Digital First – The Foundations Digital Primary Care Congress London Digital Transformation Team

1. Digital First – The Foundations Digital Primary Care Congress London Digital Transformation Team

2. London Digital First – Developing and delivering the vision

3. Responding to the LTP “By 2023/24, every patient in England will be able to access a Digital First Primary Care offer… … Digital First Primary Care will become a new option for every patient, improving fast access to convenient care”

4. Digital First recognises the challenges within our current system Workforce A recognition within the system that there is a lack of provision for digital training across the workforce. To improve the digital maturity of our system, we must upskill our workforce, co-designing solutions, an in turn, ‘bringing them on the journey’. Market supplier relationships There are vast numbers of market suppliers operating within the digital space. However, at present we are not creating and utilising opportunity to collaborate with these innovators to co-design solutions. The development of multi-supplier “innovation sandpits” is a mechanism that will allow us to harness these revised ways of working. Standardisation of operational process Across the system, there are numerous examples of operational processes within localities that could be standardised across the piste. Standardisation provides us with the opportunity to ease the burden on clinicians through familiar and well recognised pathways, reduce ambiguity for patients, and to ensure demand on services is appropriate. IT infrastructure Whilst we continue to innovate across the system, we must recognise that at present, we operate in a landscape dominated by legacy IT hardware and infrastructure. A lack of funding into upgrading these systems propagates this. To continue to innovate, we must ensure that we allocate the appropriate time and resource into these foundations Connectivity of data and sharing arrangements Data is at the heart of intelligent evidence based decision making/commissioning. At present, the NHS operates with disparate and disconnect data sources, all trying to inform how our system functions. In order to truly understand demand across services, we must develop integrated data warehouses, compliant with regulatory requirements. Access, triage and navigation At present there is no effective and simple entry point which enables a patient to access health services. In addition to this, patient pathways are often convoluted and require patients to touch base with multiple services before reaching the correct one.

5. Since it’s inception, London STPs have rapidly adopted Digital First concepts Defining Digital First “Digital First is the methodology and approach ICS /CCGs need to adopt in order to ensure patients can access health and care services consistentlyonlineasandwhentheyneedto.Thisrequiresthejoiningupofvariousstrategicdigitalcapabilitiesacrossthe health economytocreateamoreintegrated digitalpathwayforpatientswith scheduled and unscheduled careneeds”. The Digital First accelerators were originally set up back in Nov ‘18 tosupport the convergence of UEC and PC enablers as part of the Unscheduled care pathway. • NWL - Brent • NCL - 20 NCL practices • NEL - Tower Hamlets • SEL - Lambeth • SWL - Wandsworth and Merton Where are we now? Digital access to mental health and social prescribing services UTC “digital front-door” patient prioritisation Redirection to alternative service through integrated triage technology Mobilisation 5 x Digital First Accelerators selected Integrated NHS App/ Online Consultation solutions Challenges recognised, clinical mapping workshops hosted, MVPs formalised Standardised and effective IVR telephony Intelligent appointment surfacing

6. Pathway mapping before procurement Pathway mapping is at the heart of Digital First and provides the mechanisms for STPs to make intelligent commissioning decisions based on requirements from the present, and anticipated “to-be”, system. Pathway mapping

7. Welcoming innovators to assist in the redesign of patient pathways Ensuring that market innovators are “around the table” during key discussions regarding challenges within local system is integral to ensure that local digital visions are developed in conjunction with those who can provide the solutions. Innovation “sandpits”

8. DigitalFirst The 8 Digital First ‘pillars’ (Framework) Market Interaction & Engagement / Innovation Sandpits NHS App – “Digital Front-Door” Pro-active Commissioning (data insights and metrics) Remote Consultation DUEC / PC Integration Social Prescribing Culture change (patient & workforce) Service / Pathway Redesign Ensuring we have the foundations to support robust NHS service redesign Tier 3 Tier 3 User Experience Change Management Assurance and Risk Tier 2 Tier 2 Benefits & Outcomes Tier 1 Tier 1

9. Recognising the importance of our foundations

10. The 8 Digital First ‘pillars’ (Framework) Ensuring we have the foundations to support robust NHS service redesign Tier 3 Tier 3 User Experience Change Management Assurance and Risk Tier 2 Tier 2 Benefits & Outcomes Tier 1 Tier 1 Whilst we continue to build local Digital First visions and implement system wide service redesign, it is integral to ensure that we have the right foundations in place. This will allow us to innovate, upscale solutions and continuously improve our system over time.

