Prime Minister’s Challenge Fund (PMCF):
Improving Access to General Practice
Innovation Showcase Series
Using Technology to Improve Access
February 2015: Showcase Two
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
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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:
Birmingham
7 practices
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
■■ A care
planning, management and on-line
journal.
■■ A platform for healthcare professionals to
prescribe ‘digital care packages’ via email.
■■ 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.
“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
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:
10-15% reduction in A+E
attendances from live practice
patients between Nov-Dec 2013 and
Nov-Dec 2014
■■ A 72%
reduction in Did Not Attend (DNA)
statistics.
■■ Average consultation times have reduced by
almost 25%.
■■ 66% of patients are dealt with remotely.
Drivers behind change
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.
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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
08.00-20.00 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
8 practices
45,000 patient
population
Evidence to date
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 2015.
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
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Developing innovations elsewhere
Improving access, supporting primary
care integration and whole system
change, Herefordshire
Opening Doors, Morecombe
What is the offer?
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.
■■ 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.
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How have they done it? Common success factors
Phased implementation
External IT partners
All pilots included in this innovation showcase
have taken a phased approach to
implementation.
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.
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.
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.
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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.
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About PMCF
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.
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.
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