West & North Midlands Midlands & East Region GP Online - - PowerPoint PPT Presentation

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West & North Midlands Midlands & East Region GP Online - - PowerPoint PPT Presentation

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West & North Midlands Midlands & East Region GP Online Consultation Project Workshop GP Online Consultation Project Workshop 4 th May 2018 Jurys Inn, Broad Street, Birmingham B1 2HQ www.england.nhs.uk Agenda 10:00 Arrival,

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West & North Midlands Midlands & East Region GP Online Consultation Project Workshop

www.england.nhs.uk

Jury’s Inn, Broad Street, Birmingham B1 2HQ

GP Online Consultation Project Workshop 4th May 2018

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Agenda

10:00 Arrival, Networking and Coffee 10:30 Welcome and introductions – Fiona Sanders 10:35 A Digital Vision for Primary Care – Dr Ruth Chambers 10:50 Challenges and Benefits of GP Online Consultation – Dr Clive Prince 11:05 Change Management Challenge - Key issues - NHSD Transformation & Change Team – Sean Fearn

www.england.nhs.uk 2

11:05 Change Management Challenge - Key issues - NHSD Transformation & Change Team – Sean Fearn 11:15 Presentations from areas: Project implementation, common issues and lessons learned West DCO Team - Ciaron Hoye, Ravy Gabrria-Nivas & Ash Vora (Birmingham & Solihull CCGs) West DCO Team - Lynda Dando & Alan Luckman (Worcestershire CCGs) North DCO Team - Andy Hadley (Staffordshire CCGs) 12:15 Tea/Coffee Break and Networking 12:30 Interactive session - Key challenges 13:15 Questions and Next Steps: GP Online Consultation DCO HoDT / Project Managers 13:30 Close

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Welcome and Introductions

www.england.nhs.uk

Fiona Sanders

Introductions

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The Digital Vision for Primary Care

www.england.nhs.uk

Dr Ruth Chambers OBE GP, Clinical lead for TECS Staffordshire STP digital workstream, Chair Stoke-on- Trent CCG

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The Digital Vision for Primary Care

www.england.nhs.uk

The Digital Vision for Primary Care

Dr Ruth Chambers OBE,

GP, Clinical lead for TECS Staffordshire STP digital workstream, Chair Stoke-on-Trent CCG

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Digital Vision

www.england.nhs.uk 6

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GP Forward View

www.england.nhs.uk 7

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Collaboration around a defined LTC priority – new ways of delivery (e.g. skype consultations)

Patient –self care Clinical team Minimise duplication – shared care plan

www.england.nhs.uk 8

LTC pathway Evidence base Data and measurement Technology Innovation Workforce training/ upskilling

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SLIDE 9

www.england.nhs.uk

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5 million un-

  • diagnosed. 40%

poorly controlled

Heart Failure Stroke CHD

30% undiagnosed. Over half untreated

  • r poorly controlled

85% of FH undiagnosed & most people at high CVD risk do not receive statins 5 million undiagnosed. Most do not receive intervention 400k undiagnosed. 40% do not receive all 8 care processes

The Opportunities

High BP detection and treatment AF detection and anticoagulation Type 2 Diabetes preventive intervention Diabetes detection and treatment

Variation: inter- practice and inter-CCG

Detection, CVD risk assessment, treatment

Cardiovascular Disease Prevention Pathway – Risk Detection and Secondary Prevention in Primary Care

1.2m undiagnosed. Many have poor BP & proteinuria control CKD detection and management measures and support haviour change Cross Cutting:

  • 1. NHS Health Check - systematic detection of high BP, AF, NDH, T2DM, CKD, high

cholesterol, CVD risk

  • 2. System level action to support guideline implementation by clinicians
  • 3. Support for patient activation, individual behaviour change and self management

Marked increase in Type 2 DM and CVD at an earlier age

PAD

Failure

50% of all strokes & heart attacks, plus CKD & dementia

Type 1 and 2 Diabetes High CVD risk & Familial H/cholesterol Blood Pressure Atrial Fibrillation NDH (‘pre-diabetes’)

