Prime Minister s Challenge Fund (PMCF): Improving Access to General Practice. Innovation Showcase Series Using Technology to Improve Access

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1 Prime Minister s Challenge Fund (PMCF): Improving Access to General Practice Innovation Showcase Series Using Technology to Improve Access February 2015: Showcase Two

2 About PMCF In October 2013, the Prime Minister announced a 50 million Challenge Fund to help improve access to general practice. The Challenge Fund is designed to test innovative ways of providing primary care services. Of the 254 expressions of interest received for the Challenge Fund, 20 pilot sites were selected across the country; covering 1,100 general practices and 7.5 million patients. This paper is the second in a series of innovation showcases designed to highlight the successes of the 20 pilots. This paper focuses on pilots which have been effective in developing innovative technology - enabled access and solutions. The pilots featured are Birmingham, Care UK (the national pilot), Morecambe and Hertfordshire. Key messages How have pilots managed to implement their innovations? Phased implementation Potential problems with new technology are often not clear at the start. Phasing delivery can help address issues before implementing at scale. Hub delivery model This allows resources to be pooled and shared. External IT partners Establishing a strong relationship with an IT provider means that solutions can be co-developed, tested and refined with expert input. Staff buy-in Change requires staff to adjust their ways of working; achieving staff buy-in develops joint ownership and ensures success. Identifying drivers for change Early identification of existing trends allows for technology solutions to fit around patient demographics and practice infrastructure. Key issues to consider: Clinical IT system Working across multiple IT systems can be time consuming and challenging. Pilots need to work through IT interoperability solutions as soon as possible. GP capacity Pilots recognise that technology innovations are capable of freeing up GP time. Unlocking this capacity does not happen immediately and this delay should be considered when designing the implementation timeframe. Access It is important to consider the needs of all of the patient population to ensure that equality of access is maintained. Evidence of success 10-15% reduction in A&E attendances from live practice patients Birmingham HUB (Data from between Nov-Dec 2013 & Nov-Dec 2014) I was very impressed with such a quick turnaround, this was the best experience [of general practice] I ve had yet Care UK patient As well as making it easier to make contact, to book appointments and get support from the surgery, these new systems offer new routes to rapid and excellent professional advice and reassurance. Birmingham patient 2

3 Health United Birmingham (HUB) Key elements of the offer The patient pathway: A single telephony system serves patients from the participating practices. Once a patient has dialled into the system, they can choose to be put through to their surgery and book an appointment in the usual way, or connect through to the vitality health hub. The health hub team arrange for a GP/Advanced Nurse Practitioner (ANP) from the registered practice to provide a telephone or Skype consultation. If a face-to-face appointment is needed the GP/ANP can arrange one on the same day at their surgery (during core hours) or the HUB Central (during extended hours). Patients can be treated by their GP if they call on the days their GP is working, otherwise another doctor/anp will call them back. The consultation is designed to address the patients need and remove the need for a face to face appointment where appropriate. An interoperable digital environment: Patients and staff can access support, including: A care planning, management and on-line journal. A platform for healthcare professionals to prescribe digital care packages via . An ios and Android smartphone app for longterm condition patients to manage their close network to help with informal care, support and self-management. An integrated patient feedback app. Evidence to date The following headline figures have been captured for the live practices from the pilot s internal systems covering the time period from implementation to date: A 72% reduction in Did Not Attend (DNA) statistics. Average consultation times have reduced by almost 25%. 66% of patients are dealt with remotely. Birmingham 7 practices Drivers behind change 60,000 patient population Just a quick note to congratulate you on the Vitality Partnership app. Personally I think this is a great app which has allowed me to connect very easily and quickly to my doctor. Birmingham patient As well as making it easier to make contact, to book appointments and get support from the surgery, these new systems offer new routes to rapid and excellent professional advice and reassurance. Birmingham patient 10-15% reduction in A+E attendances from live practice patients between Nov-Dec 2013 and Nov-Dec 2014 Despite being one of the most deprived regions in England, Birmingham is highly digitally connected. OFCOM data shows that a higher proportion of Birmingham citizens have access to a web enabled mobile pone than in any other UK city. 3

