Skip to content >>

an Economist Intelligence Unit business healthcare

Bupa Health Dialog Care Pathways


Bupa Commissioning and Bupa Health Dialog



Bupa Commissioning was established to help PCTs and SHAs procure, deliver and evaluate healthcare treatments and services with greater clinical and cost effectiveness. Assistance was provided through the Department of Health’s national framework for bringing external support to commissioning, known as the FESC (Framework for procuring External Support for Commissioners). In 2008/9 the organisation merged with Health Dialog to become Bupa Health Dialog.

Care pathways lie at the heart of clinically and cost effective commissioning. This is because effective procurement, provision and assessment of healthcare cannot happen without detailed knowledge and consideration of the entire pathway of care – the chain of clinical steps and events linked together along a timeline that structures patient management from initial presentation in primary care, through to secondary and tertiary care. To deliver an integrated and efficient healthcare service, one must start with robust pathways of care; they are the tracks along which everything runs, the blueprints on which services get built.


The problem

Bupa Health Dialog had five evidence-based care pathways it offered to PCTs via the FESC.  The client wanted to expand this internal asset, extending its offer and utility by growing the number of pathways on offer. What they required was an organisation that could rapidly and routinely supply the foundation of these pathways – the raw materials from which new pathways could be built, allowing Bupa Health Dialog to focus on implementation of those pathways.


Our solution

Bazian supplied Bupa Health Dialog with four key products that, taken as a whole, form the structure and foundation for a care pathway and clearly display all parts of the process and all surrounding evidence:

Methods and Guidelines Comparison

  • a document displaying transparent search methodology which identified all relevant national and international care guidelines and systematic reviews; the most reliable evidence-based guidelines and research being selected, this document aimed to compare and discuss areas of content agreement and disagreement

Evidence Tables 

  • extraction of the key findings and recommendations from the selected guidelines

The Pathway

  • the key deliverable: essentially the textual synthesis of the findings, outlining best clinical practice for the chosen topic from primary care presentation through to secondary care management

Outcome Statements

  • identification of key outcomes information and statements of evidence relating to the pathway


Bazian’s vision of a care pathway was one that would lead the healthcare commissioner, provider or clinician through the entire care process and patient experience for a given clinical condition – one that displays the clinical steps linked together along a timeline that structures the entire care process. Importantly, the pathway should be able to be individualised to suit any person’s presentation and treatment response.

All of Bazian’s care pathways provided the ‘background text’ from which a structured and time-lined visual care sequence or flow diagram could be constructed. Although individualised to each condition, each pathway broadly covered the following integrated care tasks:

  • Background, epidemiology, aetiology and prognosis
  • Clinical presentation, history and examination
  • Differential diagnosis
  • ‘Red flags’ for immediate or urgent referral and indications for routine referral 
  • Any initial investigations in primary care
  • Primary care management: patient education and information, conservative management strategies, and first-line pharmacological options
  • Follow-up and assessment of response
  • Consideration as appropriate of: continuation of treatment/withdrawal of treatment, second and third-line pharmacological options, alternative diagnosis or comorbidity, and referral to secondary care for further investigations and management
  • Secondary care management
  • Discharge planning and long-term care and follow-up
  • Quality indicators (and the clinical justification for these)


The outcome

Bazian produced and updated twelve pathways covering the topics of low back pain (the ‘pilot’), type 1 diabetes in children, coeliac, dyspepsia, irritable bowel syndrome, inflammatory bowel disease, dementia, arthritis, osteoporosis, atrial fibrillation, fibromyalgia, chronic liver disease, abnormal uterine bleeding, chronic headache and migraine, benign prostatic hypertrophy.