5-fold increase in strokes,

  • ften of

greater severity Marked increase heart attack, stroke, kidney, eye, nerve damage

Intensive bhviour change (eg NHS DPP) reduces T2DM risk 30-60% Behaviour change and statins reduce life time risk of CVD BP lowering prevents strokes and heart attacks Anticoagulation prevents 2/3 of strokes in AF Control of BP, HbA1c and lipids improves CVD outcomes

Established Disease

Detection and Secondary and Tertiary Prevention

The Evidence The Outcomes Primary Prevention The Risk Condition

Marked increase in premature death and disability from CVD

Chronic Kidney Disease

Marked Increase CVD, acute kidney injury & renal replacement

Management of CVD risk, BP & proteinuria improves outcomes Population me for beh

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Shared decision making

Clinician resources High

Advanced communication skills with data on options,

  • utcomes, evidence and

risk

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resources Patient resources Low High

LTC management and prevention Acute life threatening Surgical decisions LTC management Medication compliance Behaviour change

Type of decision

Low

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Universal Capabilities – Patient Online Services

  • 1. Patients can access their GP record
  • “better informed patients” (GP)
  • “elderly patients prefer to talk to someone” (GP)

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  • 2. Patients can book GP appointments and order repeat prescriptions
  • “reduced workload as more prescriptions requested electronically” (GP)
  • “need to be computer literate to benefit from PO” (practice manager -

PM)

  • “cannot book appointments with nurses” (PM)
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Online consultations?

www.england.nhs.uk

Patient’s /clinician’s willingness- perception, choice and personal views about usefulness & outcomes, costs, availability, personal identity, accountability and governance?

Ready for change?

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Making the digital vision happen

Aim – Adopt technology enabled care as usual practice Outcomes – Improve patient /clinical management of long term conditions/adverse lifestyle habits -

www.england.nhs.uk

Scope – Which type(s)

  • f technology will you

use to achieve planned

  • utcomes/ what LTCs

will you focus on? Resources – Who/what do you need – equipment, competence, practice support, online clinical consultation triage? lifestyle habits - efficiently

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Online Consultation – Challenges & Benefits

www.england.nhs.uk

Challenges & Benefits

Dr Clive Prince FRCGP

Digital Clinical Champion – Digital Transformation of Primary Care, NHS England RCGP Person Centred Care Network of Champions

May 2018

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“Patients and information are the

www.england.nhs.uk

Cartoon with thanks to the British Medical Journal

information are the two most under-used resources in the NHS”

Dr Richard Fitton

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Digital Primary Care is NOT

1. For everyone

  • Patient Online experience; surprisingly – disabled etc

2. Extra workload

  • Primary Care hasn’t capacity

www.england.nhs.uk

3. Squeezing in extra appointments

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The Reality:

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30% 40% 50% 60% 70% 80%

Sending/receiving emails (79%) Finding information about goods and services (76%) Social networking (eg Facebook or Twitter) (63%) Reading online news, newspapers

  • r magazines (60%)

Internet banking (60%)

Internet activities in the past three months

0% 10% 20% 30% 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Looking for health-related information (eg injury, disease, nutrition, improving health etc) (51%) Using services related to travel or travel related accommodation (51%) Making an appointment with a doctor or other healthcare practitioner via a website (15%)

http://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internet accesshouseholdsandindividuals/2016

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www.england.nhs.uk

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Population Consultations Relative funding Relative workforce

Pressures on General Practice

www.england.nhs.uk

Consultations Complexity Costs Relative workforce

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7% 6%

4%

Other in practice Self care/Pharmacy Outpatients

Data from

GPs judged 26%

  • f their

consultations to be potentially avoidable

Potentially avoidable GP

www.england.nhs.uk

74%

4% 3% 3%

2% 2%

Outpatients Sick notes / appeals Care navigation Continuity/preparation Other

Data from 5,128 consultations

… 18% are about how the practice manages its workload

avoidable GP appointments

(audit by GPs)

