Digitally enabled primary and community-based care
WHY this is important for people in Suffolk and North East Essex
Technology that helps people access health and care more easily is essential if everyone in Suffolk and North East Essex is to live well.
As an Integrated Care System we will ensure that:
- People have high quality digital technology-based support to self-care and to help monitor their conditions
- People have flexible and convenient ways to access their GP and outpatient services
What’s the current picture?
The King’s Fund report ‘Digital Change in Health and Social Care’ (2016) highlighted a number of ways new technology is already being used: Video-consulting technology, such as Skype.
- Patients being monitored through smartphones combined with portable diagnostic equipment or sensors.
- Provision of mental health counselling services across a rural area.
- Smartphone-based appointment management service, where patients can reschedule or cancel appointments or book an earlier slots that another patient has cancelled.
- Triaging patients who would otherwise come in for an appointment.
- Streamlining an appointment booking system to reduce the number of empty appointment slots.
- For more information see https://www.kingsfund.org.uk/publications/digital-change-health-social-care
What do we know about people’s local experiences?
- Technology such as telecare and telehealth is beneficial, but should not replace personal contact with a clinician when required.
- Location of services and people’s travel and transport needs (including parking availability and costs) should be considered. The strict criteria for patient transport means arranging travel to healthcare appointments is more difficult.
- Repeat diagnostic tests, lack of integration of patient records, fragmented systems where people have to repeatedly tell their story is wasteful and a poor experience.
For further information see www.healthwatchessex.org.uk and www.healthwatchsuffolk.org.uk
Giving patients access to their own data: our patient portal:
Outpatient care normally feels like giving up control. You are referred… then you wait. You need some follow up… then you wait. You have tests… then you wait. While waiting, you don’t know if you’ve been forgotten, how long you might wait or when you will know the outcome.
We will change that. Our patient portal will be a secure, easy way to share the information we hold on behalf of our patients with them. It will start simply, sharing new hospital appointments. As it develops we will add features including:
- Re-booking appointments
- Sharing letters
- Sharing results (where appropriate)
- Self-care information and patient education
- Video and questionnaire-based appointments
- Sharing data from health apps or devices
Our patient representatives are helping to make it as user friendly as we can. For those who can’t or don’t want to use it, we will continue to offer our existing telephone, outpatient and letter services.
We knew that we needed to think differently about managing caseloads, so that patients could get the advice they needed as quickly and conveniently as possible. We wanted to get the most benefit we could from eConsult: as It allows us to better manage workloads – we can redirect work from the phone line to eConsult and then assign it to dedicated slots at a time that suits us.
One of the key things about eConsult, as with any other service, is to be proactive and keep reminding patients to ensure they use it. Every patient that rings our Practice and can’t get an appointment is signposted towards eConsult. We’re a big practice and we don’t want to create additional work – we want the work we have to be more manageable.
We are always striving to improve, so we share our improvements with the team. It’s a great motivation and rewarding to see our usage growing. All the team have been upskilled so that they understand exactly how use eConsult, and we’ve been thinking differently about our training and have a community volunteer patient that comes in for two hours a week to show patients how to use eConsult. It’s reassuring to see that our patients want to use the templates for children too – as a parent you often wonder if your child needs to see a doctor so eConsult is great, especially for ongoing conditions like eczema where they can upload photos and to help clinicians decide what to do next. eConsult gives patients reliable self-help information too – especially if a patient is asking about something like a verruca that a doctor doesn’t need to see!
Laptops – Thousands have been procured, built and deployed
Remote Access – Ee have significantly increased capacity and resilience
Telephony – We have increased mobiles, softphone, and core telephony resilience alongside increased access to the public (support lines and services). Only about 14% of doctor’s appointments were carried out over phone or video link in the year to February 2020. But that has all changed, with the number of phone appointments doubling in March as the public became conscious of the need for social distancing.
Online Consultation – Significant expansion in primary care, supporting triage and workflow
Video Consultation – Widespread implementation, and rapid adoption of various products. In just 5 weeks we achieved around:
- 1000 hours of saved patient travel time.
- 350 hours of saved patient check-in/wait time.
- 3500 hours of saved appointment time
- Improved engagement potential to reduce Did Not Attend rates by 50%.
- An associated saving for our communities as a representation of employee time
- The creation of a video layer to support clinical assessment and clinical engagement.
- The ability to enable flexible staffing arrangements to address resourcing,
- recruitment & isolation/infection control challenges.
