Table 2:

Characteristics of 33 managed clinical networks in Scotland*

Network purposeMembersLeadership structureResourcesProcesses
  • The networks operate across a wide variety of areas.14,15 Some are mandated in specific areas of health such as diabetes, coronary heart disease, stroke and cancer. There are also regional and local networks

  • Networks must apply to gain network status, involve patients throughout the establishment process, agree to follow a set of defined principles and operational guidelines, and show benefits

  • Networks must have a clear leadership structure, a clear statement of the specific clinical and service improvements that patients could expect; adhere to the evidence base; and seek to create new evidence where possible

  • Networks must generate better value for money, have the potential of networking with social as well as health care; and enable integration with health boards

  • Health professionals

  • Organizations from primary, secondary and tertiary care

  • Patients

  • Carers

  • Families

  • Voluntary groups

  • Each network is led by a lead clinician, a network manager and an administrator, accountable to local NHS board(s) and NHS Quality Improvement Scotland. Network leadership has some degree of autonomy to meet specific patient needs, and have some flexibility within their mandate to identify their own priorities

  • NHS Quality Improvement Scotland is responsible for endorsing, supporting and monitoring the progress of managed clinical networks

  • Start-up resources are generally made available from the Scottish Executive Health Department

  • Funding is generally time limited (first 2 years), after which boards are expected to fund networks from their existing funding envelope

  • Networks do not hold funding for direct care delivery, and instead work with local NHS boards to inform and influence strategic funding to support priority work identified by networks

The usual clinician-driven process is as follows:
  • Establish the evidence base for interventions or elements of care

  • Develop evidence-based standards that are consistent with the NHS

  • Use experiences to develop protocols and to share good practice

  • Perform clinical audit to improve patient care

  • Apply protocols and support local clinicians across wide geographical areas to offer care locally to patients within national protocols

  • Subsequently re-audit to assess the impact on patient care

  • Assist clinicians in gathering information about their performance

  • Produce annual reports

  • Note: NHS = National Health Service.

  • * These networks were initiated in 1998.