Cutting-edge technology transforms diabetes care across south London

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Cutting-edge technology transforms diabetes care across south London

L-R: Tara Donelly, Chief Digital Officer, NHSX; Oliver Brady, Head of Diabetes Transformation, South West London Health and Care Partnership; Karen Broughton, Director of Strategy and Transformation, South West London Health and Care Partnership; Vicky Parker, Programme Lead, London Diabetes Clinical Network and Ben McGough, Workstream Lead – Digital, NHS Diabetes Programme.

South London clinicians and partner organisations gathered together at Guy’s Hospital last night (30 October) to launch a brand-new diabetes service called You & Type 2.

After receiving over £500,000 funding from the NHS Test Bed programme, the You & Type 2 service is now being piloted across south London. The service combines innovative technology, improved access to services and a personalised approach.

The ambition of the project is help people living with Type 2 diabetes to have happier and healthier lives by enabling them to have more control over their care.

Designed to provide a range of further education, support and resources, You & Type 2 enables patients to work with their healthcare provider to produce a unique care plan. Part of the service is an app that will allow patients to access and update their care plan when it suits them and receive personalised videos containing recent test results, which will prepare them for informed discussions with clinicians.

Healthcare professionals using the service can update the app in real time, offering tailored support to patients. This means they are equipped to deliver the best patient-centred care, with the support of innovative technology that is linked to personal health data and individual goals.

Thirty-five GP surgeries across south London are now piloting the service, which is expected to be rolled out more widely in 2020. Clinicians who are already using the service have reported improved knowledge and skills, alongside greater job satisfaction and increased levels of team work. So far, over 1000 patients have already created their own care plans, working closely with their healthcare professionals to make something personal and meaningful to them.

A group shot of the partners involved in the You & Type 2 service

Speaking from the service launch event last night at Guys Hospital, local GP Dr Neel Basudev, Clinical Lead for You & Type 2, said: “This is such an exciting and different way to treat people living with type 2 diabetes. We know that being diagnosed and living with a long-term condition can feel overwhelming, but by using innovative technologies and working collaboratively with patients, this service helps them to overcome difficulties and improve their overall health and happiness.

“This is an exciting opportunity and I can’t wait to see how this develops and the impact it has on people’s lives, not only in my practice, but in practices across south London.”

Victoria Parker, Programme Lead for London Diabetes Clinical Network, NHS England, said: “This is such an innovative digital service and I’m happy to be here for the launch. The NHS long term plan speaks of personalisation and patient centred care.

“This service captures the essence of the long-term plan but also pushes it to a new level, offering better care and support for those with Type 2 diabetes as well as creating a model of care for any long term condition. I am excited to see where this project goes next and for the opportunities it presents for spread and adoption across London.”

For more information on the programme visit youandtype2.org

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The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

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The new GP contract didn’t mention innovation once. Yet the space it opens up for innovation is exciting, and we should seize it

Dr Caroline Chill, Clinical Director for Healthy Ageing at Health Innovation Network looks at the potential of the new contract to support innovation.

I’ve worked in primary care for over 30 years, and have been involved in leadership and innovation for most of them. GPs have a history of being innovative with the early coded electronic health record systems being a prime example. In recent years, it has felt like this innovation has been stifled by increasing workload, staffing pressures and ever changing contractual requirements. I’ve seen innovation talked about in countless different ways and these days it seems to me that policy makers are falling over themselves to describe initiatives as ‘innovative’ or to talk about the potential to improve care through innovation but with less commitment to support the delivery of innovation in practice. So, I was fascinated to see how this would be expressed in our new GP contract which to my surprise did not mention the word ‘innovation’ at all. Not a single mention, despite the contract being extremely innovative.

An obvious area relates to support for Primary Care Networks and additional staffing. The aim of Primary Care Networks is to connect the primary care teams to help deliver more integrated and comprehensive local services, to allow new models of care to emerge and to support higher levels of self-care. From 1July, 1,259 Primary Care Networks become operational and backed by nearly £1.8 billion funding over five years with most of England’s nearly 7,000 GP practices participating.

Additionally, the interim NHS workforce plan and dubbed the “People Plan” was published in June.  This focuses on three key areas – recruiting more staff; making the NHS a great place to work; and equipping the NHS to meet the challenges of 21st century healthcare.  It re commits the government to delivering 5,000 full time equivalent GPs “as soon as possible” as well as nearly 6,000 extra nurses, and the creation of “nursing associates” offering a career route from care support into registered nursing.

The GP contract acknowledges the fact that the additional staff we need in general practice will not come from doctors and nurses alone. The money available through the contract can be used to help recruit a much broader range of professionals – Initially the scheme will meet 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers.

I think it will be down to the primary care networks to find innovative ways to recruit, train, support, mentor and part fund these new roles. This is no simple task as the existing training and skills of these professionals will need to be strengthened and adapted for working in community settings, where there is less supervision and where patients need holistic care, encompassing multiple physical, social and psychological issues.

I believe GPs will rise to this challenge and seize the opportunity. . It could be the beginning of a new, more modern and holistic way for patients to experience general practice.