4 Care UK Superpractice (national) Key elements of the offer The patient pathway: When patients call their local practice they are automatically redirected to the central hub with the option of a telephone appointment with a GP or nurse based at the hub. This service is offered 24 hours a day, seven days a week. Clinicians at the hub have access to patient records so they can conduct GP triage, conduct a full telephone consultation and prescribe over the phone. Hub staff can also book the patient a face to face appointment at their local practice or out of hours provider. Challenge funding has also contributed to: The installation of WebGP at four practices so far; providing patients with a platform for selfhelp content, sign-posting options, symptom checkers, access to 111 clinicians and the ability to consult remotely with their registered GP. An enhanced appointment reminder interactive texting services; this facilitates texting to cancel appointments, source patient feedback and obtain health information from patients. This is currently live at seven practices. Drivers behind change As one of the main 111 providers, Care UK already retains large scale call centre infrastructure and central telephony hub expertise in various locations throughout the country. Care UK is utilising 111 telephony infrastructure to extend access beyond the model to 24/7 telephone treatment. Care UK also already offers text reminders to patients so has an existing relationship with their text service provider (Mjog). These provided a strong springboard from which to offer centralised clinical treatment and technology innovations to registered patients. I was very impressed with such a quick turnaround, this was the best experience [of general practice] I ve had yet Care UK patient Care UK national pilot Evidence to date 8 practices 45,000 patient population The success of the WebGP trial, initially launched at two practices, led to wider roll out of this innovation, with plans to be live at all eight by March Patient feedback: I have been very impressed with considerable improvement in waiting times over recent weeks. Usually I am waiting hours for a call back whereas this time it was just 45 seconds I think Superpractices are the future of general practice, and I am proud to be a part of it. This is how things are going to get done everywhere in the future Dr Nasir Hanann of the central hub I am using the interactive texting innovation for appointment reminders and campaign messages to offer appropriate services to patients eg, smoking cessation advice. I am also using it to get Friends and Family feedback... I am finding it an extremely useful tool Patient Liaison Manager at Care UK practice 4

5 Developing innovations elsewhere Improving access, supporting primary care integration and whole system change, Herefordshire Opening Doors, Morecombe What is the offer? Secure GP video consultations for care home residents. This innovation has been chosen to ensure patients receive the most appropriate level of care and to increase confidence of care home staff in referring to primary or secondary care. A unique health and social care App mainly aimed at younger people. How will technology be used to improve access? Three of the county s 24 practices have been identified as sites for the Taurus primary care access hubs and are integrating access to existing GP patient records across in-hours primary care and extended 8-8 and weekend services over 365 days. The pilot now offers pre-booked GP video consultations for patients at two residential care and nursing homes on Sundays. The pilot uses NHS One software to facilitate secure video consultations through use of a Tough Pad (a new rubberised tablet with infection control advantages), with GPs delivering the consultations based at the Hereford City hub. Also being trialled is an Ipad Tough Pac with docking station. The Taurus Health App has been built to a bespoke design by the pilot s IT lead. Taurus is keen to ensure that the app is available on all major platforms and will be free to download. The App will act as a health service directory, a central tool for access and opening time information for the pilot s three hubs and a booking enquiry form. It will be advertised on the Taurus website. This App is being developed with the intention of educating and supporting young people s appropriate access to primary care. What is the offer? The Florence tele-health tool is an SMSbased reminder system which is being used to provide alerts or reminders to patients; for example, reminding patients about their medication or to take a reading and submit the results back to their practice via a text message. The app enables protocols to be designed around each patient s clinical needs. This innovation has been chosen to support patients with long term illness to take greater ownership for the management of their condition. It is anticipated that this self-care tool will reduce unnecessary exacerbations of their condition and associated hospital attendances and admissions. It is also hoped to reduce demand on the nursing staff within the practices. How will technology be used to improve access? Within the wider Florence system, practice staff will be able to design individual protocols for patients (setting individual threshold for alerts for example) and will be able to review and analyse system information using trend charts. GPs have been asked to identify suitable patients for this app; it is currently being trialled with 20 patients from one practice, with plans for it to be rolled out to a larger sample of patients across all five pilot practices in the near future. In measuring impact, the pilot intends to undertake a six month audit of patients to examine the impact on exacerbations of a patients condition. To increase uptake the pilot is funding and issuing monitoring equipment to further support patients. 5

