The Royal College of General Practitioners has produced guidance which outlines considerations for GPs and GP practices considering using or implementing online consultation services. It also includes advice for commissioning bodies such as Clinical Commissioning Groups in England that might be considering a system for their local population – one question being whether the system is likely to address current demand or generate new demand, and if the latter, what resources are available to meet it.
This report comes as a growing number of services offering consultations online, most commonly via a smartphone apps, are hitting the market. Whilst many of these are private, some have developed partnerships with GP practices in order to deliver NHS care.
“The College recognises that online consultations can be beneficial for patients, and indeed many practices across the country are already implementing in some form. However, we want to ensure that they are being implemented in a way that is safe for patients, and alleviates pressures in general practice and across the NHS. We also think that online consultations should be provided in addition to traditional services, not instead of them.
Professor Martin Marshall, Vice Chair of the RCGP and author of the guidance, said “We hope this guidance will help everyone – patients, GPs, practice team members and commissioners – gain a better insight into online consultations, and, most importantly, help equip them with the information they need, so that patients are receiving high-quality, safe care, whichever way they choose to receive it (Royal College of General Practitioners).
The King’s Fund spotlights the work of Liverpool Commissioning Group, responsible for NHS services across the city which is implementing a shared patient record amongst other technology developments; and Essex University Partnership Trust, a community and mental health provider covering one of the largest geographic areas of any single trust. While the Commissioning Group is using technology with the aim of improving residents’ health; Essex University Partnership Trust has been using digital technology to change its service delivery to patients. Each of these areas are using electronic records and enabling staff to access their office facilities through mobile working.
The blog post outlines the difficulties in managing digital change as well as discussing the benefits of implementing digital technology, such as improved patient safety as a result of better information. They conclude there are three key drivers of success in such digital projects
the quality and level of clinical engagement and involvement in project and system design
the belief in your work and involvement at board level
resourcing your support and training correctly.
Neither of the interviewees in the case studies neither found digital change easy, but they outlined that to facilitate these changes there was a need for peer-to-peer communication, clinical leadership and ensuring those at the front line are involved in designing their service.
NHS Digital has begun roll out of NHS WiFi to GP surgeries in England and it should be completed by the end of the year.
Using NHS WiFi, patients will be able to access the internet free of charge in their GP’s waiting room, via their smart phone or tablet. It will enable patients to link in with local health clinics and services and is paving the way for future developments in digital patient care.
NHS WiFi will provide a secure, stable, and reliable WiFi capability, consistent across all NHS settings. It will allow patients and the public to download health apps, browse the internet and access health and care information.
Local Clinical Commissioning Groups (CCGs) are responsible for choosing a supplier that can provide an NHS WiFi compliant system which suits their needs, and working with them to implement it across their local NHS sites. The chosen system must be based on a set of policies and guidance defined by NHS Digital.
What CCGs need to do to implement NHS WiFi in GP practices:
assign a named project manager to oversee the process and act as the primary point of contact for their CCG with the NHS Digital WiFi project team
design a solution that meets NHS WiFi standards and requirements and fulfils local needs
choose a supplier to provide the solution and buy it from them (procure it)
tell GP practices and other local stakeholders what is going to happen and when
implement the chosen NHS WiFi compliant solution in GP practices locally, following local ICT policy
report progress to NHS Digital at defined stages of the process
Guidance is available via NHS Digital relating to implementing NHS WiFi in GP practices.
Objectives: Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care.
Conclusions: Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation.
Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service explains how mobile solutions are transforming the work of community-based health teams | NHE
As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government.
The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service.
As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted:
A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
Sufficient battery life to get through an entire working day
A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input
The document will guide providers through the available data, and support them to make the necessary changes on their e-RS systems | NHS Digital
The NHS e-Referral Service (e-RS) combines electronic booking with a choice of place, date and time for first outpatient appointments. Patients can arrange their hospital appointment with their GP during consultation, or independently either online or by telephone.
The purpose of this guidance is to:
Provide summary information to support provider organisations in submitting their plans in Quarter 1 and making the necessary changes on the NHS e-Referral Service to deliver the Quarter 2 to Quarter 4 CQUIN requirements, appending or signposting to appropriate detailed guidance.
Support providers and commissioners in understanding the data available within e-RS to help with the monitoring of delivery.