Scaling a self-management solution across South West London

Ben Wanless, Consultant Physiotherapist, St George’s University Hospitals NHS Trust and Digital Pioneer Fellow.

Overview of project:

• To scale the getUBetter web and smartphone self-management solution across South-West London to enable effective self-management of musculoskeletal (MSK) conditions.
• getUBetter delivers personalised recovery and prevention self-management support for common MSK conditions and injuries – the mobile platform and web-app provides true self-management that helps patients to trust their recovery and therefore they utilise less healthcare resource.
• It can be made available to the whole population and be provided wherever a patient interacts with the system – such as self-referral, primary care, out-of-ours services (OOH), emergency department, physio or from work.
• Each element of a CCG’s MSK pathways are configured and integrated locally and then made available to the population. getUBetter is a whole pathway approach that does not redirect patients to use resource elsewhere unless absolutely needed.
• By supporting patients using evidence-based tools, it promotes safe self-management but can also automate referrals for treatment appropriately.

The app is a great alternative to face-to-face time with my GP to manage my condition (…) the app has improved my understanding of my recovery (…) it helps me develop relevant skills to self-manage my injury.

– Patient

Impact of project:

• Increase clinician and user engagement. All 38 GP practices consistently prescribing the app in Wandsworth. Patient activation rates have improved from 35% to 43%.
• Develop a robust way of collecting and analysing data to prove effectiveness. They have successfully triangulated Primary Care Network (PCN) patient data, getUBetter user data and acute trust (St George’s Hospital) data to be able to assess whole system impact.
• Use lessons from Wandsworth to scale getUBetter to other SWL boroughs and beyond.

Statistics:

• Estimated number of patients to have benefited: Approximately 100,000 patients.
• Estimated number of NHS/social care staff to have benefited: Over 200 staff (primary and secondary care clinicians).

Very helpful app, patients were initially a little sceptical but like the fact it links so retains their connection with a clinician in the pathway (…) Knowing that the app is medically registered provides me the assurance I need to enable patients to self-refer from our website.

– Clinician

Key learnings from the project delivery to date:

• Clinician and patient behaviour change is challenging. Understanding this is critical to successfully implementing digital health technology as it ensures you don’t assume anything. Speak to both groups to try and understand how to maximise adoption.
• Culturally we still have a long way to go to shift the locus of control from clinicians to patients. Digital health tech trusted and prescribed by a clinician still reigns supreme, but with these clinicians on board, getting patients to self-manage is much easier.
• Data gathering and triangulation is an incredibly important but onerous task. Models to make this easier need to be developed and shared.