Case study: Video consultations in primary care

This case study, produced by NECS explores how they have supported primary care with the introduction of video consultation.

Background

The purpose of the Video Consultation project was to establish best practice and define new ways of working so that the potential value of using video consultations in primary care could be realised and to make recommendations to support an informed and coordinated future deployment of video consultation capability across the North East and North Cumbria region. This was to ensure GP Practices continue to be well positioned to deliver video consultations and are informed to make future procurement decisions.

Problem

Prior to the COVID-19 pandemic there were very few practices in the North East and North Cumbria (NENC) region with access to video consultation solutions, and the knowledge of how to use them effectively and safely was limited.

Our Approach

Initially project delivery was focused on the COVID-19 response, ensuring and demonstrating that all NENC practices had a video consultation solution enabled ahead of the Secretary of State deadline. Focus then moved to tracking and supporting the utilisation of video consultation solutions, a bespoke dashboard was created to track activity at regional, CCG and practice levels.

During the practice engagement phase, lessons and experiences were collated from practices and this is also the phase that the Landscape Analysis and Benefit Milestone Report deliverables were produced.

Finally, project delivery focused on supporting future procurements, collating and prioritising requirements and liaising with the Procurement Hub to secure SMS bridging arrangements.

Benefits

• Improved patient experience by providing flexibility and choice along with avoiding unnecessary travel
• Reduction in practice footfall
• Time saving efficiencies with streamlined work processes
• Improved allocation of face to face appointments

Outcomes

Prior to the escalation of the COVID-19 pandemic in March 2020 the use of video consultations in NENC Practices was low with only a small number of practices taking part in regional trials. By April 2020 all NENC practices (371) had a solution enabled and consultations increased from zero at the start of the year to circa 28K per month at peak activity levels in April 2020.

Informed by engagement workshops with practices, a Landscape Analysis document was produced along with updated process maps and decision points.
Anticipated benefits from the sustained adoption of video consultation alongside face to face and telephone consultations as part of maintained business as usual (BAU) processes are described in the Benefits Milestone Report.

A Primary Care Guide was written and shared with key stakeholders describing best practice, scenarios to increase utilisation and highlighted potential challenges.
An online learning resource was produced including key learning from the project with the aim of supporting future projects or initiatives.

To support future procurement activities, video consultation requirements were collated, prioritised and aligned with the new Digital First Primary Care OC/VC Framework capabilities.

Productive and beneficial relationships have been established with a range of suppliers partly through mobilising the COVID-19 response, but also through plans and preparation for future procurements and potential support to assist with embedding new ways of working.

Testimonials

“Our practice has really embraced the use of technology during the COVID-19 pandemic. Video Consultations has changed the way we work and has proven to be an incredibly efficient tool to enable us to consult with our patients.

“Patients have provided us with feedback that they have often preferred this method as opposed to a telephone call as it gives them more reassurance to see the clinician that they are speaking to when discussing their care.

“They also felt it was much more convenient than having to visit the practice. Having our video consultation platform integrated within our clinical system has made things even easier and follow up documents/images can be saved to the record accordingly with just a few clicks.

“Clinicians have found the quality of the video and audio to be efficient and have had no major concerns. Our practice will continue to use video consultations moving forward as we see it as a method to provide our patients with greater choice and flexibility”.

Andrea Francis, Clifton Court Medical Practice

“Adopting and using video consultations has allowed us to continue to support our beneficiaries during the pandemic using 1:2:1 video consultations, remote exercise prescription and regular follow ups.

“We have found this to be an effective way to deliver rehabilitative exercise and to monitor a beneficiaries progress, along with providing a resource to answer questions, provide reassurance and give timely advice.

“Going forward, digital provision will continue to be part of our what we offer and will be blended with our other services. It has improved access into our service, speeded up response times, has enabled us to reach more of our beneficiaries and it has allowed us to continue to provide help and support to our beneficiaries through these most challenging of times”.

Chris Gould, Physiotherapy Lead Practitioner for the Fire Fighters Charity

“Training of clinical and non-clinical staff and guidance for clinicians and patients on how to make the most of a video consultation is likely to help widespread adoption. Resources should be made available now for organisations to release staff from other duties to deliver and monitor the change.”

Trisha Greenhalgh, Nuffield Department of Primary Care Health Sciences, University of Oxford.

“I was apprehensive when I started using the technology to enable me to do a video consultation, even though I was used to face timing my daughter.
I wanted to teach a patient to use a peak flow meter. The patient was, due to Covid unable to come into the practice. Thus, we arranged a video consultation, in Arabic, with our in-house interpreter.

“I have known this patient since 2008, and for the first time I was able to see him in his home, not in a clinical setting. I was able to explain and demonstrate how to use a peak flow meter, which would help with his asthma management and control.

“But for me, most importantly, I was able to see that he needed help from his wife to sit up and I could understand the difficulties he had in managing very basic activities, and thus was able to offer additional social support. He was also in his own surroundings, seemed relaxed, did not have to leave his home.

“He was also positive about this new way of consulting with his nurse, and liked the fact he could stay at home to be seen”.

Ann Gregory, Page Hall Medical Centre