New report shows remote mental health consultations make care more accessible but are not the right solution for all patients

Clinician pictured in remote consultation with patient

Remote technology has transformed mental health consultations during Covid-19 but it’s not the solution for every situation nor for all patients.

Key stats

  • 6,030 patients responded to the Trust surveys
  • 554 clinicians that responded to the Trust surveys
  • The report included a synthesis of 77 papers from 19 countries

A new report has found the shift to remote mental health consultations held by telephone or video, rather than face-to-face because of the pandemic, led to improved access, reduced missed appointments, and reduced travel stress. However, it also highlighted challenges, including access to technology, issues around broadband connectivity and data packages.

The report, produced by the NHS’s Health Innovation Network, NIHR Applied Research Collaboration South London, King’s Improvement Science and involving experts by experience, South London and Maudsley NHS Foundation Trust, South West London and St George’s Mental Health NHS Trust and Oxleas NHS Foundation Trust, makes several recommendations to inform clinical practice and to determine ongoing gaps in knowledge.

Key findings from the 6,030 patients who responded to the Trust surveys on remote consultations in mental health settings were that they allowed the flexibility of varying levels of support during the pandemic, and care was more accessible to populations who may have previously found travel to appointments challenging and some patients felt more relaxed in their own home during the consultation.

From the 554 clinicians that responded to the Trust surveys, including psychologists, psychiatrists, psychotherapists and nurses, training to use technology was raised as a need for both clinicians and patients.

Patients, carers, and clinicians said remote consultations were more convenient, reduced travel time, saved travel costs and meant family members were readily able to attend family sessions. In particular, remote mental health consultations were acceptable to people during Covid-19 to continue their treatment.

However, there is no ‘one size fits all’ and an individualised approach will always remain the gold standard, especially for new patients and children, those with a psychosis diagnosis, learning difficulties or the digitally excluded. Other barriers to remote consultations included where patients or clinicians could not access a private space where they were confident they would not be interrupted.

The report includes three evaluations:

  • Two evidence reviews of research both before and during Covid-19 were conducted jointly with the NIHR Mental Health Policy Research Unit.
  • Thematic analysis of patient and staff surveys from across the three Trusts, which received 6,608 responses.
  • The results of an e-survey on 32 projects with a focus on patient and/or staff perspectives on experience.
“Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments. ”Dr Natasha Curran, Medical Director Health Innovation Network

Health Innovation Network Medical Director Natasha Curran said:

“Access to mental health services during Covid-19 has been disrupted as patients were isolated and clinicians were unable to hold face-to-face consultations. Technology has allowed clinicians to provide consultations remotely, and this has been well received by many patients who say it is more convenient and saves the time and stress of having to travel to appointments.

“This study also shows that remote consultations don’t work for everyone for a variety of reasons: the nature of some patients’ condition, technological barriers, or privacy, for both clinicians and patients. This comprehensive report points to the benefits of a hybrid system, the importance of patient choice, where some consultations can be carried out remotely and others face to face, that could support vital ongoing mental health treatment both during Covid-19 and beyond.”

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Modern telephony promises to transform the patient experience – but the marketplace is daunting for commissioners

Clinician with mobile phone and computer

New telephony systems mean a revolution in the patient experience as part of the shift to ‘Total Triage’. But the wealth of systems on the market means GP surgeries face a daunting challenge identifying the right system, says Denis Duignan, the HIN’s Head of Digital Transformation & Technology.

Covid-19 has highlighted the inadequacies of traditional telephone systems in primary care. Patients waiting to get through on the phone, having to manually search for patient records and GP’s working remotely were all issues that have highlighted the shortcomings. But new systems help manage demand, enable remote working and improve the patient experience.

The promise of modern telephony is a transformed patient experience. However, with a multitude of systems on the market offering a range of different and complex packages, the decisions facing practices and Primary Care Networks (PCNs) keen to take advantage of new technology in this field are daunting.

The Health Innovation Network (HIN), working with Our Healthier South East London, has produced a ‘Commissioner’s Guide to Telephony’, which explores the primary care telephony market and aims to support better decision making for GP practices, federations, and primary care networks looking to upgrade or migrate their telephony solutions.

The inadequacies of traditional telephony

In 2019, poor telephone systems were identified as one of the key areas affecting patient experience and access to local primary care services within the London borough of Lambeth. The south east London Digital First Programme set out to improve primary care telephony through local healthcare, patient and industry stakeholder engagement which led to a workshop that stimulated many general practices to upgrade their systems. Whilst the learning from this was being consolidated, Covid-19 broke out across England. This very quickly highlighted the inadequacies of traditional telephone systems in facilitating an effective move to ‘Total Triage’ and remote working for clinical and non-clinical staff.
Many GP practices still use traditional phone systems, which consist of an on-site private branch exchange (PBX) which connects through fixed lines to the public switched telephone network (PSTN). This system has limited functionality and flexibility compared to more modern voice over internet protocol (VoIP) telephone systems.

What is Voice Over Internet Protocol?

