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NCL STP Digital First Programme – 2nd Digital Primary Care Congress

NCL STP Digital First Programme – 2nd Digital Primary Care Congress. Thursday 12 September 2019. Dr. Shakil Alam, GP and UEC Clinical Lead Rob Neave, Programme Manager (Senior Consultant, NEL CSU). 1. Introduction and Context. 1.1. North Central London STP. Approx. 1.5m patients.

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NCL STP Digital First Programme – 2nd Digital Primary Care Congress

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  1. NCL STP Digital First Programme – 2nd Digital Primary Care Congress Thursday 12 September 2019 Dr. Shakil Alam, GP and UEC Clinical Lead Rob Neave, Programme Manager(Senior Consultant, NEL CSU)

  2. 1. Introduction and Context

  3. 1.1 North Central London STP Approx. 1.5m patients 90.8 mile2 footprint Enfield 5 CCGs and 5 Local Authorities c£2.5b health budget and £800m social care budget Barnet 1. Introduction Harrow Waltham Forest Haringey Hackney Brent Islington Camden Tower Hamlets Westminster 12 Community, Secondary Care and Specialist Providers Southwark K&C H&F 225 GP Practices Lambeth City Wandsworth Lewisham

  4. 1.2 Our Partners 1. Introduction

  5. 1.3 Digital Vision and Programme of Works • NCL Supporting Digital Vision • To become a leading digitally integrated and evidenced based health and care system – using digital technology to help empower residents and care professionals 1. Introduction The STP digital portfolio of work is focused on the following programmes: • Digital First Primary Care – programme to improve pathways, flow and access to clinicians, ensuring patients access the most appropriate service for their needs – online consultations and NHS App integration • Health Information Exchange (HIE) – a programme to create a real-time summary view of a resident/patient’s key health and care information health and care professionals can access for care delivery • HealtheIntent – building on the above to use data from systems NCL STP health and care providers which can be used to proactively manage their care by health and care professionals e.g. population heath management • CCG Consolidation and Digital Optimisation – like most systems we intend to move toward a single CCG by April 2020.

  6. 1.4 Primary Care Pressures A Shortage of GPs NCL’s ever-growing and more diverse population, demonstrates the need to develop and grow the NCL GP workforce significantly over the next few years. The number of patients per practice is variable; Islington, Barnet and Enfield have on average fewer patients per practice than Camden and Haringey, suggesting a greater proportion of smaller practices in Islington, Barnet and Enfield. The number of practitioners per practice is also variable, with the smallest number of professionals per 100,000 patients in Enfield and Haringey. Three-fold GP and Nurses Workforce Challenges: Shortage Retirements New Ways of Working 1. Introduction *data as at March 2018, excludes registrars, retainers and locums Patients per practice Up to 9,250 in Camden and Haringey Up to 7,750 in Islington, Barnet and Enfield

  7. 1.5 Primary Care Pressures New GPs want a different way of working A recent survey of GP trainees demonstrated the need to consider different employment models and portfolio careers. The majority of GP trainees (93%) want a portfolio career,with 78% wanting to be involved in education and teaching. An added pressure is the draw on the GP workforce to innovative roles across organisational interfaces, such as UTCs, or new models of provision, which offer more attractive salary scales. Finally, there is evidence the trend towards more part-time or portfolio-working is being driven by a push away from general practice by the unattractive aspects of the job rather than a pull towards the alternative options; this aspect must not be overlooked. GPs are retiring 25% of the GP workforce is over 55 and therefore likely to retire within the next 10 years. A recent NCL Local Medical Committee (LMC) survey collected data showing that 45% of responding practices are due to lose one or more GPs to retirement in the next three years. * RCGPs: London average is 22% 1. Introduction Long-term locum 18% Salaried GP 47% Short-term locum 19% Non-GP work 41% One in four GPs is aged over 55

  8. 1.6 UECand System Pressures We also have the following system challenges: • Patient-flow – areas of bottlenecking in the system e.g. getting an appointment in Primary Care and increases in activity in Urgent and Emergency Care • Appropriateness – no effective / accessible means to determine patient need to ensure access to the right clinician • MDT effectiveness – underutilisation of the skills of the MDT e.g. pharmacists and other highly-skilled professionals in both Primary Care and UEC • Complex pathways – we have a complex system with multiple entry points that likely confuses patients As a result we have patients going to services where they may be better seen elsewhere, quicker and more effectively. 1. Introduction

  9. 1.7 Value and Benefits Alongside the NHS Long-Term Plan Digital First requirement, the introduction of the Digital First Primary Care Programme came at an opportune time for us due to our challenges, summarised as: • An increase in demand for UEC and PC • Workforce challenges • Patient flow and a complex system Shifting towards a more digitally-enabled system, which through online triage is able to: • signpost to self-care or the most appropriate clinical service, and • to enable online and videoconsultations, will significantly support our system to overcome the aforementioned challenges. 1. Introduction

  10. 1.8 Digital First Primary Care Our Digital First Primary Care Programme comprises of two key projects: • Online Consultations • Digital Accelerator • The programme has established governance, with an SRO and a programme board reporting into the STP Digital Transformation Board. • We will provide backgrounds and information on both of these projects. • And what we are ultimately trying to achieve with an end-to-end digital pathway for our residents and patients. 1. Introduction

