Making video consultations in primary care accessible and safe

Challenge / Problem Identified

The COVID-19 pandemic forced healthcare services to rapidly change delivery models, reducing face-to-face contact in favour of online consultations wherever possible so those working in health and care could continue to support their populations safely.

Whilst there were pockets of best practice, online consultations were not utilised consistently across primary care services and there were concerns that there may be insufficient hardware, digital tools and cyber security arrangements to enable online consultations to be used safely and effectively. These challenges needed to be addressed whilst supporting a stretched workforce and upholding the highest governance standards.

Delivering the necessary reconfiguration at scale and pace required coordination and support between partners, providers and commissioners across the region.

Eastern AHSN worked with partners as part of the COVID Digital Cell for the East of England to support delivery of this transformation. The cell comprised a number of workstreams, with Eastern AHSN supporting two in particular: new capabilities and cyber security. The new capabilities workstream’s objective was to work at pace to roll out existing procured solutions for remote triage and video consultation. And the key objective of the cyber security workstream was to identify and minimise local cyber threats.

Actions Taken

Cyber security workstream

Eastern AHSN led the cyber security workstream, developing a working group across STPs, trusts and CSUs to identify and minimise local cyber threats. The group worked closely with the National Cyber Security Centre and Cyber Security Information Sharing Partnership (CiSP) to ensure the local work was delivered to the best possible standards.

The group implemented infrastructural improvements to support the technology and connectivity required to deliver online consultations. This included commissioning and distributing £3 million of hardware across primary care providers in the region funded by the NHS.

New capabilities workstream

Eastern AHSN staff were redeployed alongside others from NHS Digital, NHS England as well as staff from the AstraZeneca fieldforce working pro bono as part of a blended team to support uptake of existing procured remote and video consultation tools in primary care.

Eastern AHSN also developed a dashboard to track implementation and uptake of the various online consultation and video consultation solutions across the region at STP, CCG and practice level.

The COVID Digital Cell was comprised of operational leads from across the region. The Cell acted as a conduit for both regional and national NHS Digital, NHSX and NHS England and Improvement contacts to share national learnings for local implementation.

Impacts / Outcomes

The COVID Digital Cell has accelerated the digital maturity of healthcare services in the East of England through a unified and collaborative approach, ensuring lessons were applied across the region and best practice was shared and celebrated. Digital transformation was already recognised as a key enabler to supporting more effective healthcare services, but its acceleration during the pandemic represents a step-change in how services can be delivered in future.

Due to the collective efforts of the COVID Digital Cell, there is now 100% coverage for virtual consultation capability in the East of England. 1,799 laptops distributed into primary care and a further 2,699 were distributed to secondary care providers across the East of England, to enable continuity of care through online consultations. Numerous infrastructural barriers were addressed to enable easier uptake of procured solutions for remote triage and consultation, which has allowed many GP practices to adapt their delivery models during the COVID-19 pandemic.

Lessons Learned

An after-action review was undertaken to ensure shared learning.

The effectiveness of the COVID Digital Cell in the response to the pandemic was made possible because of the foundations laid by the East Accord – a collaboration of leaders from STP/ICSs across the East of England with an aspirational goal of a mature digital economy across health and social care in order to reduce the inefficiencies and improve patient experience. A cross-organisational approach is very effective for embedding innovation with a mix of experiences, perspectives and technical and project management skills.

The programme highlighted the importance of clear lines of communication and the sharing of consistent information on a national, regional and local level when leading a system change. Having a single unifying challenge and priority also helped as it allowed a clear focus on addressing the clinical need for change.

Although the initial response focused on NHS services, community and care home support was missing. We are pleased that this is now being addressed through support and funding for remote care, with Eastern AHSN supporting this regional programme.

A key learning point from the programme was the importance of ensuring that innovations must have explicitly defined agreed outputs to robustly monitor and show benefits. Some suppliers had not historically been required to provide data, which made it difficult to track progress and coverage of the new services. Ensuring we identify target benefits and the data required to evidence this is at the core of Eastern AHSN’s support for remote care going forward.

Future Plans / Next Steps

Whilst huge progress was achieved in just a few months the work continues. The network of IT, digital and service delivery leads across organisations continues to collaborate to drive forward the digital maturity of healthcare services in the East of England.

Eastern AHSN continues to engage partners across the region as we collectively build on the advances made during the coronavirus response and support NHS reset and recovery. This has included commissioning a survey in partnership with NHS England and Improvement to understand the role of innovations in response to the pandemic.

Eastern AHSN continues to evaluate solutions that have been rolled out to ensure they are as effective as possible. Building on the work of the digital cell, the healthcare system is collaborating to develop the capacity for remote triage and digital consultations between primary care and residential and care homes.