bit.ly/time4caretool1

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10 High Impact Actions

to release time for care

Introduce new communication methods for some consultations, such as phone and email. Where clinically appropriate, these can improve continuity and convenience for the patient, and reduce clinical time per contact. Phone Use of the telephone for consultations is growing rapidly in general practice. Some practices have been offering this kind of consultation for ten years or more, but interest has grown significantly since about 2012. From a starting point of treating phone contacts as brief triage encounters, practices are increasingly recognising the feasibility and value of fully addressing the patient’s need in a single phone contact where appropriate. Experienced consulters generally find phone consultations are half the length of face-to-face ones, and that approximately 75% of consultations can be fully concluded on the phone. This releases GP time, reducing waiting times for patients, and making it easier to offer better continuity and longer face-to-face appointments for patients who need it. Most practices implement phone consultations as part of other changes, for example the introduction of active signposting and redesign of systems to create more productive workflows, particularly with a focus on matching capacity with patterns of demand through the week. E-consultations

www.england.nhs.uk

Using a mobile app or online portal, patients can contact the GP. This may be a follow-up or a new consultation. The e-consultation system may be largely passive, providing a means to pass on unstructured input from the patient, or include specific prompts in response to symptoms described. It may offer advice about self care and other sources of help, as well as the option to send information to the GP for a response. Text message In addition to sending reminders, text messaging can be used for more interactive two-way communication between patients and their practice. Systems exist to help automate this, allowing for quite sophisticated packages of education, reminders and support self-care. Group consultations For patients with longterm conditions, group consultations provide an efficient approach to building knowledge and confidence in managing the condition, which includes a peer-led approach as well as expert input from professionals.
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“Enthusiasts have led the introduction of alternatives to the face- to-face consultation in general practice though uptake has been patchy and practices have concerns about being inundated by patients.

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patients. Patients like them and find them convenient on the whole”.

Atherton H, Brant H, Ziebland, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. Alternative to the face-to-face consultation in general practice: focused ethnographic case study. BrJGenPractice April 2018. Read full-length citable article online @bjgp.org

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“Electronic consultation systems may be useful for simple tasks.”

www.england.nhs.uk

Banks J, Farr M, Salisbury C, Bernard E, Northstone K, Edwards E, Horwood J. Use of an electronic consultation system in primary care. Br J Gen Practice January 2018. Read full-length citable article @bjgp.org.

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Conclusion: “ The experiences of the practices in this study demonstrate that the technology, in its current form, fell short of providing an effective platform for

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clinicians to consult with patients and did not justify their financial investment in the system”.

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Conclusion: Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and

www.england.nhs.uk

and staff workload may be both modest and gradual

Atherton H, Brant H, Ziebland, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. Alternative to the face-to-face consultation in general practice: focused ethnographic case study. BrJGenPractice April 2018. Read full-length citable article online @bjgp.org

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Conclusion: “It may offer convenience to patients with discrete, single problems, and a welcome variation to GP’s workload. Tele-Doc’s potential for addressing more complex

www.england.nhs.uk

Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter

  • site. Br J Gen Practice November 2017 e736.

problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.”

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Digital Transformation in General Practice

Enable self-care and support self-management for patients Reduce burden in General Practice through patient services. Enable patient self-care through access to record Reduce workload Reduce the burden in general practice to free up time to better

OBJECTIVE: By 2020 we will have transformed the way in which technology and information supports General Practice to:

www.england.nhs.uk

Reduce the burden in general practice to free up time to better serve patients Help practices who want to work together to operate at scale Support practices that want to work together at scale and new models to deliver integrated care Support greater efficiency across the whole system
 Support the integration of services across the NHS and support the ambitions from other care settings to implement new services for patients

Objectives agreed by the Digital Transformation in General Practice Domain Board and referenced in General Practice Forward View

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GENERAL PRACTICE FORWARD VIEW

Benefits Benefits Process Process Support Support About About Find information about your symptoms

  • r a condition

Find information about your symptoms

  • r a condition

Send a consultation to your practice Send a consultation to your practice Request repeat prescription, check test results, book appointment Request repeat prescription, check test results, book appointment

What does it look like?

www.england.nhs.uk

Type details of the problem or question here… Type details of the problem or question here… Send Send

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About About Benefits Benefits Process Process Support Support About About

GENERAL PRACTICE FORWARD VIEW

Improved access

More convenient access, connected to the most appropriate person first time, signposted to self help ad community resources

  • eg Unity Health, York: GP wait reduced from 2-3 weeks to 1 day, DNAs from 10% to 3 - 5%
  • eg Larwood surgery, Workshop: named GP wait reduced from 1-5 weeks to a few hours

