At a recent session on digital access e-hubs for online consultations at HTN Now we were joined by a group of speakers including Paul Charnley (digital lead and chair of the National Blueprinting Steering Group); Saj Kahrod (assistant director of programmes in blueprinting and knowledge sharing at NHS England); Aaron Hamilton (senior project manager at Healthcare Centre London GP Federation); and Nigel Gausden (SME programme manager and subject matter expert in primary care and urgent care for Seneca Advisory).
Paul introduced the session, sharing how the blueprinting programme had started with the global digital exemplar programme whilst he was CIO at Wirral, which was one of the sites selected for funding in return for blueprints of the work that was completed.
“We did that so we could speed up people following us and facilitate peer-to-peer learning,” he said. “A blueprint is a group of assets and artefacts that people can use – they might put their own badge on it, but it will help them along the way. They are step-by-step guides on how a particular organisation went about achieving a set of digital benefits, and they have been peer-reviewed by a team that works with us within the blueprinting programme.”
Paul talked about how the blueprinting team try to take up initiatives around the different strategic drivers that apply to the digital landscape, and how current work is ongoing to “try and tie together so we can be more joined-up with all these initiatives”.
Saj shared a few of the blueprinting team’s current objectives, including increasing their portfolio around good practice within the NHS and the EPR levelling-up agenda, creating more blueprints that will add value for frontline users, and working on bespoke blueprints in areas such bed management.
“We’re really keen to create a blueprint to raise the profile of good practice, and with the digital access e-hub for online consultations the trust have actually implemented something that has added value. By blueprinting it, we’re trying to raise quality, safety and efficiency across the health and care system. It has the potential to reduce pressures, but also to optimise information that could be shared across an ICS.”
Saj then went on to highlight some of the examples of blueprinting work undertaken to date, including Manchester University NHS Foundation Trust’s EMIS migration and merger project blueprint, and South Tyneside and Sunderland NHS Foundation Trust’s electronic observations blueprint. On statistics, she revealed that the Blueprinting Workspace currently has over 3,400 members, with just under 3,000 views of the Blueprinting Library in February of 2024, with a total of 211 blueprints and 215 ‘blueprints on a page’ published for people to browse.
“The full blueprint tells the whole story of a digital solution, in terms of process, successes and challenges. You then have a one-page blueprinting summary which tells you about key insights and benefits achieved, and finally a technical annex, which offers a more detailed overview of implementing technical solutions and roll-out. At the moment, our library offers blueprints around clinical noting, bed management, remote monitoring and so on. Our libraries align with the business capabilities around the digital maturity assessment, and we’re looking to enhance and develop more on areas such cybersecurity and EPR.”
Digital access e-hub North West London
Aaron Hamilton, senior project manager for the Healthcare Centre London (HCL) GP Federation, took over the conversation at this point, along with Nigel Gausden, senior programme manager and subject matter expert in primary care and urgent care for Seneca Advisory.
Aaron explained that the federation covers 32 practices in central London and shared a little of HCL’s work, including operating several NHS contracts on behalf of their four PCNs and providing a range of support to practices and PCNs, running patient engagement and leading several transformation projects.
Nigel explained how the digital access e-hub project was funded, saying that North West London ICB wanted to help practices and primary care to work at scale and adopt new working practices around how patients want to access healthcare. On where the journey started, Nigel said, “We encouraged PCN clinical directors, through lots of engagement, to understand how they could work at-scale – what the benefits of this could be for their work-life balance and also for their practices.”
Aaron shared that HCL wanted to work towards the new GMS contract requirement and IIF requirements that came in for practices on online consultations for patients. They already had eConsult, he added, which was commissioned as an online consultation tool across NW London, before receiving seed funding from the NWL digital team.
“We took proposals to all of our practices around the at-scale delivery model, and we found that there was lots of anxiety about how they would manage online consultations. I think for some practices, it felt like we were opening another lane on the motorway that needed to be staffed, and they were so busy with the day-to-day work that there wasn’t really time for them to look at how they could take on online consultations at a practice level. So it was welcomed that the federation would do this on their behalf.”
When it came to getting practices on board, Nigel explained that as a digital first team, they had worked to put together a simple process for expression of interest, to say which practices, PCNs and groups of PCNs would be willing to test the model. This also worked to outline possible benefits and gauge appetite for collective working, sharing roles and combining budgets.
