Finding an alternative to face-to-face appointments

 

“The AHSN team were key to facilitating collaboration that allowed us to become a part of influential brainstorming sessions and informative conversations with a range of people across the London. As a result, I had the opportunity to think bigger, to influence across a system and create better things to help our patients access the best care .”

– Claire Kennedy, Project Manager, Service Transformation, Royal Free London NHS Foundation Trust

 

Challenge / Problem Identified

COVID-19 meant NHS Trusts had to find an alternative to face-to-face consultations for many patients, in order to both protect vulnerable patient groups and safeguard staff. NHS Trusts responded by rapidly accelerating the availability of virtual consultations.

The three London AHSNs (UCLPartners, Health Innovation Network and Imperial College Health Partners) have been working with NHS England and NHS Improvement, alongside secondary care Trusts to support the roll out, optimisation and long-term use of Attend Anywhere – a secure web-based video consultation solution. A national licence for this platform was procured by NHS England and NHS Improvement for 12 months, to accelerate uptake of video consultations in all secondary care settings, allowing NHS staff to deliver clinics and services virtually.

Although, prior to COVID-19, there were some trailblazer sites where implementation was being observed and evaluated, there had not been plans or the infrastructure normally required for system wide implementation at pace. This meant that some Trusts found themselves experiencing similar obstacles and challenges, but there was no ‘system learning’ and ‘solution sharing’ mechanism in place.

Actions Taken

Using a collaborative, pan-London approach, the London AHSNs actively supported secondary care Trusts by:

  • Sharing existing documentation and best practice directly with Trusts. This was done by;
  • Creating video and audio footage of clinicians sharing their experience of delivering virtual consultations during the pandemic
  • Bringing together clinical guides and useful resources, in one place as an impartial, easy-reference resource library

Sharing various resources with Trusts directly through NHS Futures, including Standard Operating Procedures, training packages, equality impact assessments, patient-facing material and Trust individual rollout materials.

  • Producing both a patient and clinician survey template and working with a small number of London Trusts to implement and tailor surveys to meet local needs and gather a first-look evidence base of video consultation usage across London.

Successfully hosting two webinars – “Building video consultations into the workflow” and “Equity of Access”, with over 70 and 100 attendees, respectively.

Impacts / Outcomes

As a result of the work we engaged with 29 Trusts across London, providing opportunities for colleagues to hear from others and share tips of what works in practice. This allowed us to build a community of colleagues working on similar challenges/solutions around the implementation of virtual consultations.

For common issues that weren’t resolved, the AHSNs provided a strong platform for these issues to be highlighted and escalated. AHSNs also facilitated conversations about creating a collaboration for sharing best practice and tools.

Working with five Trusts, AHSNs implemented a pilot patient and clinician feedback survey to build a first-look evidence base for video consultations across London.

Lessons Learned

When responding to a national emergency, it isn’t always possible to have a concise and concrete brief and offer, so adaptability around emerging needs and developing Trust priorities is vital. One of the best ways to define needs in this scenario was through conversation with clinicians who recognised the adaptations required and were able to prioritise these for us so that the patient remained central in the project.

We may not have all the answers, but we are able to bring people together to create a large scale, joined up acknowledgement of gaps in knowledge.

Ultimately, people want to share what they have learnt for the benefit of others and are equally happy to learn from the achievements of peers. However, this needs to be coordinated in a sensitive and non-critical manner to mitigate alienation of stakeholders. When everyone is learning, all experiences are valid and should result in shared learning.

Future Plans / Next Steps

We plan to continue to engage with Trusts and provide tailored support where appropriate, such as;

  • Share resources, case studies and best practice guidance
  • Maintain the UCLPartners non face-to-face clinic webpage and resource library
  • Continue to share clinician experiences of virtual consultations
  • Continue to connect Trusts so that they can learn from each other’s experience and share resources where appropriate.