Improved access

More convenient access, connected to the most appropriate person first time, signposted to self help ad community resources

  • eg Unity Health, York: GP wait reduced from 2-3 weeks to 1 day, DNAs from 10% to 3 - 5%
  • eg Larwood surgery, Workshop: named GP wait reduced from 1-5 weeks to a few hours

More efficient use of GP time More efficient use of GP time

Benefits in practice

www.england.nhs.uk

More efficient use of GP time

Clerical queries addressed by clerical staff, some problems resolved without face to face appointment, tests done before appointment

  • eg Docklands Medical Centre: 40% of contacts resolved without patient needing to come in, mean 2.9 minutes’ GP time
  • eg Unity Health, York: 66% handled remotely, take <10 min for clinician

More efficient use of GP time

Clerical queries addressed by clerical staff, some problems resolved without face to face appointment, tests done before appointment

  • eg Docklands Medical Centre: 40% of contacts resolved without patient needing to come in, mean 2.9 minutes’ GP time
  • eg Unity Health, York: 66% handled remotely, take <10 min for clinician

More effective consultations

GP can deal more effectively with the problem because details of the history and the patient’s ideas, concerns and expectations known in advance

  • ne of the first things reported by many GPs
  • it is hoped that future academic research will seek to quantify this

More effective consultations

GP can deal more effectively with the problem because details of the history and the patient’s ideas, concerns and expectations known in advance

  • ne of the first things reported by many GPs
  • it is hoped that future academic research will seek to quantify this
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About About Benefits Benefits Process Process Support Support About About

GENERAL PRACTICE FORWARD VIEW

Do patients use it?

Yes … if they know about it and are encouraged by staff

  • Where patients are not engaged by the practice, the service is hard to find on

the website or staff are not confident in describing the benefits, patient uptake can be very low.

  • This is not surprising, but it is sometimes overlooked by practices. Recent

academic publications confirm this.

www.england.nhs.uk

academic publications confirm this.

Potential shift to ‘click first’ for patients

  • Rydal practice (suburban): 40% contacts online within 3 months
  • Unity Health (suburban and student): 87% online

Potential shift to ‘click first’ for patients:

eg Rydal practice (N London): 40% contacts

  • nline within 3 months

eg Unity Health (York): 87%

Use crosses the generations

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Key messages

  • Digital services need to add value
  • We need to involve all staff (clinical and non-

clinical) at all levels to ensure change works

  • Solutions need technically appropriate and

care appropriate

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care appropriate

  • Breaking down vision into manageable

milestones, helps to keep momentum going and demonstrates achievements

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Quick wins for general practice and patients

How to reduce the burden for practices and maximise system capacity How to reduce the burden for practices and maximise system capacity

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Automation of filing of normal results/publication to patients Automation of filing of normal results/publication to patients Practice websites – effective communication with patients Practice websites – effective communication with patients

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What further webinars would you like?

www.england.nhs.uk Thank you

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GP Online Consultation Lessons Learned for engaging with Primary Care

www.england.nhs.uk

Sean Fearn - NHS Digital

engaging with Primary Care

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GP Online Consultation Lessons Learned for engaging with Primary Care

presented by Sean Fearn NHS Digital

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Background

  • Lessons Learned based on:

– increasing the use of Summary Care Record with Additional Information in the North Humber and Northern Additional Information in the North Humber and Northern Lincolnshire region – Academic research

38

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Four key tips

  • 1. Know your product and it’s benefits
  • 2. Engage at multiple levels

39

  • 2. Engage at multiple levels
  • 3. Person first, tech last
  • 4. Stay the course
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  • 1. Know your products and the benefits
  • Projects often fail as the benefits are unclear
  • Understand the product and explain ‘ why?’
  • Understand the product and explain ‘ why?’
  • What are benefits to:

– Patients – GP Practice staff – Others?

