Initially conceived as a way to improve productivity, access and convenience, while also cutting carbon emissions, virtual consultations have now become a central plank of the government’s social distancing measures, with health care providers being asked to shift to remote working as soon as possible.
Here we look at three Health Foundation projects that are playing a key role in rolling out video consultations across the UK, including as part of NHS efforts to reduce the spread of COVID-19.
1. NHS Highland – Pharmacy Anywhere and NHS Near Me
NHS Near Me, a video consulting service powered by the Attend Anywhere web platform, began in the Scottish Highlands. This is a sparsely populated area with difficult terrain and limited transport links, so the aim was to provide consultations as close to home as possible.
The work started life as Pharmacy Anywhere, a project in the Health Foundation’s Innovating for Improvement programme run by NHS Highland in 2017 to enable pharmacists to provide care remotely. During the pilot, 331 patients had a remote consultation, 70% of which resulted in an intervention to ensure safe and effective medicines use; in follow up 3-6 months later, 99% did not need further interventions. Satisfaction was high among patients and staff. Where internet connectivity in remote locations proved to be a barrier to video consultations, phone consultations were used instead.
The success of Pharmacy Anywhere led to the creation of NHS Near Me to provide remote outpatient appointments across NHS Highland in multiple specialties. Initially delivered at local clinics, funding through the Health Foundation’s Q Exchange in 2018 allowed it to be extended to enable patients to use NHS Near Me from home.
Now called Near Me (to reflect its use across social care settings too), video consulting is currently being implemented across Scotland and elsewhere in the UK, including as a crucial part of the response to coronavirus. Supported by £1.8m of Scottish Government funding, it is now being made available to all GP practices and Health Boards in Scotland. Scotland’s First Minister Nicola Sturgeon recently tweeted that ‘NHS Near Me will be essential to help reduce face-to-face contact’ given increased need for self-isolation.
Crucially, Near Me has been co-produced with patients, clinicians and other staff. According to Clare Morrison, national Near Me lead in the Scottish Government’s Technology Enabled Care Programme, ‘we learnt so much from patients in the early development of NHS Near Me, so we knew that co-designing the service was essential.’ The co-design process highlighted key enablers for success: a readiness to focus on telehealth, applying quality improvement methodology, and buy-in from clinicians. It also showed that support to tackle technical and operational issues, as well as ensuring that clinical and non-clinical staff are properly trained, will be essential in effective implementation.
2. Aneurin Bevan University Health Board – Connecting with Telehealth to Children in Hospital (CWTCH)
Led by Aneurin Bevan University Health Board in Wales, this project was set up in 2019 as part of the Health Foundation’s Innovating for Improvement programme to deliver psychiatric assessment and care through video conferencing to young people who self harm or have eating disorders.
The initial aim was to offer young people admitted to hospital the chance to have a specialist assessment by video with the Child and Adolescent Mental Health Service (CAMHS) team. The team have been able to expand the programme with virtual CAMHS appointments now being offered to young people at home, in GP surgeries and in schools.
While the project is not due to finish until later this year, early feedback has been positive. Young people and their families have appreciated the convenience as well as the ability to have an appointment in a comfortable and familiar setting. Professionals have valued the ease of access video conferencing offers. In the first few months of implementation there appeared to be significant savings compared to usual practice – in clinician time, travel expenses and CO2 emissions. CWTCH is now being rolled out into mainstream practice, with the intention of all CAMHS staff being able to offer virtual appointments where appropriate.
Following the trial of the technology though this project, which like NHS Near Me uses the Attend Anywhere web platform, video consultations are now being rolled-out to GPs across Wales in response to the COVID-19 pandemic. Training and clinical guidance is being developed for primary care across Wales. Professor Alka Ahuja, the project lead, has also recently been appointed as National Clinical Lead for Technology Enabled Healthcare in Wales and is supporting the emergency roll-out.
3. Barts Health NHS Trust – Virtual outpatient consultations
A team at Barts Health NHS Trust wanted to explore whether online consultations could provide more accessible and cost-effective care in the diabetes department, using readily-available, affordable technology. Supported by a Health Foundation Shine award in 2011, they set up a project to offer Skype consultations to diabetes outpatients.
Early results were promising: almost two-thirds of eligible patients signed up, the service’s ‘did not attend’ rate fell markedly and service productivity rose (video consultations were on average six minutes shorter than standard appointments). Patient feedback was also positive. People preferred the convenience of the web-based service and felt the quality of the care they received was comparable to face-to-face appointments.
Following this success, Skype-based consultations were set up in other services within the trust, including the cancer surgery clinic. Evaluation of this work found that setting up and delivering a virtual consultation service in a busy NHS clinic can be far more complex than commonly assumed. In particular, technical issues must be addressed, and not all patients (or staff) are sufficiently skilled or confident to undertake the necessary ‘troubleshooting’ to achieve and maintain the video connection. However, the evaluation also found that when clinical, technical and practical preconditions are met, video consultations appear to be safe and popular with patients and staff.
As part of the Health Foundation’s Scaling Up Improvement programme, the Barts team has been working to spread the model to Oxford University Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust. They are now aiming to spread this model further through a virtual consultations unit, providing expertise, resources and demonstration clinics, as well as working with national policymakers on issues such as tariff and training.
In response to the current situation, the Barts team is working rapidly to streamline the set-up of clinics locally and advising others, including training staff, working with information technology teams on bandwidth and fast-tracking the changes required to appointment systems. The latest information and up-to-date guidance is available on their website.
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