CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22 nd 2010

1. High Impact Change - Approach and experiences of Virtual Clinics An exploration and discussion on the nature and impact of ‘Virtual Clinics’ in providing care Mark Kingston - CCM Demonstrator National Team CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22nd 2010 Roger Richards, Mark Kingston

2. The Triple Challenge Increasing Demand Reducing Treatment Times Reduced Resources

3. Virtual Approaches CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22nd 2010 Roger Richards, Mark Kingston

4. Joint Review model i.e. a consultant attends a GP practice to discuss challenging or complex cases identified by the practice Examples1 & 2 • Advice Service model i.e. GP seeks specialist opinion through letter, email or telephone Example 3 • Secondary Care led Review model i.e. specialist analyses notes of patients on waiting list/new referrals to expedite decision making Examples 4 and 5 • What should a consultant do - consult more, see less of everything slowly, and more of some things quickly?

5. Cardiff & Vale Diabetes Virtual Clinics • One year Joint Review project – part of ICC • 5 GP practices in one neighbourhood • Virtual and live clinics in GP practices • MDT - Consultant, GP, DSN, Practice Nurse, Dietician • Full audit/evaluation plan (see CCMD EP 5) • Shift from live (c.45mins pp) to virtual approach (c.10mins pp) • Expanding remit of virtual clinics • Poor control/patients in secondary care/triage for live clinics • Type 1 and Type 2 • +ve feedback - integration of SC/PC, education, patient benefits • Full results March 2011

6. Wrexham Virtual Clinics – Diabetes • 8 month Joint Review pilot aiming to rationalise and triage referrals, and improve PC/SC mutual knowledge and understanding • For more details • CCM Demonstrator Learning Paper 13 • Year 2 case studies report

7. Wrexham Email Clinics • 10 week Email Advice Service pilot - • 12 participating practices across Wrexham and Flintshire • 5 Specialties • 5 day max response

8. Wrexham Email and Virtual Clinics CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22nd 2010 Roger Richards, Mark Kingston

9. Wrexham Email and Virtual Clinics CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22nd 2010 Roger Richards, Mark Kingston

10. ABMU ENT Secondary Care led Review “‘Virtual Clinics’ have reduced unnecessary follow-up reviews in the ENT department at the Princess of Wales Hospital. The effect of this change of practice has benefit for both patients and hospital. By adopting the ‘Virtual Clinic’ philosophy outpatient waiting lists will undoubtedly reduce.” • Activity • Six month review (2009/2010) by ENT clinicians to assess • need for follow up appointments for.. • ENT patients having outpatient imaging investigations - (169 patients) • ENT ‘long waits’ – (288 patients) • Patients and GPs informed by letter +/- telephone of normal investigation results or if change to planned ENT follow-up

11. ABMU ENT Secondary Care led Review • 3320 minutes of actual ENT clinic time saved • Reviews fully embedded in practice • Further research estimated 75% less follow-up clinic appointments

12. Cardiology Virtual Clinic 50 GP Practices 275,000 patients Patient Problem, Query, or Concern Telephone Email Letter Fax Single Point Entry & Signposting One-Stop Cardiology Clinic Specialist Cardiology Clinics Possible Testing Virtual Diagnosis, decision or plan by Cardiology Consultant Communicated by telephone, email and/or letter

13. Overall Consistent with models of integrated working and shared care Improve access to specialist opinion Speed up patient journeys Evidence of efficiency savings and reducing OP appointments Applicable to different conditions Considerations Clinical leadership Requires behaviour changes (i.e. advice seeking) Governance arrangements Further work needed to support mainstreaming e.g. on waiting times, patient outcomes, cost savings CCM Demonstrators – Deliverables, Evidence and Mainstreaming National CCM Cop April 22nd 2010 Roger Richards, Mark Kingston