40

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  • 2. Engage at multiple levels
  • Raise awareness

– Events and workshops – Promote through existing meetings, LDR Boards, Primary Care Meetings – Send emails

Targeted or untargeted – you decide If targeted – try and personalise it using Practice population figures etc

– Phone

41

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  • 3. Person first, tech last

Identify the people that support change, can champion and lead change

– Local Medical Committees – GPs and GP Federations (Collaboration) – CCG Clinical Leads – CCG Clinical Leads – Practice & Business Managers

Don’t forget the IT, IG and Training Leads they support the how

42

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Educate & Train

  • Provide a simple ‘implementation’

guide with links to supporting documents

  • Share Frequently Asked Questions

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  • 4. Stay the course
  • Identify overall sponsor for work
  • Identify a project manager

– Create a plan, monitor progress, keep it current – Include engagement and communications plan – Maintain risk and issue log with mitigating actions! – Maintain risk and issue log with mitigating actions!

  • Task and Finish group
  • Listen and learn

– Share best practice

  • Case Studies to share the benefits and how to overcome

barriers

44

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Use us…

  • Local contacts
  • Regional/local knowledge

45

  • Regional/local knowledge
  • Lessons Learned
  • Advice and guidance on

business change

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Your thoughts and feedback

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www.digital.nhs.uk @nhsdigital enquiries@nhsdigital.nhs.uk enquiries@nhsdigital.nhs.uk 0300 303 5678

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Presentations from areas: Project implementation,

www.england.nhs.uk

Project implementation, common issues and lessons learned

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Presentation from: WEST DCO Ciaron Hoye (Head of Digital), Ravy Gabrria-Nivas (Senior Primary Care Quality & Development

www.england.nhs.uk

Care Quality & Development Manager) and Ash Vora (SDS myhealthcare) Birmingham & Solihull CCG

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Background

  • Birmingham and Solihull Clinical Commissioning Group became

the largest clinically-led commissioning organisation in England on 1 April 2018.

  • We were created following approval by NHS England for a merger

between Birmingham Cross City, Birmingham South Central and

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between Birmingham Cross City, Birmingham South Central and Solihull CCGs.

  • We look after a population of around 1.3 million people and our

budget is in excess of £1.8 billion – almost 2% of the total NHS resource.

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STP view

Enablers

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Enablers Digital Innovation & Integration

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Strategic view

A move towards a single ‘digital front door’:

  • Single electronic point for patients/citizens to access services.
  • Not a single solution (e.g. integration with other systems).
  • Online consultation as part of a programme of work.

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  • Interactions with extended access, out of hours, etc.
  • How does this interact with other organisations in the economy.
  • Acute care, Social care, Mental Health.
  • Employ a ‘Google’ effect to increase digital footfall and literacy.
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SLIDE 53
  • !"!
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MyHealthcare Digital App

Appointment Booking

Booking of appointments for your own pracrtice, local hub or the virtual services

My Medical Record

View your medical coded medical record as per Patient Online requirements

Long Term Condition Mgt.

Empower patients to self-monitor their specific conditions

Self-Help Guides

Provide personalised guides for key conditions and topics with direct sign-posting into services Patient Online requirements Accessible Consented Secure Multi-Language

Medication Management

View medication and order repeat prescriptions from your GP record

Lifestyle Management

View and manage your key lifestyle factors for prevention of long term conditions

Interoperability with EMIS & SystmOne

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#$ Birmingham and Solihull Rollout

Currently rolled out to 30+ practices with 180,000 patients population. Supporting both GMS and Extended Access operations with multiple GP federtations/organisations now on the app.

Further Developments

Design and development of other componets delivered, in live test or in development (see next slides for details)

Procurement via DPS

On the Online Consultation DPS framework under Substrakt Health, however offer much more than just online consultation.

Funding vs. Local Digital Roadmap

Funding is currently split by focus areas and solutions, but the collective of solutions needs to provide a coherient digital strategy and patient experience.

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%&

'( ) '(! & )* ' ) &&(& ) ) +&' ' && ))

  • +)'

& +()& && ,&&)- )&&)& .) * &) / * ) * &

All roadmap deliver timescales are estimated and subject to change
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0)&

Patient Record Access

Full coded record access means we can match patients and their specific conditions without lengthy questioning

Triage to right place

Configurable to enable specific outcomes to map to specific appointments and services

Provide Self-care content

https://drive.google.com/open?id=1mz-opjeVi57MMXhCRJeLTOBDD-H5d2EO

Provide Self-care content

When appropriate, self-care information will be provided to patients based on their inputs

Direct Booking

If required, the patient can book directly into urgent and routine appointments based on their triage