Increasing the numbers of physiotherapists and other community-trained staff could lead to another important shift. Take MSK as an example which includes chronic knee, hip and back pain, has a major impact on an individual’s quality of life and society. It is the second most common reason for GP visits, accounts for around 25% of all GP consultations and is estimated that 9.3 million working days are lost in the UK to MSK problems.

An intervention that relieves chronic joint pain, called Joint Pain Advice , already exists and can be delivered by a wide range of professionals and lead to lasting improvements in pain. The model focuses on reducing reliance on painkillers through exercise and education. Trained professionals, who could be physiotherapists, community health trainers, or others provide a series of face-to-face consultations, working collaboratively with people with hip and/or knee osteoarthritis and/or back pain, focusing on supporting self-management. The programme consists of up to four 30-minute face-to-face consultations between the advisors and people with hip or knee osteoarthritis (OA) or back pain. Patients attend an assessment where they discuss their lifestyle, challenges and personal goals and then jointly develop a personalised care plan that gives tailored advice and support based on NICE guidelines for the management of OA. They are then invited to attend reviews after three weeks, six weeks and six months to access further tailored support and advice. This has the potential to reduce pressure on existing physiotherapy services and potentially reduce demand for GP follow up consultations.

To date, more than 500 patients have used the service led by physiotherapists. In a previous pilot in Lewisham, south London, they reported less pain, better function and higher activity levels. A high satisfaction rate was achieved which included reduced BMI, body weight and waist circumference and has led to fewer GP consultations, investigations and onward referrals.

In addition to the patient benefits, for every £1 spent on the programme there is a saving to the health and social care system of up to £4, according a Social Return on Investment (SROI) analysis.

Why not embed this training into these new roles? This could genuinely help deliver one of the aims of PCNs to empower people to self-care and improve the quality of life for people living with MSK pain. This one example could radically change the approach for addressing the needs of people living with MSK pain helping them to become fitter, more active and more empowered,  provided that the additional funding for primary care staffing does not result in reduced provision in other sectors.

Primary care will find countless other ways of using new staff to do more in primary care. While this doesn’t magically reduce our workload in practices, it has the potential to shift it and makes it easier for patients to access a broader range of professionals in community settings without the need for referrals to hospital.

These initiatives alone will not be enough to completely transform and modernise primary care but they are a great starting point. Change is easy to talk about but difficult and complex to enact. Even innovations that will lead to significant savings will often require upfront investment of resources, time and goodwill. The introduction of state based indemnity is very welcome to help retain experienced GPs, however,  changes to pension contributions and tax implications may have an equal and opposite effect impacting  the number of sessions doctors are choosing to work.

For me the key headlines which make the new GP contract so innovative and exciting are the significant increased staff funding, support for the development of Primary Care Networks, a five-year timeline and introduction of state based indemnity.  What we now need is the time and space to deliver.

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Social prescribing champion training sessions

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Social prescribing champion training sessions

Health Innovation Network are proud to be delivering ‘Social Prescribing Champion Training’ sessions in June and July in collaboration with Wandsworth and Merton CCGs. For those working health and care, based in GP practices, working with voluntary groups and/or do some signposting. Please select a date out of four options and book this fantastic opportunity.

Training dates – One half-day (four-hour) session:

Thursday 21 June 9:00 – 13:00, Book here

Friday 22 June 12:00 – 16:00, Book here

Monday 2 July 9:00 – 13:00, Book here

Friday 6 July 12:00 – 16:00, Book here

For further details, please contact Urvi Shah at urvi.shah2@nhs.net

What is Social Prescribing?

Social prescribing is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.*

*kingsfund.org.uk/publications/social-prescribing

Support for the deployment of GP online consultation systems in south London

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Support for the deployment of GP online consultation systems in south London

Since its inception, Health Innovation Network’s Technology team has been interested in how new communications technologies offer the opportunity to enhance healthcare interactions. Such interactions could include clinical consultations between a GP or specialist and a patient in general practice or hospital outpatients’ department. They could also include discussions between professionals, for instance:

  • A multi-disciplinary team (MDT) meeting in a hospital/community setting
  • A GP seeking the input of an expert specialist.

In July 2016,we undertook a review of the Hurley Group’s ‘eConsult’ (formerly ‘WebGP’) platform, in which we sought to understand the nature and extent of this particular opportunity to transform access to general practice. More recently, we have undertaken work to promote the spread and adoption, specifically, of video-based remote consultation in hospitals—often generically referred to as ‘Skype clinics’.

Given the announcement in October 2017 of NHS England’s GP Online Consultation Systems Fund, Health Innovation Network’s Technology team is now exploring how it could be of support to CCGs and GPs in south London as they progress plans to introduce or further develop provision for GP online consultation.

We are well-aware that CCGs across south London are by no means lacking in ambition where digital transformation is concerned, and many are already forging ahead with enhancements to primary care provision with online consultation solutions of one form or another at their heart. We watch these developments with great interest and excitement.

We would be interested to hear from colleagues across south London to understand your plans for offering GP online consultation, and to discuss how can best support you in this endeavour. We are in the process of engaging CCGs across the patch, but if you would like to discuss this support opportunity further now, please contact Tim Burdsey, Technology Project Manager at tim.burdsey@nhs.net We look forward to hearing from you—and to working with you, to help realise your digital ambitions for primary care and for your wider local health and care system.