Overcoming inertia in the NHS to applying technology enabled healthcare services in practice

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Overview summary:
The Long Term Conditions (LTC) Network has delivered a stream of programmes to encourage uptake of remote delivery of care for LTCs and adverse lifestyle habits. These include options for delivery of care such as Flo simple telehealth, video consultation, Closed Facebook Groups, apps and aid to diagnosis.
Challenge identified and actions taken :
Lack of clinicians’ awareness of viable options for TEC; competence and confidence in their usage:
  • good practical examples described and signposted in LTC Network bulletin to clinicians
  • publications in national journals
  • support for development & launch of national training module
Lack of patients’ awareness of viable options for TEC;competence and confidence in their usage
  • good practical examples described for patients
  • pilot upskilling course for patients
  • support set up and usage of health professional supervised Closed Facebook Groups by three specialties in acute healthcare settings (and a few local Patient Participation Groups (PPGs) in practices
  • support medical students Year 5 to encourage patients to sign up to Patient Online to access their own records
  • write article for citizen readership in the North Staffordshire Sentinel newspaper
Confusion about universal approach to shared management of care of LTCs between providers of care and different modes of remote delivery of care:
  • Create LTC shared management website, with clinician and patient sections;
Lack of leadership across health economies in relation to synchrony/sharing of remoted modes of delivery of care
  • create example interaction across Staffordshire in relation to videoconsultation for clinical consultations
  • shared learning of usage of TECs
Impacts / outcomes:
Facebook:
UHNM closed Facebook groups – a total of 354 members, MS (168), AF (91) and cardiac rehab (95)
Public pages – AF – 895 reach per month/498 post engagements per month; Cardiac rehab – 2099 reach per month/791 post engagements per month

Twitter: Over 97,000 accounts reached from tweets

Manage your Health App: 330 users

Flo Simple Telehealth: 652 protocols registered across the West Midlands region

Telehealth E-learning course: Since December 2016 when the RCGP CPD course went live there has been 236 registrations with 42 people having completed the course. Users have rated the course 4.3 out of 5 stars.

Publications:
‘Digital Healthcare: The essential guide’, (Authors: Chambers R, Schmid M, Birch-Jones J), 2016
http://www.otmoorpublishing.com/publications/digitalhealthcare
‘Clinicians rise to the social media challenge’ – Primary Care Commissioning CIC
https://www.pcc-cic.org.uk/sites/default/files/comm_excellence_june_2016_aw_web.pdf
‘How video consultations can benefit patients’ – GP Online
http://www.gponline.com/video-consultations-benefit-patients-nhs/article/1401346
‘How to set up a Skype consultation service’ – Medeconomics
http://www.medeconomics.co.uk/article/1401405/set-skype-consultation-service
‘GPs launch Skype to care homes project in Staffordshire’ – Fabsnhsstuff
http://fabnhsstuff.net/2016/06/26/gps-launch-skype-care-home-project-staffordshire/
‘How should we respond to negative comments on social media’ (Authors: Ruth Chambers, Marc Schmid):
http://www.pulsetoday.co.uk/your-practice/dilemmas/how-should-we-respond-to-negative-comments-on-social-media/20032472.article
‘How a Skype trolley saves GP time’ (Authors: Ruth Chambers, Marc Schmid)
http://www.pulsetoday.co.uk/your-practice/focus-on/how-a-skype-trolley-saves-gp-time/20032834.article
Evaluation report, Autographer plus Flo (Authors: Sue Molesworth, Lisa Sharrock)
http://www.simple.uk.net/home/casestudies/casestudiescontent/mental-health-memory-support-for-mild-cognitive-impairment-or-mild-to-moderate-dementia
Stoke and North Staffordshire leading the way in hi-tech help for patients:
http://www.leek-news.co.uk/8203-stoke-and-north-staffordshire-leading-the-way-in-hi-tech-help- for-patients/story-29733613-detail/story.html
‘Revamp your website to reduce demand’ (Authors: Ruth Chambers, Marc Schmid)
http://pulse-learning.co.uk/practice-business-finance-modules/practice-business-finance/revamp-website-reduce-demand
‘Helping the elderly take tablets’ (Authors: John Marszal, Aoife Donnelly, Ruth Chambers)
http://www.health21.org.uk/2016/11/01/old-people-will-use-tech-if-clinicians-let-them/
‘Promoting best practice in COPD management’ (Authors: Rosie Piggott, Elaine Cook, Faye Foster, Alwyn Ralphs, Lucy Teece, Roger Beech)
https://www.bjpcn.com/browse/editorial/item/1943-promoting-best-practice-in-copd-management.html
Video: ‘COPD patient avoids A&E and acute admissions through self-management with Flo’ (Author: Ann Hughes)
https://sites.google.com/a/simple.uk.net/community/home/casestudies/casestudiescontent/copd-patient-avoids-a-e-and-acute-admissions-through-self-management-with-flo
The Health Foundation - The Power of People
Video: Introducing Flo: Telehealth with a human touch
http://healthfdn.org.uk/4Y2-4MPPC-35ITUGKE86/cr.aspx
E-Learning: Telehealth, telemedicine and telecare: an introduction to “TECS” (Technology Enabled Care Services)
http://elearning.rcgp.org.uk/mod/page/view.php?id=4117#register
BMJ – Link to back pain article (STarT Back Tool)
http://www.bmj.com/content/356/bmj.i6748
Year 5 Medical Students x 4 Patient Online Initiative – North Staffordshire & Stoke-on-Trent CCG newsletter publication –
www.stokeccg.nhs.uk/news/staffordshire-students-help-patients-to-log-on-to-gp-services-online-4028/<http://nhs.us6.list-manage.com/track/click?u=ef12432f7b285a04d0bfe1494&id=21f44def52&e=33cdefcc95>
Video: https://vimeo.com/206196885/4a38152bac
WMAHSN LTC Network Newsletter – Publication commenced in January 2017 to 500+, the database has now increased to c.750.
Staffordshire Sentinel – weekly ‘Ask the Doctor’ health articles:
http://www.stokesentinel.co.uk/search/search.html?searchType=&searchPhrase=Ruth+Chambers&where=
‘GP praises Endoscope-i’: https://vimeo.com/191810628?ref=em-share