  • utcome

Recording of consultation

The consultation with the patient will be filed on the patients record with transcript and PDF consultation report

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1 &

TARGETED PATIENT MESSAGING WITH ACTION

  • Send Push Messages, SMS and Emails in a targeted campaign approach to

Birmingham and Solihull population Birmingham and Solihull population

  • Reduce costs for whole system to support paying for the MyHealthcare

App and further innovation projects / development

  • Can be used for any use case of patient call / recall with actions such as

booking of appointments, ordering medication, delivery of content fully integrated

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+ *1 Self-service stations in/out NHS setting

Creation of self-testing stations that identify patients, deliver structured Creation of self-testing stations that identify patients, deliver structured health education personalised to individual patients and enable self

  • monitoring. The solution also enables automation of existing pathways

and screening to improve service capacity.

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#'20& Enable Clinicians to access records anywhere

Utilising the MyHealthcare App, we are now able to provide clincians Utilising the MyHealthcare App, we are now able to provide clincians and third party access to read / write GP Records without a clinical

  • system. A service can be provided a specific ‘view’ based on the

data required to perform the given service. Currently in development for Nursing Homes and Third Sector Organisations.

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0' Chatbot Consultations / Info

Building upon the patient experience within MyHelathcare App, we are currently developing the ability to perform chat-bot messaging

  • consultations. This technology can be used across the NHS to to

provide services such as pre-consultation quesionnaires, out patient service information

https://drive.google.com/open?id=1mz-opjeVi57MMXhCRJeLTOBDD-H5d2EO

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SLIDE 62

3 0,%& Hypertension Recall Service

Develop a proof of concept engine to identify potential patients who are at risk of Develop a proof of concept engine to identify potential patients who are at risk of developing hypertension or other cardiovasicular conditions early. Once identifed the patient can be proactively approached to book them in for a review.

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#&$ Key Building blocks

All of the above conponents are already been developed or in development with the ability re-use together and/or in multiple settings

True service transformation

Using the components above, we can shift the way patients use and interact with health, care and social services. A move from reactive to proactive care

No proliferation

Using a multi-product, vendor neutual approach to acheive a joint up patient experience. A best of bred of solutions rather than individual solutions for each area approach.

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SLIDE 64

Presentation from: WEST DCO Lynda Dando (Head of Primary Care) and Alan Luckman (Programme Manager, Midlands and Lancashire

www.england.nhs.uk

Manager, Midlands and Lancashire CSU) Worcestershire Project update

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Decision to pilot

Online Consultation Systems considered:

  • askmyGP (GP Access) - http://askmygp.uk/
  • eConsult (Hurley Group) - https://econsult.net/
  • Engage Consult (WigglyAmps) - http://engagehealth.uk/
  • Online Triage (Emis Health) - https://www.emishealth.com/products/emis-online-

triage/

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triage/ Demo sites promoted in the local estate:

  • askmyGP (GP Access) -

https://live.askmygp.uk/howcanwehelp/NzkxMjc3OCQ4MjYyMy0xNg%3D%3D

  • eConsult (Emis Health) - http://demo.webgp.com/
  • EMIS Online Triage - https://www.emisonlinetriage.com/org/rawdon-house-

surgery

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Pilot Details

3 Practices are currently piloting the Engage Consult (WigglyAmps) system:

  • South Worcestershire CCG - St Johns House Surgery, Worcester

(registered patients 12,615). Semi-rural but with new housing developments nearby.

www.england.nhs.uk 66

developments nearby.

  • Redditch & Bromsgrove CCG - Winyates Health Centre, Redditch

(registered patients 16,213). Semi-rural residential area.

  • Wyre Forest CCG - Stourport Health Centre, Stourport-On-Severn

(registered patients 9,225). Semi-rural practice.

Source: Registered practice patient population figures from NHS Digital as @ 1/4/2018.

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SLIDE 67

Support and promotion

The practices have all had system installation, training and also have access to on-going supplier assistance. All practices have promoted the new service via the following:

  • Website.

