot be used in conjunction with any other offer. Full T&Cs available upon request)