Joint Working: A ten-step process

Joint Working Criteria

 

Red Questions

Yes

No

1 Is the main benefit of the project focused on the patient?    
2 Do all parties acknowledge that the arrangement may benefit the NHS and company partner(s) involved?    
3 Are any subsequent benefits at an organisational level and not specific to any individual?    
4 Is there a significant contribution of pooled resources from all parties, which may include people, finance and equipment wholly or partly dedicated to the project?    
5 Is there a shared commitment to joint development, implementation and successful delivery of a patient-centred project by all parties involved?    
6 Will anonymised, aggregated, patient outcome data be measured and documented?    
7 Are all partners are committed to publishing an executive summary of the Joint Working Agreement?    
8 Are all proposed treatments involved in line with national guidance where it exists?    
9 Will all activities be conducted in an open and transparent manner?    
10 Has an exit strategy and any contingency arrangements been agreed?    

 

 

Amber Questions

Yes

No

11 Will the project be managed by a Joint Working Team with industry, NHS and any appropriate third-party representation?    
12 Do all parties and their respective organisations have appropriate skills and capabilities in place to manage the project, thus enabling delivery of patient outcomes?    
13 Have all partner organisations got clear procedures in place for reviewing and approving Joint Working projects?    
14 Are all parties aware of and committed to using the Joint Working Agreement Template (or equivalent) developed by the DHSC and the ABPI?    
15 Are all partners clear on who within their organisations is the signatory to ensure Joint Working Agreements can be certified?    

Step 1: Project Scoping

  • Potential partner organisations from NHS and industry identify concepts that will help improve patient care and outcomes. These ideas are often drawn from data analysis or patient feedback which highlight an area of proven patient need
  • Potential partners consider desired benefits and outcomes, in addition to sustainability beyond the life of the project and how it could be replicated or scaled if successful
  • Once the initial idea has been generated, the foundation project team is encouraged to review it against the Joint Working criteria checklist set out in Step 2
  • At this point, it is also worth investigating if other healthcare organisations have successfully tackled a similar challenge and, if so, whether it may be more appropriate to replicate/modify their work than to initiate a completely new Joint Working project

Step 2: Check Joint Working Criteria

  • Potential partner organisations review the checklist overleaf and satisfy themselves that each criterion will be met under the project
  • If the answer to any RED Questions is “NO”, the project is NOT a true Joint Working arrangement. Appropriate action to address these areas should be taken before proceeding further. If adequate changes to the project cannot be made, then partners should consider a MEGS agreement or alternative approach (see Appendix 3)
  • A negative response to any AMBER questions signals potential issues that should be addressed in advance to ensure successful and timely project delivery

Step 3: Gain Stakeholder Alignment

  • Potential partner organisations now check that the project aligns with both organisations’ objectives and compliance processes
  • A governance committee or internal review committee (IRC) should be in place to review and sign off the project concept
  • IRCs will also review the project at various stages by partner to ensure that it remains compliant and meets the criteria set out by the DHSC guidance and ABPI Code of Practice
  • Partners are encouraged before progressing with this stage to have:

- Reviewed the principles of the project against the Joint Working Criteria

- Had the initial idea reviewed by each participating organisations’ management and experts (note – as this is a non-promotional draft document it can be emailed to all parties without needing further approval)

  • The Internal Review Process for an organisation involved in Joint Working usually consists of legal, medical, compliance, Joint Working and/ or Partnership leads, who have the authority as a panel to sanction each stage of Joint Working projects
  • At this stage, communication between partners is maintained to align and manage expectations, refine the outcomes and objectives of the project and confirm the inputs into the project from each organisation. During this time, it is useful to set realistic timescales and deadlines, and to complete a stakeholder map, communication plan and data collection plan

Step 4: Draft Project Initiation Document (PID)

  • When the project concept has been approved in principle by both partner organisations, a more detailed plan or project initiation document (PID) is developed
  • The PID captures all relevant details of the project and is appended to the Joint Working Agreement (JWA). It includes:

- Aims and objectives

- Benefits to patients/NHS/Pharmaceutical company partner(s)

- Principal activities and accountabilities - Composition of the steering group and project group

- Timelines and project milestones - Description of pooled resources

- Plans for monitoring and evaluation - Communications plan

- Process for project amendment, should this be required

- Defined exit strategy (for all parties)

Step 5: Seeking Approval

  • Timelines for this stage can vary depending on the complexity of both the project and the organisations concerned
  • If any organisation seeking to enter into a Joint Working project does not have an established IRC or similar, it must identify relevant stakeholders with authority to approve the project

Step 6: Complete PID

  • The Joint Working Project Team reconvenes to discuss and implement actions from the IRC’s review.
  • In some instances, the Joint Working Project Team may have to return to their IRCs to gain further comment before completing the Project Initiation Document

Step 7: Sign the Joint Working Agreement

  • Once all IRC signatories have approved the PID, all organisations sign the Joint Working Agreement
  • The project team produces an executive summary using content from the PID
  • The executive summary is published on the respective company(ies) website for the duration of the project at a minimum
  • The project CANNOT commence until the executive summary has been published

Step 8: Project Commences

  • The project begins AFTER the Joint Working Agreement has been signed by all parties and the executive summary has been published on the industry partner(s) website(s)

Step 9: Project Monitoring and Delivery

  • It is critical that baseline measurements and the method and frequency of monitoring progress and outcomes are determined at the outset of the project
  • Monitoring of agreed messages begins and may include:

- Increased numbers of appropriately diagnosed or treated patients

- Changes to patient satisfaction/experience levels

- Patient reported outcomes

- Improved patient concordance and adherence to therapy

- Reduced wastage

- System efficiency measures e.g. waiting times, touchpoints which may also link to patient experience indicators

- Market expansion with consequent proportionate increase in the appropriate use of specific medicines, aligned to local or national guidance

- Proxy patient outcomes

  • Regular review meetings are set up at for the duration of the project to monitor progress against objectives and milestones and to ensure that people/resource allocation is fit for purpose
  • Timelines should be monitored and plans put in place if an overrun or delay looks likely. This can be in the form of a letter of amendment or extension

Step 10: Project Completion

  • Once completed, the defined outcomes are measured and documented. All parties consider completing a case study write-up of the project to enable others to replicate
  • Review of lessons learned between all parties
  • Best practice: Within three months of completion, parties publish a short summary of outcomes and lessons learned

A summary guide to the ten steps involved in Joint Working

1. Scoping:

Partners involved, often Healthcare Professionals and Industry Representatives, scope the concepts that will help improve patient care and outcomes

2. Check Joint Working Criteria:

Each party reviews the proposed project against the Joint Working Criteria to ensure that these will be met

3. Gain Stakeholder Alignment:

Each party involved reviews the project idea to check it aligns with their respective objectives and compliance processes

4. Draft Project Initiation Document (PID):

A more detailed plan or “Project Initiation Document” (PID) can be developed

5. Seek Approval:

Representatives from each organisation submit the PID for review through their own internal governance structure

6. Progress and Complete PID:

The Joint Working Project team reconvenes to finalise the PID, taking into account any feedback.

This may involve resubmission for final approval

7. Sign the Joint Working Agreement:

Once the PID is approved, each party signs the Joint Working Agreement and an Executive Summary is published on the company website

8. Commence Project:

The Project can only start after the JW Agreement has been signed and the Executive Summary has been published

9. Project Delivery & Monitoring:

Project Team deliver the agreed activities and monitor progress in accordance with the Joint Working Agreement

10. Project Completion:

Defined outcomes are documented and consideration is given to producing a case study to share learning