Also called IP telephony, VoIP is defined as a method and group of technologies for the delivery of voice communications and multimedia sessions over Internet Protocol networks, such as the Internet. Some of the key areas where VoIP telephony has been seen to benefit primary care include:

  • Clinical system integration: The incoming caller’s patient record can be automatically ‘popped’ on screen, and calls can be made directly from the patient record using click-to-dial, streamlining the receptionist’s workflow.
  • Live call reporting and dashboards can enable practice managers to identify busy times and manage their workforce accordingly.
  • The ability to customise the phone system through an online portal giving practice managers control over auto-attendant/interactive voice response options so that they can route their calls in a way that suits their individual practice.
  • The flexibility of VoIP telephone systems enables them to be configured for different ways of working including central hub models and remote working using staff mobiles or telephony software on their laptops to receive and manage calls. The Commissioner’s Guide to Telephony provides further detail on the features and benefits of modern telephony systems.

The supplier market is large and complex

Another key area of guidance included in the report is in navigating the supplier market. The hosted telephony market in the UK is large and complex and comprises a diverse range of businesses from small family-run providers to large multi-national corporations, including both original equipment manufacturers and resellers. Understanding the capabilities of suppliers can be challenging for non-technical customers due to the number of acronyms, abbreviations, and jargon used and it is generally difficult to differentiate suppliers based on capabilities due to the range of add-on services a company can incorporate within their offer. In an effort to simplify the market for primary care, the guide includes a functional comparison of suppliers with primary care focussed products.

Practices that have adopted modern telephony systems have been overwhelmingly positive about the impact it has had on service delivery relative to their previous systems. This commissioning guide can assist other practices looking to update their telephony and realise the benefits of modern telephony.

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St George’s Hospital unveils dual electronic queue management and self check-in

Clinicians in ED

St George’s University Hospital Emergency Department unveils one of UK’s first dual queuing and self check-in system where patients see real time updates of their queue position on TV screens and smartphones.

HIN Innovation Grants supported project

St George’s installed the system after winning a HIN Innovation Grants award in 2019

St George’s University Hospital is one of the first Emergency Departments in the UK to introduce a dual queuing and self check-in.

Patients in the ED can map their queue position through real time updates on TV screens and smartphones.

In a move that reassures patients that they have not been missed or bypassed, the new system called “Patientcheck.in” helps free up emergency reception staff who handle a high volume of questions from patients about their wait and queue position. This has a knock-on delay in booking in new patients. Patientcheck.in – previously called “EDck.in” – also allows patients to complete a brief assessment questionnaire while they wait, using their own smartphone, which saves time during the assessment.

The technology aims to reduce patient anxiety around waiting times and improve efficiency.

Funded by the NHS’s Health Innovation Network, a joint Emergency Department and Transformation project team at St George’s was awarded £9,928 to design and build the software system and install TV monitors in the waiting areas.

Previously, a whiteboard behind the reception desk was used to display general waiting times and updated every hour. Lack of visibility of individual positions in the queue can cause concern for patients, who can worry that they have been forgotten, passed over or missed their call to see the emergency team. This can lead to repeated queries to reception staff about the waiting time and occasionally result in aggressive and abusive behaviours which puts additional pressure on staff.

The second function – the assessment questionnaire – has three major benefits. It empowers patients to tell clinicians why they are in the ED, in their own words using a non-verbal communication channel; reduces clinical administration workload and creates better quality, standardised medical documentation.

Through its integration with Cerner, the hospitals’ electronic health record system, Patientcheck.in sends the questionnaire responses directly into the electronic clinical notes. This reduces note-typing time by around eight minutes per patient. Therefore, if just half of St George’s 400 ED daily attenders complete Patientcheck.in, this equates to a potential saving of more than 26 hours of clinical time every day.

The Health Innovation Network grant was used to develop and implement the system. Now live, the team hope that Patientcheck.in will be adopted by other NHS Emergency Departments. There is also an opportunity to use it in outpatient departments and development projects are underway.

Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust, said:

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.
“Emergency departments are pressured and all you want is to do the best for patients. It’s difficult at the moment when we can’t easily answer their top question: when will I be seen? With relatively simple technology we believe we can make a huge difference to their experience and support staff at the same time by reducing interruptions. Greater transparency over the complex queues we operate will help everyone gain a greater understanding of how teams are working to help people.”

“We are passionate about trying new ways to improve patient experience and safety and we believe better queue visibility will give patients reassurance and free up reception team time.”Dr Gabriel Jones, Emergency Medicine Consultant at St George’s University Hospitals NHS Foundation Trust

Health Innovation Network Programme Director for Innovation Lesley Soden said:
“Hospital emergency departments can often be highly volatile as by their nature they have anxious patients waiting to be seen. Those patients often worry that they have been missed or passed over by other patients and this can lead to repeated questions to hard pressed reception staff, who are then preventing from getting on with their work to triage.
“This is a simple system using existing technology that can improve the patient experience, free up reception staff to focus on registering arriving patients and ultimately lead to faster care in hospital emergency departments.”

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