“We offered this out across NW London, which has a patient population of just over 2.6 million and over 350 practices, across 43 PCNs. One of the most expressive and forward-thinking ones was HCL, and we proceeded to award seed funding and work with them to develop their service,” he said. “When looking at deciding the operating model, we looked at the type of consultations that should be administered by the hub, how it would be financially sustainable post-seed funding, what ARRS roles were available at PCN level to support, and how we could support those who might be digitally excluded.”
Nigel added: “Crucially, we did a lot of internal marketing, so not only the GPs and the partners, but to the practice managers, reception staff, practice leads, and so on. They could then help us work on changing that direction, supporting the extended use of the NHS app, and linking that in with Patients Know Best.”
Realising the vision
Aaron shared some insight around the way that the hub’s overall vision was decided upon, through discussions with practices and PCNs. An agreement was reached that the hub should be supporting the more transactional care, whilst the relational issues would be going back to practices.
The digital first team initially rolled out an online consultation product during COVID. Nigel said that following a lot of patient and practice feedback, a new procurement process was launched which led to the procurement of PATCHs, which had “more integrated hub working or working-at-scale functionality”.
“We needed to ensure that that was available to everybody, that the full healthcare record could be seen when triaging. This was one entry point for the patient, offering a seamless patient journey. Data sharing agreements were put in place, and we also aligned this with the Accurx messaging platform for clinicians, so there was easy consultation with patients going forward, whether that was video consultation or a telephony consultation. Then we had common coding for requests coming through, with requests being visible to member practices, so HCL could see the amount that was coming in across the board rather than just a snapshot.”
Aaron talked about setting standard operating procedures for practices with inclusion and exclusion criteria, and how initially this was mainly care coordinators providing an administrative function. As time went on, however, they began “layering up” and including a clinical MDT within that.
“At HCL, we have data processing capabilities across our BI team, so we made sure we got good quality data back to practices – that meant they could see what patients were coming through, what times, what days, what they were coming for, what proportion of online consultations were closed at hub level and so on. We had a clear governance process, we did regular audits with mechanisms for regularly reviewing those, and we had tools for communicating across the team, using WhatsApp and MS Teams initially.”
Moving forward: the hub in practice
Around the development of the hub, Aaron highlighted the role of a senior clinical decision maker who oversaw decision making and processes to make sure they were safe, and the team’s work on creating a pilot with a small cohort of practices “to make sure we got it right”. Alongside their clear governance structure, they conducted liability mapping around patient journeys to test who was responsible and at what point.
“It was an in-hours service, so offered 8am-6:30pm Monday to Friday, with the team based at the HCL office. The core team was comprised of a GP clinical lead, six ARRS-funded care coordinators, and two ARRS-funded advanced nurse practitioners. Then we added in the extended team, which was the clinical pharmacists, first-contact physios, and then community pharmacist consultation service .”
“This work has given us a solid foundation to start to layer on top of. We are in the process of moving all of our practices onto one shared cloud telephony system, and linking that up so that the centralised hub can provide another layer of support to our practices via the team of already-dedicated care coordinators that have been working to process online consultations. We’ve got solid redirection pathways in place to redirect patients out into the community and self-help services; we’re in line with IIF targets; and we’ve made efficiency savings working at-scale and taking a centralised approach.”
When it came to accelerating the hub’s development, Aaron talked about some of the key features which had made an impact, including a new translate feature which enabled patient submissions in their native language, and a feature which allowed patients to dictate their symptoms which would then come through to the hub as an online consultation request.
“One of the things we did was we held a competition for practice administrators, acknowledging the input that they had, and the valuable role that they played in getting patients to submit online consultations. About two thirds of our practices were hitting those KPI targets of six percent of practice lists being registered for online consultations, and achieving a rate of one online consultation per 1,000 registered patients per day.”
Looking at where the hub is today, Nigel highlighted its impact on tackling same-day demand and the 8am rush, and the benefits offered to bring hard-to-reach patients on board, taking advantage of the ability to deal with multiple requests through one contact, “which helps practices with their targets and also leads into population healthcare which was one of the features of the PCN model”.
“HCL have really grabbed this with both hands and taken this model forward. It’s nowhere near the end of its journey; it’s probably nearer the beginning; but it’s already opened up opportunities to see what it can achieve in the future.”
We’d like to thank our panellists for their time in sharing these insights with us.
