What digital challenges do we face? What TECS projects are we working on at the moment, and what benefits do we expect to achieve? Over the past year which TECS project are we most proud of?
Like many CCGs North Staffordshire and Stoke-on-Trent CCGs cover diverse areas of urban and rural populations and need to respond to the consequent health challenges that this can bring. Challenges include physical access to health services and issues regarding low literacy levels which impact on access to health literacy and access to health services and health messages. The population is very dependent on direct intervention, which can lead to seeking treatment in A&E for example when a GP appointment may not be immediately available.
Stoke-on-Trent CCG in particular, has been at the forefront of using and promoting simple technology to improve patients’ understanding of their health, and to reduce their dependence on face-to-face consultations with clinicians in general practice or A&E departments.
The CCGs are proud to have worked with Keele University School of Pharmacy to produce apps for smartphones so that patients can have critical information in a format that they find appealing, and accessible are which less likely to be discarded or lost than paper based formats.
The conditions included so far are Type 2 Diabetes, COPD, asthma, back pain, and hypertension, with Atrial Fibrillation soon to be added. Many visual items are included to enable messages to be understood, even by users whose first language may not be English or may have low levels of literacy. With asthma and COPD, for example, videos of an avatar demonstrating the correct use of different inhalers has been included. There are also several cartoons and diagrams, as well as an animated whiteboard.
The CCGs also use the Florence (Flo) simple telehealth text messaging system. There are many different applications of this, including hypertension, diabetes, asthma, COPD, anxiety and depression, dementia, weight management, smoking cessation, where interactive remote monitoring is possible. It is also used for simple medication reminders as many patients do not take their prescribed medication consistently, resulting in deterioration leading to further intervention. Simple reminders to take tablets or an inhaler can ensure medication use is optimal. This involves not only general practices and hospitals, but also local community pharmacists in providing simple text messages especially when patients start new medication. Using Flo for the management of COPD and asthma should reduce the number of patients who require emergency admission by advising them to take action before an acute situation is reached.
TECS can help reduce the pressure on stretched NHS resources in primary care in a number of ways, skype consultations, (at present mainly between GPs and nursing homes), can save a considerable amount of travelling time for the GP, and a better service for patients. The aim is to be able to provide Skype appointments as an alternative for patients to be able to access their GP more conveniently. Using a smartphone, patients can consult while at their place of work, instead of needing time off to travel to an appointment.
Most of the CCGs’ general practices have a Facebook site, giving information and general advice, such as encouraging patients to have a flu vaccination. Some have also set up closed groups for specific conditions, where invited patients can support each other eg. for weight management. Facebook provides a platform for video presentations by clinicians and patients to inform and encourage improvements in healthcare.
Work is currently taking place to complete a website aimed at patients in Stoke-on-Trent and North Staffordshire with long-term conditions. This includes written advice and also quizzes, cartoons, and videos of patients using TECS, or of annual reviews of asthma, COPD, or hypertension, to try to achieve better consistency across the area.
It is well evidenced that lifestyle choices contributes to positive and negative health outcomes – an example being the impact of obesity on a number of conditions, including the prevalence and management of Type 2 Diabetes. The CCGs are working with a group of children to develop ways to influence children’s approach to health, including developing a children’s app to increase the understanding of aspects of healthy eating.
While text messaging, Skype and apps are familiar to most people aged below 50, many of our older population feel that they are unable to manage any of these, and can only contact their GP surgery in person or by phone, rather than make appointments, order prescriptions, or update personal details online. We have therefore linked to the Workers’ Educational Association to provide awareness sessions for patients, and have organised basic courses through Staffordshire University to introduce patients to computers, tablets / smartphones and text messaging.
It is essential that CCGs maximise opportunities to enable patients to use simple technology for the management of their own health.
What systems are providers in our area using?
Systems vary between and within health and social care organisations. It is widely anticipated that one of the on-going challenges for the Digital Workstream (Local Digital Roadmap see below) will be managing the migration paths for each organisation onto a common digital architecture that enables personal information to be shared safely, securely and appropriately.
Are we working towards a shared care record, and how?
The development of the first Local Digital Roadmap (LDR) in Staffordshire and Stoke-on-Trent has been carried out across organisational boundaries and accompanies the area’s draft Sustainability and Transformation plan (STP) submission to NHS England.
The inclusion of a Digital Work stream in the STP programme structure has ensured that local Health and Social Care priorities are at the heart of the LDR.
Every local Health and Social Care system is expected to make progress against a set of 10 Universal Capabilities demonstrating clear momentum before March 2017, and substantive delivery before end-March 2018. The Universal Capabilities are described below but may evolve over time:
- Professionals across care settings can access GP-held information on GP-prescribed medications, patient allergies and adverse reactions
- Clinicians in urgent and emergency care settings can access key GP-held information for those patients previously identified by GPs as most likely to present (in U&EC)
- Patients can access their GP record
- GPs can refer electronically to secondary care
- GPs receive timely electronic discharge summaries from secondary care
- Social care receive timely electronic Assessment, Discharge, Withdrawal Notices from acute care
- Clinicians in unscheduled care settings can access child protection information with social care professionals notified accordingly
- Professionals across care settings made aware of end-of-life preference information
- GPs and community pharmacists can utilise electronic prescriptions
- Patients can book appointments and order repeat prescriptions from their GP practice
The 10 Universal capabilities have been arranged into themes which include clinicians in urgent and emergency and unscheduled care settings and other professionals’ access to appropriate information held in care records.
What’s top of our digital agenda?
In line with national ambition, we want to support the adoption and design of technology to enable self-care and self-management for patients; help to reduce workload in practices; help practices/multi-specialty care providers that want to work together to operate at scale; support greater efficiency across the whole system.
New consultation types (telephone, e-consultations, text messages) are one of the ten high impact actions planned to release capacity in general practice to transform traditional models of care and support and to enable greater self-management of care and support people and their carers to be as independent as possible as well as reducing admissions and readmissions to hospital and enhancing long term care among older people.
Florence (Flo) simple telehealth text messaging system – which has applications to remotely monitor patients with long term conditions to enable self-care and empower patients.