  11. 2. Online Consultations and DoctorLink

  12. 2.1 Background • Funding was secured to support the adoption of an OC service.STP took the decision to approach Online Consultations project as a system, rather than at place level. • 2 product specs were developed using patient and GP Practice feedback 1) ‘entry level’ and 2) more advanced e.g. direct appt booking and algorithm based chatbot functionality, etc. • The National Procurement hub ran a competition on our behalf with the 21 DPS Framework accredited suppliers. DoctorLink were the successful suppliers for both specifications. • Contracts for the two specifications were formally issued at the beginning of April 2019. • A fortunate delay has uniquely positioned us to develop and align a concise, strategic message and proposal to share with our stakeholders. • We have chosen to have an NHS-led service, accessible through the NHS App. 2. Online Consultations

  13. 2.2 How does DoctorLink help? Symptom Assessment (SA) Tool Importing Outcome Reports Administrative Requests Clinically-validated algorithms 2. Online Consultations Self-care provision &appropriate signposting Links to Local Directory of Service Diverting Workflow Safety-netting/Red-Flag functionality Tailoring Triage Functionality Consultation Reports linked to General Practice

  14. 2.3 How to use DoctorLink? ……… ……… 2. Online Consultations 1. Check your symptoms Answer a series of relevant questions based on your symptoms and concerns, confidentially and anytime. 2. Get guidance to the right care DoctorLink will advise on how to best manage your symptoms or see the right healthcare service to suit your needs, whether that’s an appointment with your doctor, nurse, emergency care, visiting a pharmacy or other healthcare professional. 3. Book an appointment with your GP If your symptoms mean you need to see a doctor, you can book an appointment directly with your surgery, the same day if your condition is urgent.

  15. 2.4 Early NCL STP Results • Since April we have achieved the following: • 35practices implemented • Available to 338,646 Patients (approx. 23% of our population) • On average, 26% of Doctorlink users have been safely and appropriate diverted away from their GP Practice to other services. Meaning only 74% need action by their GP. • This will improve further when the DoS work is completed in the next phase of work. Sign-posting will be even further refined to U&EC and Extended Hours Access Hubs. 2. Online Consultations

  16. 3. The NCL STP Digital Accelerator

  17. 3.1 Background • Early 2019 Healthy London Partnership (HLP) provided each London STP with funds to commence, what was then termed, an Unscheduled Care Digital Accelerator Project. • With the potential scope being endless, we sought out to immediately identify our areas of need and priorities e.g. how and what area of our system would most benefit from being ‘Digitally Accelerated’? • To do this we held clinical scenario sessions throughout March.Dummy patients were taken through existing pathways. • Good governance, a PID went to the STPs Digital Transformation Board. • Our three recommended project areas were approved, as well as a new governance approach and for the programme to follow ‘agile methodology’. 3. Digital Accelerator

  18. 3.2 Clinical Scenario Sessions • ‘Dummy’ patients were created, with their digital inclusion scale included… 3. Digital Accelerator

  19. 3.3 Clinical Scenario Sessions • …the patients were taken through our current system to identify ‘areas of need’. 3. Digital Accelerator

  20. 3.4 Longlist 3. Digital Accelerator

  21. 3.5 Shortlist • The longlist ideas went through a process of critiquing to shortlist them to three ideas. 3. Digital Accelerator

  22. 3.6 Proposed Digital Pathway NEED ENTRY TRIAGE TREAT DECISION REFER Triage Integration into Practice Message Phone Video F2F Apt DX code / Disposition Selfcare 3. Digital Accelerator Contact Primary care Pharmacy GP Patient orcarer GP OOHs / UTC NHSapp ED • Uses NHSlogin • Commonjourney • Available24/7 NHS111 CAS 1. Single Authentication 2. Triage Integration 4. Video Consultations 3. DoS Integration THE ‘ASK’ =

  23. 3.7 Channel Shift and Digital Social Prescribing 3. Digital Accelerator UEC PRIMARY CARE SELF-CARE / SPx • Digital Social Prescribing work-stream soon to begin, looking at four key areas: • Collating social care directory of services – both for patient usage and SPLWs in PCNs • Social Prescribing case management software • Triage functionality to identify most appropriate service • Integration with the NHS App

  24. 3.8 Lessons Learned / Key Learning Points • Setting a vision early – be ambitious! • Early and meaningful stakeholder engagement – particularly General Practice – think ‘hearts and minds’ • Go with the energy – curve of innovation diffusion! Who are your early adopters and how can they be supported to embrace this change? • Governance! Complex because Digital First Primary Care cuts across 1) Primary Care or Out of Hospital 2) UEC and 3) Digital itself • For systems, engagement with your Regional team, the National team, NHS Digital and the NHS App team – understand their strategic direction and their roadmap e.g. release of APIs • Having a willing and committed supplier – comes from a strong and robust procurement • System or place – pros and cons for both • Clinical leadership 3. Digital Accelerator

  25. Contact us… • To find out more • If you would like to discuss any element of this presentation, please contact: • Rob Neave • Digital First Programme Manager (Senior Consultant, NEL CSU) • E: robert.neave@nhs.net • T: 07557 012727 • Dr Shakil Alam • GP, UEC Clinical Lead and Clinical Advisor • E: shakil.alam2@nhs.net

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