11. Digital First – developing the foundation ‘functions and capabilities’ around the core principle of quality Why is quality important? • Recognition that quality directly correlates with clinical safety • Ensures we are delivering the highest quality of care, and therefore patient satisfaction • Allows us to benchmark and ensure we continue to improve outcomes What outputs are we looking for? Developing a quality offer • Identify and share good practice and address challenges within the foundation elements • Obtain and act on Patient feedback to formulate valuable insights into user experience • Host Quality workshops with clinical leadership to identify areas requiring improvement and develop QI strategies • Definition of what a high quality digital offer would look like for patients • Understand how a high quality digital offer can be delivered by the workforce, utilising technology • Clinical leadership to enable optimal decision making and timely delivery What does a quality offer consist of? Clear and concise communication Single and standard access to services Efficient triage and signposting Clinical safety and reliability Connected technology and pathways

12. Foundation Element – Aligned Communication Strategy Aligned Comms GP Online Services Education and Signposting Digital Literacy and Digital Champions Clear aligned communication is the root of interaction and understanding. It is the mechanism by which we transfer information across the system and ensure service providers and service users understand processes and systems. Good communication results in clarity Tools and resources Solutions • To develop a consistent regional approach to comms dissemination Ensure STP and CCG Comms leads manage the process • STP/CCG comms leads to monitor quality of comms and ensure it is easily accessible and reaches the correct stakeholders and patients • Sign post to websites, toolkits, webinars and social media platforms • Email • Facebook • WhatsApp • Digital Champions • CCG and GP practice websites • Electronic boards • Local Newsletter/Bulletin Objective To deliver clear robust digital services that meet user needs. To ensure service users and providers understand and promote digital pathways. To deliver aligned messages to prevent confusion, risk and poor implementation of digital initiatives

13. Foundation Element - GP Online Services: Appointments, Repeat Prescriptions, Record Access Aligned Comms GP Online Services Education and Signposting Digital Literacy and Digital Champions GP online services is an initiative designed to support general practices to confidently enable service users to book appointments, order repeat prescriptions and view their GP medical record. In turn, this increases choice, convenience and responds to service user needs. The delivery of a good quality online offer will ensure that the population have easy access into services. Tools and resources Solutions • The foundation elements that make up the quality offer should be owned at a CCG/STP level • Workshops will be rolled out regionally to define and imbed a more consistent GP online offer to service users • NHS App toolkit • Good practice recommendations from NHS App research team. • Sharing of local best practice • POMI data and NHS App dashboard providing data on uptake and utilisation Objective To provide service users with the same, or a better offer, through GP online services than they currently receive through the traditional routes. This includes queuing up at the GP practice or using legacy telephony solutions

14. Foundation Element – Education & sign posting support for service users Aligned Comms GP Online Services Education and Signposting Digital Literacy and Digital Champions • Educating service users is important to ensure that they are equipped to utilise and maximise benefit from digital tools and services. When a face to face appointment with a clinician is not required, sign posting enables patients to access more appropriate timely care in a resource limited environment. Tools and resources Solutions • PPG • NHS App toolkit • Local communication channels to service users • NHS.UK website • GP practice website • Information in GP Practice electronic board and posters • GP practice staff • PPG champions • Care navigators • Media promotion (”how to” videos in GP practices) Objective To ensure service providers support citizens by ‘walking them through’ how to best use the digital tools or services that are available. The process of education and signposting enables patients to utilise and benefit from the wider health care resources available

15. Foundation Element – Digitally literate workforce & Digital Champions Aligned Comms GP Online Services Education and Signposting Digital Literacy and Digital Champions • Digital tool and services are part of daily life for most people. Digital health can provide significant benefits to the patient and system. To utilise digital effectively it requires a digital literate, confident and competent workforce. Digital champions can be part of the workforce to support colleagues and patients or volunteers with a desire to help others who can lead by example and provide invaluable peer support and guidance. Tools and resources Solutions • Local Primary Care IT team and CSU/Federation to upskill staff • Digital Champions within the workforce • Patient Participation Groups (PPG) • Digital networks e.g. nurses & PPG • Toolkits (i.e. NHS App) • Webinars and online training Objective To ensure the workforce and voluntary sector are confident and competent using digital tools and services and in turn able to support patients to maximise benefit from digital health