Methods to spread and scale that involve identifying and communicating priorities rely on sending clear signals to national and/or local systems or bodies about the need for spread and scale in a specific area or for a specific intervention.
Four methods have been identified in this category and are summarised below.
Effectiveness
The effectiveness of these methods will vary depending on context, but key strengths of methods which identify and communicate priorities include:
- Large choice of methods and tools that can be used to reach different audiences
- May not require additional resources – but priorities and resources overall must be aligned to support delivery[i]
- May influence system culture and senior leaders across the system
- Local needs identification allows a co-ordinated call for partnership with industry and others to collaborate to tackle the challenge
However, there will be limitations to these methods which may include:
- Will not be effective unless targeted and purposeful – there are a limit to the number of ‘signals’ that can be sent before they risk getting lost in system ‘noise’ or become competing priorities[ii]
- Reasonable degree of clinical and professional consensus required to be effective
- Where barriers to spread relate to funding, or there is entrenched resistance other methods may be required as well
Methods and Levers
Local Needs identification
Production of report outlining local needs for innovation or improvement – sends signal to local or regional commissioners on priorities and to others to develop possible solutions. Solutioning here is a key step as part of ideation generating coproduction and local ownership. Examples include:
- AAC demand signalling
- InHIP programme.
Horizon Scanning
Analysis of regulatory database, clinical trials data, industry database, or investment reports to produce pipeline of near to market innovation/research in key priority areas. Communicated to system to raise awareness/increase planning for adoption. Examples include:
- AAC horizon scanning through NIHR Innovation Observatory (NIHRIO)
- horizon scanning for commercial medicines through SPS
- Solving Together.
National Clinical Guidelines
Development of clinical guidelines (non-mandatory) placing an intervention as part of best practice in a particular pathway. Publications setting out position of new innovations or improvements in new pathways. Examples include:
- NICE guidelines
- Royal College clinical guidelines e.g. RCOS
- NHSE National Guidance for Lipid Management
Commissioning Guidelines
Inclusion of intervention in commissioning guidance or governance. Examples include:
- RMOCs Advice
- guidelines on High Intensity Use services as part of UEC
- National Commissioning Guidance for post-covid services.
Practical considerations for use
| Method or approach | Stage of development * | Audience and scale ** | Resources needed | Timeframe |
| Local needs identification | Ideation, proof of concept, prototype/testing | National, regional or local, targeted by clinical speciality / problem | Local consensus and buy in | 6 -18 months |
| Horizon scanning | Prototype/testing and spread | National, regional or local, targeted by clinical specialty / problem | Analytical resource; Communications channel and support, industry input | 6-18 months |
| National clinical guidelines | Spread | National, regional or local, targeted by clinical specialty | Sufficient evidence base and clinical consensus | 6-18 months, plus additional time for implementation |
| Commissioning guidelines | Spread | Local, targeted by clinical specialty | Sufficient evidence base and clinical consensus | Variable |
[i] and [ii] Department of Business, Innovation and Skills and Department of Health. Accelerated Access Review: Interim Report. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/471562/AAR_Interim_Report_acc.pdf