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  • Website.
  • Email.
  • Branded posters provided by the supplier.
  • Branded leaflets provided by the supplier.
  • Typically distributed by receptionists, Nurses and Doctors.
  • Text messages (via the Mjog messaging service).
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SLIDE 68

System Utilisation Stats

Practice Start Date 8th February 2nd March 6th April 20th April Totals St Johns 30/01/2018 Medical 1 35 43 27 106 Admin 1 19 44 12 76 Total 2 54 87 39 182 Stourport 01/02/2018 Medical 1 7 58 8 74

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Admin 1 7 22 4 34 Total 2 14 80 12 108 Winyates 07/12/2017 Medical 2 23 21 7 53 Admin 6 11 11 5 33 Total 8 34 32 12 86 Totals Medical 4 65 122 42 233 Admin 8 37 77 21 143 Total 12 102 199 63 376

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Utilisation Chart

60 70 80 90 100

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10 20 30 40 50 Medical Admin Total Stourport Medical Admin Total Winyates Medical Admin Total 8th February 2nd March 6th April

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SLIDE 70

Commentary on usage statistics

Cumulative figures (11 or 16 weeks as at 20th April 2018):

  • St John’s has gone from a total of 57 consultations after 6 weeks to

144 after 11 weeks. The feedback is strongly positive from patients.

  • Stourport has gone from 16 consultations after 5 weeks to 94 after

11 weeks, but the feedback is significantly less positive than either

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11 weeks, but the feedback is significantly less positive than either St John’s or Winyates.

  • Winyates has gone from 42 consultations after 11 weeks to 74 after

16 weeks, so still behind the other two, but a significant improvement and the feedback is very positive.

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Feedback and Lessons Learnt

  • GP phone system to leave pre–recorded messages – important.
  • Important for all staff clinical and admin to promote new service at each

patient contact.

  • System may be seen as ‘extra system’ rather than supplementing

current systems with another communication route for patients.

  • Need to quantify how efficiencies are to be gained.

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  • Need to quantify how efficiencies are to be gained.
  • Quality of [consultation] questionnaire completion can be poor. This

may result in a return call being needed.

  • Administrative queries can be dealt with efficiently via Engage but

systems in place for this currently.

  • Uptake by practice using Phone First for appointments seemed

poorest.

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SLIDE 72

Presentation from: NORTH DCO Andy Hadley CCG Digital Lead and

www.england.nhs.uk

CCG Digital Lead and Staffordshire GPFV Digital Lead Staffordshire Project

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Background

  • Started early when GPFV funding was announced, linked in with

Head of Digital Technology at NHS England around what the plans were.

  • Discussed potential approaches at our GPFV checkpoint meetings.
  • Lots of interest from practices so we looked at how we could

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  • Lots of interest from practices so we looked at how we could

support this knowing funds were following shortly.

  • Or at least we thought they were…
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SLIDE 74

Getting started

  • Hit the ground running in April 2017 by reviewing the initial

specification/requirements the programme expected to go through NHS England processes.

  • Linked in with areas who have already rolled out at large scale – IoW

and Hampshire.

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and Hampshire.

  • Pulled together a product review team which included LMC reps,

clinical leads, CCG staff.

  • Reviewed market leaders at that time – 4 suppliers.
  • Ensured products fit with the clinical and practice requirements which

had been made clear through initial engagement with the enthusiasts.

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What is the evidence this works?

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Programme Outline

  • Lead across six Staffordshire CCGs – maintained links with

colleagues in partner CCGs as locality based support is key.

  • Strong clinical leadership across our large geographical area.
  • Clear in what we wanted to achieve:

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  • Build local evidence, pilot products and produce case studies

including implementation challenges – This is not an IT project!

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Capturing enthusiasm

  • A good number of practices pro-actively made contact to trial

products they had seen advertised.

  • In order to capture the enthusiasm, we had an agreed approach

with the review team, with LMC supporting our ask in regards to case studies and workload to pilot practices.

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case studies and workload to pilot practices.

  • A programme briefing was produced and all 158 practices were

invited to register interest – naming their product of choice.

  • Choice - felt important in maintaining interest.
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Maintaining enthusiasm

  • Low levels of bureaucracy.
  • As this is a change programme with a focus on quality

improvement we have committed resources to support implementation and continued review/learning.

  • Understanding the workforce pressures.

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  • Understanding the workforce pressures.
  • Regular contact with practices. Suggesting ways in which the new

tool/change in practice could help manage demand, but being clear

  • n the practice input required.
  • Again, this is a business change and not just a digital product.
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Procurement

  • Things went quiet on the programme with no real news about when

funding would follow – it was hard to keep updating practices with nothing to say.

