Virtual consultations and clinics

There were a number of London Trusts working on virtual consultations in the Collaborative, including Oxleas NHS Foundation Trust, St. George’s University Hospitals NHS Foundation Trust and Kingston Hospital NHS Foundation Trust.

Improving patient choice and making sure patients received the right care, at the right time, was at the heart of these changes. In some cases, such as in gastroenterology at St George’s, virtual consultations were able to improve the value of subsequent face-to-face interactions by pre-investigating conditions. This also means that serious cases can be escalated even more quickly than they would usually be, as the virtual consultation was able to be delivered faster and enable rapid upgrade to cancer pathways as a result.

Leadership Matters, and some Trusts found that asking the Executive Team to lead by example helped to set the right tone and culture for change. The Oxleas Executive Team, for example, committed to a minimum of one video call per week for supervision/internal meetings to encourage trust-wide adoption of the technology.

Video calling at Oxleas enabled a 75 year old wheelchair user to complete her course of cognitive behavioural therapy without having to travel or park.
This just shows that we can’t always assume age is a barrier to using technology!

“We have gained useful insights in to the benefits and challenges of implementing virtual consultations via the Digital Outpatients Collaborative experience. We have also gained some momentum in Kingston for delivering virtual consultations in two specialities. We will share this, and the learning, through our own implementation with outpatients teams across the Trust.”

Kingston Quality Improvement Team

“St. George’s Hospital has set itself an ambition to deliver 20% of new outpatients attendances and 50% of follow-up outpatient attendances differently by 2020. This includes implementation of integrated community models, intermediate services, advice and guidance, demand management pathways and delivery of virtual consultations. The Collaborative was an opportunity for SGH to meet other Trusts and share best practice virtual working models and provided a forum for challenge with peers around virtual models in the design and test phase.”

St George’s Outpatient Transformation Team 

 

 

 

 

Oxleas NHS Foundation Trust

“Video consultations in an IAPT (Improving Access to Psychology Therapies) service.”

Background and aims

The team from Oxleas joined the Collaborative to progress their project to increase uptake of virtual consultations in “Greenwich Time to Talk”, an Improving Access to Psychology Therapies (IAPT) service.  Oxleas is has a clear digital vision and has already implemented a number of new initiatives: an EPR (Electronic Patient Records) system is in place, mobile working on iPads which provide access to the EPR while clinicians are off-site, and digital dictation being used which involves speech recognition and an electronic document transfer system. In line with this digital vision, the Trust team wanted to implement virtual meetings, with an intention to:

  • Reduce do not attends (DNA) by 5%;
  • Reduce staff travel expense claims by 5% over the next twelve months;
  • Improve/expand patient choice for how they attend appointments;
  • Hold drop-in sessions across the Trust for staff to learn about how to use the technology.

Key points on approach

  • Identified patient groups for which there was a higher need for a virtual platform;
  • Researched, tested and evaluated different software types before deciding on a suitable software solution;
  • Video calling drop-in sessions took place across the Trust for staff to learn how to the use the technology;
  • Engaged the executive team, who committedto a minimum of one video call per week for supervision/internal meetings to encourage Trust-wide adoption of the technology;
  • Worked with reception and administrative staff to map out the patient onboarding process. The process mapping session, which was facilitated by DigitalHealth.London, led to a number of changes such as ensuring patients were asked on referral if they were interested in video call appointments and this information being flagged in their EPR.
Number of Appointments:
Number of video calling appointments completed

Achievements and learnings during the Collaborative

  • CBT therapists received positive feedback from patients who had undertaken virtual appointments; especially those with mobility issues who found it difficult to travel to clinic;
  • The pilot increased staff confidence in using technology; interestingly patients didn’t report concerns about the technical side of things, but there was initial reluctance among some staff;
  • Therapists were able to apply a tailored approach with a mixture of face-to-face and virtual appointments for patients, to meet the needs of patients and offer greater choice.

“The Collaborative was extremely useful. The Health Innovation Network were very helpful and gave us some valuable help and advice for our project.”

Melony James, Project Manager, Clinical Transformation,
Oxleas NHS Foundation Trust

Virtual consultations at Oxleas save health visitors an hour per visit

In addition to the work on IAPT through the Collaborative, the team also worked on changes to its health visiting service. Healthvisitors from Greenwich Central began a pilot to see ante-natal patients for follow-up via a virtual meeting. To improve the uptake of the antenatal contact (from a baseline of 81% towards a KPI of 95%) the Health Visiting team hoped to offer a different style of contact, recognising that women have busy lives and are often still working later into their pregnancies. Telephone and video calling received positive client feedback. Virtual meetings were also found to save the health visitor approximately one hour per visit.  It is hoped that these more flexible contacts will mean that the health visiting services are able to reach a greater number of women in the antenatal period offering support and health advice to help them to make informed health choices for themselves and their new baby.

St. George’s University Hospitals NHS Foundation Trust 

“Right place, right time, right information and right clinician.”

View St. George’s final showcase presentation here 

Background and aims

The Gastroenterology Clinical Assessment Service (CAS) sought to work collaboratively with GP and commissioning partners to develop a more efficient and cost-effective gastroenterology service for patients using a prototyping methodology. The team wanted to modernise the way they deliver outpatient services through more virtual working, supported by better use of technology. They were also aiming to improve the value of outpatient appointments by pre-investigating patients ahead of their first attendance (saving time for patients and clinicians). Other aims included reducing referral to treatment time and increasing the number of virtual pathways. 

The CAS project team consisted of consultant gastroenterologists, GPs, Operational Service Managers, Transformation Team Project Managers, Pathway Coordinators, IT Project Managers and Commissioners.

St. George’s Approach to Implementing New Models of Care

Key points on approach

  • Gained a lot from learning of other Trusts, who shared other virtual clinic models;
  • Used the challenges posed by peers at the Collaborative to inform the redesign of our Gastroenterology Clinical Assessment Service prototyping;
  • Found the PDSA cycle template, Life QI and Slack helpful for bringing better structure to prototyping.
  • Focused on achieving excellent clinical buy-in, so models were clinically led and a true example of change from grassroots upwards;
  • Encouraged greater collaborative working across teams/divisions which usually work in silo achieved through a clear vision and shared purpose for change;
  • Ensured the team had space to learning from mistakes and adapt as the project developed.

Achievements and learnings during the Collaborative

  • St. George’s introduced a new Clinical Assessment Service consisting of a consultant-led enhanced triage service to achieve faster diagnosis, shorter pathways and access to relevant clinicians. Results also found shorter patient pathways due to fewer attendances through removal of non-value appointments. Suitable patients are now being managed on a virtual pathway with comprehensive diagnosis and management plans to GP and patient. The project has also started to breakdown some of the traditional boundaries and ways of working between the Trust, commissioners and GP partners.While all of the above benefits are very welcome, the most important success during this period was that the new process enabled suspected cancer patients to be identified earlier with rapid upgrade to the cancer pathway.Following the collaboratives, the St. George’s project team are now working on a virtual fracture clinic service.Browse project posters from Trusts who took part