Conferences:
Person Centred Care Conference held in Birmingham on 6th May 2016 – 60 delegates

‘Making Change Happen with Simple Telehealth and Florence’ held in Stoke-on-Trent on 25th January 2017 – sharing success and best practice with breakout sessions for Acute, Community and Primary Care – 82 delegates
Supporting quote for the innovation from key stakeholders:
Marc Schmid – Digital Expert, Redmoor Communications:
“The programme has brought patient networks together around MS, cardiac rehab and AF and stroke, providing peer to peer support and regular information from clinicians. The introduction of video consultations has enhanced the care available as well as improving the efficiency of service delivery”.

Luke Bracegirdle – Head of Digital & Business Analytics, Keele University School of Pharmacy:
“West Midlands Academic Science Network part funded a development project to extend work on the Manage Your Health app, to include additional content on long term conditions. Prof Ruth Chambers (Clinical lead Long Term Conditions Network, WMAHSN) has been very supportive and used the network to connect our development team with partners with complementary skills as well as link to further initiatives in the region to promote patient information resources in the area of Atrial Fibrillation”.

Phil O’Connell – Chairman & Chief Innovation Officer, simple.uk.net:
"The WMASHN Long Term Conditions (LTC) Network has provided invaluable support for clinical teams, helping to raise awareness of practical and pragmatic remote delivery of care options. The LTC Network has worked with us, encouraging evidence based uptake through clinical peer to peer sharing of case studies and evaluation across traditional organisational boundaries of the techniques and methods used by our members to address LTCs and adverse lifestyle habits.
International dissemination of the learning, evaluation and case studies developed through the 'Simple Telehealth' programme of work including Florence in the UK, has been greatly assisted by the practical clinical applications and evaluation made possible by the WMAHSN. The techniques and methods evaluated have achieved replicable positive clinical and productivity outcomes that are now being studied for implementation in Ireland, USA and Australia."

Jodie Williams – Stroke Prevention Clinical Nurse Specialist, University Hospitals of North Midlands NHS Trust:
“The AHSN has widely supported the AF Stroke Prevention Team over the last 2 years.
It has supported the provision for expert advisory for Atrial Fibrillation, its education and management throughout both Primary and Secondary Care. It has supported the promotion of an online GP Masterclass for Atrial Fibrillation to GPs in Primary Care to continue education and evidence based management for AF patients reducing the risk of AF related stroke. The AHSN has supported the AF stroke prevention team in becoming champions within both Primary and Secondary Care enhancing self care management, reducing major disabling strokes with a positive impact to the Local Health Economy”.
Which local or national clinical or policy priorities does this innovation address:
GP Forward View (New models of care/patient empowerment) Underpin delivery - clinical management of key LTCs: Asthma, COPD, diabetes, hypertension, AF
Plans for the future:
  • Continue with pan-Staffordshire rollout of video-consultation option for clinician/patient follow up interaction in all healthcare settings; extend to social care settings as appropriate; share learning and urge adoption across the region
  • Promote the impact/how to overcome inertia to remote options for delivery of care at all levels of NHS across West Midlands and beyond via events, conferences (e.g. focus on CVD and diabetes 10.5.17; quality improvement 13.6.17), publications, LTC Network bulletin, Twitter, etc.
  • Evaluation of Trust-wide rollout of Flo Simple telehealth Sandwell & West Birmingham Trust; county-wide rollout of videoconsultation; use of Facebook in general practices
  • Develop online learning resources and simple course for citizens to use to enhance their confidence and competence in personal use of TEC for their own LTC(s)
  • Promote or develop online learning resources for clinicians to enhance their competence & confidence in adoption of TEC
Tips for adoption:
  1. Inertia is common in the NHS in relation to any new way of working – persist in engaging all those who are vital in making change happen.
  2. Don’t keep what you’ve learnt about the adoption of an innovation to yourself - evaluate, promote, disseminate it.
Contact for further information:
Ruth Chambers - LTC Network Clinical Lead
Ruth.Chambers@stoke.nhs.uk

Sue Wood - LTC Network Project Manager
Sue.wood@wmahsn.org

Marc Schmid - Digital Expert, Redmoor Communications Social Media
Marcgs72@gmail.com

Luke Bracegirdle - Head of Digital & Business Analytics, Keele University School of Pharmacy - Manage Your Health app
l.bracegirdle@keele.ac.uk

Chris Chambers - Telehealthcare Facilitator, Stoke-on-Trent and North Staffordshire CCGs - Flo telehealth
chris.chambers@stoke.nhs.uk
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