  • Fast forward to December 2017… national bidding process and

then the long wait to hear if funds are available.

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then the long wait to hear if funds are available.

  • Our plan was supported by NHS England so we re-engaged

practices, confirming they were still happy to pilot in phase one.

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SLIDE 80

Roll out

  • Beginning of Phase one now – 24 practices.
  • 19 EMIS Online Triage and 5 eConsult.
  • Had some of the initial practices drop off, quickly replaced by
  • thers who wanted to be involved so interest was growing as there

was more news in the media about money available to practices.

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was more news in the media about money available to practices.

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What benefits are we looking for?

  • As many as we can get!
  • The pilot will be key in assessing the potential benefits – will it be a

case of you get out what you put in?

  • Empowered patients, increase in digital activity supporting the

national GP Online programme and the NHSE empower the person

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national GP Online programme and the NHSE empower the person work streams.

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What is the ask to pilot sites…

  • Monthly/Bi-Monthly reporting to Programme lead on implementation/usage.
  • Produce a case study on implementation and experiences of using the tool.
  • A clinician and practice manager from the pilot sites will use the case study to

share experiences of this new way of working with member practices via CCG boards which will then be shared across the STP footprint.

  • Assess and report on the impact the tool has had on practice activity, back office

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  • Assess and report on the impact the tool has had on practice activity, back office

functions and clinician session planning.

  • Provide feedback on the impact on cultural change and provide necessary

evidence of new processes that may be required to support patient care and experience.

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Why has it worked?

  • Reviewed what has been done – asked how it would work for us.
  • Very clear about what we wanted to do and why – evidence base,

phased approach, low bureaucracy, support on the ground.

  • Learned from past experiences of rushing in and imposing a

system.

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system.

  • Worked collaboratively with clinicians, LMC, CCG teams to ensure

this programme is supported and the approach is right per site – don’t be driven down a single approach.

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SLIDE 84

Coffee Break

www.england.nhs.uk

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SLIDE 85

Interactive session – Key challenges

www.england.nhs.uk

Fiona Sanders, Saj Kahrod, Alan Turrell & Imtiaz Bala

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Group Exercise

  • Organised into tables of eight
  • 4 tables to discuss each issue
  • Mix of people from different geographical areas
  • Group discussion for 20 minutes

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  • Feedback from each pair of tables for 25 minutes (includes

questions and answers)

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SLIDE 87

Exercise

  • Discuss the following two issues (transformation planning and

communications & engagement) and in doing so take into account:

  • What are the critical success factors?
  • How do you engage General Practice in developing and taking

co-ownership?

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co-ownership?

  • What are the 3 must do’s in tackling these issues?
  • What are the key challenges for each of these issues and how

will they be overcome?

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Issue 1 – Transformation planning

Please consider the following in your discussions:

  • What changes do we need to make in primary care to take

advantage of the opportunities from online consultation?

  • What are the types of things we need to consider (e.g. roles of the

practice team, current and future processes)?

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practice team, current and future processes)?

  • Who needs to be involved (e.g. primary care, practices, etc)?
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SLIDE 89

Issue 2 - Engagement

Please consider the following in your discussions:

  • How are we going to secure engagement and buy-in from general

practice to online consultation?

  • Who are the other key stakeholders and how do they need to be

engaged?

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engaged?

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SLIDE 90

Feedback

www.england.nhs.uk

Fiona Sanders & Saj Kahrod

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SLIDE 91

Questions and Next Steps

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Next Steps

Fiona Sanders & Saj Kahrod

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SLIDE 92

Any Questions?

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Contact

Alan Turrell Project Manager West Mobile: 07946 762 692 Onlineconsultation.west@nhs.net

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Imtiaz Bala Project Manager North Mobile: 07817 986 148 Onlineconsultation.north@nhs.net

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Commercial and Procurement Lead: Garry Mitchell garry.mitchell@nhs.net

Contact – Procurement Hub

www.england.nhs.uk

garry.mitchell@nhs.net Tel: 07786 275 627 Commercial & Procurement HUB General Contact: commercial.procurementhub@nhs.net

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