Muir Gray: Defining the scope of systems of care

Muir Gray

Read the first in this series of blogs about designing and planning population based systems of care here.

Step 1: Defining the scope

The focus of a system may be:

  • A symptom such as breathlessness.
  • A condition such as inflammatory arthritis or multiple sclerosis.
  • A sub group of the population such as frail elderly people, or children, or single homeless people.

Whatever is chosen as the focus it is essential to define the scope precisely. For example, the project initiated to develop a system “for diabetes” specified the scope as:

The system focuses on type 1 diabetes, but a parallel project on type 2 diabetes, following the same lines should be initiated. In addition there should be sub projects on type 1 diabetes in children and teenagers.

When the Yorkshire and Humber children and teenagers’ network got their teeth into the design of a system for people in transition this was the scope they produced:

The system is designed to meet the needs of people with type 1 diabetes during the years of transition. Many of the principles and objectives will be relevant to children with type 1 diabetes but the psychological issues in adolescence, combined with the cultures of teenage boys and girls necessitate a distinct, but related, system. This also needs to have a sub-system focused on the challenges that arise when care has to be shared between the longstanding relationships with general practice and specialists who have looked after the young person since diagnosis and the student health service and related specialist service in the city where they are studying.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.