Supporting vulnerable people to defer treatment during the pandemic


“Extremely worthwhile. Very useful and very important piece of work for patient benefit. Accurate data recording and overall maximum benefit to patient in establishing correct diagnosis and treatment.”

– Clinician


Challenge / Problem Identified

During the pandemic there was a lack of capacity within the NHS to be able to provide normal referral and treatment pathways for secondary care appointments, such as outpatient consultations and minor surgeries.

It was quickly identified that a process was needed to help clinicians delay secondary care appointments for patients who had COVID-19 symptoms until they recovered. As well as give vulnerable and shielding patients the option to be able to delay appointments until the risk of coronavirus infection had improved.

Delaying treatment for patients who could be safely deferred until capacity in hospitals stabilised was also needed to ensure that those who were seriously ill could still receive vital treatment.

The Northern Cancer Alliance requested support for a ‘delayed/deferred treatment process’ via the Clinical Digital Resource Collaborative (CDRC), which the Academic Health Science Network for the North East and North Cumbria (AHSN NENC) is part of.

Regional primary care clinicians also approached CDRC to develop a number of resources to support patients with suspected COVID-19 and those at risk of complications and to support clinicians with recording cases and test requests correctly and where to refer patients for up-to-date information.

Actions Taken

CDRC is a collaboration between AHSN NENC, the North of England Commissioning Support unit (NECS), GP Federations and Clinical Commissioning Groups (CCGs), with each partner taking a different role.

The CDRC supported primary care through the COVID-19 response by becoming a central regional and national hub for development of digital resources that can be used in clinical systems EMIS and SystmOne.

The CDRC has supported the requests from primary care during the pandemic by development of powerful clinical searches, created templates, alerts and patient status icons that identify patients at risk and manage these appropriately. This allowed clinicians to streamline processes, improve communication, improve case finding whilst ensuring conditions are appropriately medicated to improving patient outcomes.

The role of the AHSN NENC in CDRC includes;

  • Providing day-to-day project management, including regional and national implementation capacity
  • Senior Leadership to guide strategic decisions
  • Providing expert clinical guidance in SystmOne & EMIS
  • Project support to manage day-to-day communications and coordination
  • Providing marketing / engagement lead to ensure resources are readily available at national level through the CDRC website

Impacts / Outcomes

The national roll out of the COVID-19 ‘cancer delayed/deferral resources’ through Northern Cancer Alliance networks.

The national roll out of COVID-19 resources including;

  • Assessment and management of patients with suspected COVID-19
  • Identification of patients at high risk of COVID-19 complications
  • How to record COVID-19 correctly in the clinical systems
  • Where to refer patients for up-to-date information
  • Recording mechanism of COVID-19 tests requested
  • How to manage patients with end of life / palliative care
  • Development of a cremation form and a notification of infectious disease.
  • The delayed treatment module in DCS provides a structured way to capture any intervention that is delayed.

Lessons Learned

CDRC is able to respond to requests for urgent development of clinical digital resources that meet the needs of stakeholders.

CDRC provides a system that supported primary care during the peak of the COVID-19 pandemic and continues to provide on-going and evolving support in the reset phase.

Future Plans / Next Steps

AHSN NENC continue to support any COVID-19 regional and national activity through developments of regional and national resources in EMIS and SystmOne.

The AHSN continues to support the roll out of resources developed in clinical systems, and marketing and engagement with national and regional stakeholders to inform and update new resources and developments.