6 How have they done it? Common success factors Phased implementation All pilots included in this innovation showcase have taken a phased approach to implementation. Birmingham HUB commenced its technology model with two live practices and phasing in the third and fourth; Care UK went live with two practices before concentrating on IT interoperability solutions necessary for the model to be scalable and rolled out to remaining practices. Herefordshire s video link appointments have gone live with two care homes on the same site and the Florence care app in Morecambe is currently being trialled with 20 patients at the same practice before being rolled out elsewhere. There are a number of strategic reasons behind this: Implementing a technology service often requires solutions after going live; issues are often not clear before operation. By taking a phased approach these can be ironed out before implementation at scale. These lessons learnt can then be shared with other sites to increase efficiency in wider implementation. Often success from the first wave of implementation will encourage buy-in from remaining GPs and practices. External IT partners Close working with external IT partners in delivering new technology innovations was a common enabler of success. Care UK had an existing relationship with Mjog (software partner) which accelerated their service enhancement, whilst Birmingham HUB cited that working closely with a dedicated technology partner meant that solutions can be actively co-developed, tested and refined when problems arose. Staff buy-in Without the support of staff, the implementation of technology is not possible. Change requires staff to adjust their ways of working; achieving staff buy-in develops joint ownership and ensures success. Hub model Both Care UK and Birmingham HUB share elements of a centralised hub model. Birmingham HUB s approach uses a multichannel contact centre to feed all live practice patient communications through; whilst all Care UK patients registered at the live practices are directed to a central call centre with the option of booking a face to face appointment or a telephone consultation. In addition, Herefordshire s video link appointments are a virtual extension of their hub model for care home patients. In each case the use of such a model has allowed resources to be pooled and shared more widely. Identifying drivers for change The drivers behind each of these technology innovations differ. The models and innovations used are a result of early identification of existing trends and corresponding technology solutions. In the case of Care UK, the existing telephony infrastructure and call centre expertise was identified as a springboard for alleviating GP pressures. In the case of Birmingham HUB, identification of a high digital activation rate at scoping stage provided the basis for a technology-driven pilot model. In the case of both Herefordshire and Morecambe, the presence of chronic patients whose worsening conditions could be avoided through the implementation of technology-related innovations signalled that there would be demand for such a service. 6

7 Common themes to consider Clinical IT system capacity issues Care UK is currently working closely with both EMIS web and SystmOne clinical IT systems to find a solution which will enable IT interoperability for clinicians based at the central hub wishing to access patient records at multiple practices. Whilst Birmingham HUB s practices are all EMIS based system, this has still required close working with EMIS. Working across multiple IT systems can be time consuming and challenging. Pilots need to work through IT interoperability solutions as soon as possible. Technology access If pilots are moving towards a model of using technology to enable access for patients, it is important to consider the needs of all of the patient population to ensure that equality of access is maintained. Unlocking GP capacity A common theme amongst these pilots is utilising the efficiencies afforded by their technology innovations to free up GP time to meet the diverse health needs of their patient population. Unlocking this extra capacity, however, does take some time, which should be considered when designing the implementation timeframe for such a pilot. 7

8 The National Evaluation In summer 2014, NHS England commissioned Mott MacDonald, an independent organisation, to undertake an evaluation of the programme. The evaluation team is working alongside the pilots as they deliver their projects, working with them to learn and share delivery lessons. The evaluation involves a multi-methods approach including: Interviews with pilot leaders and those involved in implementation during the programme. Interviews with pilot partners and stakeholders involved in delivery. Engagement with a selection of practices and patients. Assessment of the impacts and outcomes measured against a basket of nine national metrics. Identifying, examining and sharing good practice. About PMCF There are three primary objectives of the challenge Fund programme and also some supplementary objectives that the programme is looking to achieve: Primary objectives: To provide additional hours of GP appointment time. To reduce demand elsewhere in the system (e.g. A&E, NHS 111 and existing out-of-hours services. To improve patient satisfaction with access. Supplementary objectives: To improve staff satisfaction with access. To tackle health inequalities in the local health economy. To facilitate learning to better enable pilots to implement change. To stimulate a culture change amongst staff involved in general practice with regard to future delivery of primary care. To deliver value for money and a return on investment. To establish sustainable models which go beyond the PMCF pilot lifetime. To identify models that can be replicated in similar health economies elsewhere. Coming up next... The next innovation showcases will look at: Engaging with patients to help ensure pilot activity is aligned to their needs. Liaising with practices to maximise buy-in, co-design and ownership. 8