NHS England | September 2018 | 17,000 hospital nights and £7m saved for NHS through early treatment ‘iCares’ scheme
A scheme that identifies and flags patients with long term conditions at high risk of hospital admission is able to ensure they are seen as early as possible. The early treatment ‘iCares’ scheme was established by Ruth Williams, Clinical Directorate Lead at Sandwell and West Birmingham Hospitals, s five years ago after realising how difficult it was for patients to navigate the system and the waste created by multiple teams working in silo.
Patients or carers can ring one line if they need help and are triaged with urgent referrals seen in three hours by a part of the team dedicated to hospital avoidance.
The team of 100 staff make sure patients are seen as early as possible. The team unites physios, occupational therapists, advanced clinical practitioners (ACPs), community matrons, nurses, speech and language therapists and many more. Previously, patients were coping at home until in some cases they needed hospital admission. The scheme is based on need, rather than diagnosis.
So far the scheme has helped to reduce hospital admissions by 2,478 per year – 93% of patients who access the service stay in the community after an urgent visit rather than being admitted to hospital. It has also contributed to a reduced length of stay in A&E, reduced length of stay in hospital from 10 days to seven days and reduced readmission rates (Source: NHS England).
Full details on the innovation at NHS England
Reeves, David et al. The challenge of ageing populations and patient frailty: can primary care adapt? BMJ 2018;362:k3349
BMJ analysis notes in overstretched UK primary care system, acid test is likely to be whether GPs find that a focus on frailty helps to reduce, rather than increase, professional burden in dealing with their most complex patients, while also benefiting their older frail patients.
Parker S, Prince A, Thomas L On behalf of the IMPACT Study Group, et al. Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ Open 2018;8:e019192. doi: 10.1136/bmjopen-2017-019192
The objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.
Setting and participants: Studies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.
Results: Eighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.
Conclusions: Research incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.
NHS Confederation | August 2018 |Ready to roll: how nationally funded innovations are taking the NHS by storm
Dr Liz Mear chief executive of the Innovation Agency, discusses a new national programme helping health and care providers overcome the barriers to adopting and spreading innovation. She emphasises that there’s no catch involved in NHS NHS England’s Innovation and Technology Payment (ITP) programme, which was launched earlier this year. The ITP funds the cost of evaluating four ‘real-world’ products to overcome financial barriers and encourage speedy uptake across the country.
This follows the Innovation and Technology Tariff (ITT) launched in 2017 and live until March 2019 – which offers seven other innovations for free.
Dr Mair also acknowledges some of the challenges of adopting “free” technology, X acknowledges that “even when new products are free, there are reasons why health and care providers struggle to introduce them”.
For instance, considerations such as how the new product will impact on practice
will it require staff training or changes in process, it may also create additional work for the procurement and finance team
Mair also signposts to the report from the King’s Fund Adoption and spread of innovation in the NHS, which draws lessons from eight innovations that have overcome obstacles to be successfully adopted in the NHS (Source: NHS Confederation).
Read the full news item at NHS Confederation
The AHSN Network Innovation and Technology Payment (ITP)
Nuffield Trust | August 2018 | Rethinking outpatient services: Learning from an interactive workshop
A new briefing from the Nuffield Trust in collaboration with health leaders across the country looks at outpatients. The authors reflect on how several STPs have outlined plans to reduce the number of outpatients. Leicester, Leicestershire and Rutland intends to reduce outpatient activity by 30% by removing unnecessary new and follow-up appointments. Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby are aiming to achieve a reduction in consultant-led first outpatient appointments by a fifth.
This briefing reveals opportunities to improve the design of services and challenges if some services should be delivered in their current form.
Read the full news item from the Nuffield Trust
Download the briefing in full here
NHS England | August 2018 | Rapid Access Diagnostic Clinic for vague symptoms at Guy’ and St Thomas’
At Guy’ and St Thomas’ a new Rapid Access Diagnostic Clinic (RADC) was implemented to help speed up cancer diagnosis, as well as finding more cancers at grade one and two, in patients presenting with vague symptoms. It was rolled out to the six other CCGs across South London earlier this year.
The RADC provides a diagnostic service to patients who have presented to their GP or at the Accident and Emergency Department with vague but worrying ‘red flag’ symptoms. It follows a model of fast patient triage; coordinated access to diagnostic tests; second follow up appointment or telephone consultation resulting in rapid specialist referral or patient discharge.
Although it is too early to say that the RADC has definitely improved patient outcomes the early findings are promising:
- 570 patients completed their RADC journey during its first 16 months of operation
- 300 (58.82%) patients diagnosed with a serious benign condition including cirrhosis of the liver, multiple sclerosis, tuberculosis, heart failure, emphysema and Crohn’s disease
- 44 (8.6% of all patients) diagnosed with cancer;
- 11 of these 44 (25%) cancers were diagnosed at grade 1 or 2
- 93% of patients rated their care as very good.
- Patients with cancer and other serious conditions are diagnosed quickly, referred for appropriate treatment and start treatment much more quickly
- Patients who have traditionally struggled to get a diagnosis, now have a diagnosis for their condition
- Patients are being diagnosed in a clinic where appropriate advice and support can be given rather than at A&E
- Patients feel listened to and that their symptoms are being taken seriously, leading to high levels of patient satisfaction
- Many patients are quickly reassured that they do not have cancer, as well as receiving a prompt referral to the appropriate specialist
- Very high patient satisfaction levels [93%  rated their care as very good].
The team at the RADC have seen:
- Patients quickly diagnosed and appropriately referred for treatment
- Increased uptake in GP referrals
- Early stage cancers diagnosed in patients who ordinarily might be missed due to vague symptoms
- Over time, the team expect to see a reduction in A&E presentations and repeated presentations to their GP of patients with certain cancers such as GI cancers (Source: NHS England)
Full details from NHS England
NHS England | August 2018 |Breast cancer survivors control their follow-up care in Maidstone
A new case study from NHS England highlights how patients with breast cancer in are able to control their own care in Maidstone, Kent. The Open Access programme enables patients to have access to regular mammograms, support advice and appropriate clinical follow up up to five years following treatment for breast cancer. The programme recognises patients as individuals and that the way in which they want to be supported may change during their recovery, the team introduced an Open Access Programme, based upon a successful model in place at the Royal Marsden Hospital.
- A reduction of 3,000 breast outpatient appointments
- Patients access suitable clinical appointments and contact their nurse appropriately.
- Timely referral to an appropriate clinician (ie surgeon, oncologist, nurse)
- Appointments aligned to patient need or want
- Fast access to the Cancer Nurse to answer questions and concerns.
Full story at NHS England