Tablets – Now in wards, Critical Care Units, care homes, and community hospitals
Microsoft Teams – We have adopted this widely, enabling collaboration, virtual meetings and rapid learning
Virtual Desktop – Capability for a wide range of clinical services, pilots are underway ahead of migration to national infrastructure
Virtual SmartCard – 300 allocated to our ICS, currently being adopted
Robotic Process Automation – NHSMail accounts created for Nursing & Care Homes, and shopping vouchers delivered to Social Care Organisations across our ICS area
Chat Bots – Testing is underway for call handling chat bots
Apps – are being developed everywhere
Remote Monitoring – Pilots being developed
HOW we plan to make a difference
1.1 People have access to integrated health and wellbeing information, advice and support in the formats most convenient to them.
- The NHS App will provide advice and check symptoms. It will connect people with healthcare professionals including via telephone and video consultation. The NHS App will be a digital front door for advice and information, and to access services to improve access to support. Development of local patient portal apps will work towards integration with the NHS app to ensure one ‘front door’ for patients to access online services for ease of access and simplicity of use.
- We will support the development, testing and implementation of mobile and web-based applications. Improved access to online resources helps to support good physical and mental health and enable recovery, and self-care for long term conditions. It will enable patients to access virtual services via computer or smartphone. Information should be integrated wherever possible, between mental and physical health and health and social care. Citizens and community services should also be able to contribute information, and help co- design the design of resources.
- Primary care roles such as pharmacists and care navigators support digital self-care. A whole neighbourhood approach to self-care improves people’s access to information and support.
1.2 People with long term conditions can access technology that enables their clinicians to be fully informed about their health.
- Trialling of innovative devices such as smart inhalers for remote monitoring of conditions. Remote monitoring of conditions enables an early and tailored response to deteriorating health. Infrastructure will need to develop to support this way of working and ensure clinicians interpret data accurately and respond quickly where risks arise.
2.1 People can access a GP service more quickly and conveniently through online consultations.
- People will have the right to choose an online consultation with either their GP or a digital GP provider, by March 2024. Digital-first options improve fast access to convenient primary care, saving waiting and travelling for patients. Digital provisions could also support functions such as online medication reviews and outpatient follow ups.
- Primary Care Networks will have a new framework to commission digital suppliers through the national GP Futures framework. Digital maturity of practices and PCNs should be monitored closely to understand areas of strength and weakness to ensure capacity of resources and usefulness of new capabilities will meet public demand.
- Measures will be in place to ensure digital-first practices are safe and beneficial, and funding for practices is fair. Linked to this way of working is the need to enhance access to support services such as phlebotomy, and connectivity between primary care databases and other health and care information systems.
- GP terms and conditions will support GPs return to practice and increase participation in digital-first ways of working. This new model of working can also help expand the GP workforce by providing flexible opportunities to part time GPs and free up GP time for face-to-face consultations.
- PCNs and Practices will be trained and supported to redesign how they deliver services to make best use of the digital first technology on offer.
2.2 People use outpatient services only where necessary and in the most convenient way for them, taking into account the older population and our rural areas.
Redesign of outpatient services will include:
- Better support to GPs to avoid the need for a hospital referral
- Online booking systems
- Appointments closer to home
- Alternatives to traditional appointments where appropriate, including digital appointments and avoiding unnecessary appointments. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care. Redesigning outpatients means patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year nationally. This will save patients time and inconvenience, will free up significant medical and nursing time, will allow current outpatient teams to work differently, and will avoid spending an extra £1.1 billion a year on additional outpatient visits. The use of digital means such as video consultations will support patients in their own homes without the need to travel to access follow up appointments.
3.1 People can access digital options that fit their needs and choices. We will enable this by:
- Supporting good digital connectivity in rural areas to support both staff and patients’ access. Investment has been made in fibre connectivity within the region by both health and social care partners, working with wider partners to improve connectivity.
- Supporting people who do not have digital resources to improve access and confidence in using the technology. The voluntary sector can play a key role in supporting widening of access for people who do not normally use digital resources, including older people.
- Supporting people who do not have access to digital resources during normal surgery times to improve access and confidence in using the technology. Helping people such as working parents or family carers to access digital options at times convenient to them helps reduce demand at peak times and provides a better patient experience.
- Ensuring people can access and add information to their own care records. Systems such as My Care Choices for long term conditions people with learning disabilities and/or autism, frailty and dementia as well as end of life care could be used to enable people to have direct input into their care records. These records would then be accessible to the person and the professionals involved in their care.
- Supporting staff in their access to and use of digital tools to support the best patient care. Building skills and resources to enable staff to work confidently with digital provisions will be key. Providing clear communications around patient record sharing through the use of the My Care Record approach will support both staff and patients to have confidence about how records will be shared to support patient care.
- Ensuring equality of choice to access digital options. Improving availability of digital options is essential, but should be balanced with the needs and choices of people who want face to face options.
We will know we are making a difference because we will see:
Increase in the proportion of the population registered to use the NHS App, from 0.2% in 2018/19 to 30% in 2023/24
Increase in proportion of people registered with their GP who have access to online consultations, from 26.6% in 2018/19 to 100% by 2021/22