Oli Hudson, content director at Wilmington Healthcare, explores some of the new pathways in the NHS’ ‘digital playbook’
The new world of digital services in the NHS is taking shape – and it points the way to how the patient journey will look in the future.
NHS England has just published a series of ‘digital playbooks’ – best practice resources from around the country covering five major therapy areas including cardiology, respiratory, dermatology musculoskeletal, and ophthalmology.
Each of these explore the latest developments in remote consultation, virtual outpatients clinics, remote monitoring, appointment management, AI-assisted analysis and online rehabilitation.
The playbooks look at all stages of the pathway, so for example in the cardiology playbook, there are resources to help manage patients through referral management, primary care, diagnostics, outpatients, surgery and inpatients, and community rehabilitation.
In the surgery section, pre- and post- operative aids are available, such as via health and care videos to provide perioperative guidance, or telehealth for managing pre-operative hypertension.
Taking the musculoskeletal playbook as a model, we see an expansion of virtual clinic models.
King’s College Hospital NHS Foundation Trust introduced a virtual fracture clinic (VFC) model for patients with an acute bone injury not requiring immediate on-call review. All patients are referred into a virtual review, which takes place within 72 hours of their attendance at A&E.
Following the introduction of the VFC model, all patients are now referred into a virtual review. There are written guidelines for the management of the most common injuries, so the care is standardised between all clinicians on both sites. The most appropriate treatment for their injury is now started immediately.
The result has been that after VFC review, 48% of patients no longer require a face to face fracture clinic review.
For remote consultations, Northumbria Healthcare FT provides a way forward.
After the first nationwide lockdown, the trust fitted all of the outpatient department consultation rooms with video consultation hardware. Approximately 40% of patients have accepted a video consultation over other methods to date and many say they prefer this method to a telephone call. The hardware can also be used for remote monitoring.
On the clinician side, several areas have introduced virtual decision making, involving online meetings of everyone in multidisciplinary teams (MDTs) – for example in the Sussex MSK partnership.
Previously, face to face meetings were the norm. For orthopaedics this mainly meant physiotherapists, osteopaths and psychologists, with little input from secondary care.
Now, in the partnerships own words, ‘a truly MDT meeting can take place, as neurosurgeons, pain consultants, GPs with special interest in rheumatology and advanced practitioners in pain and spine all share the same virtual space, discussing and streamlining patient care’.
It’s noteworthy that Sussex MSK is working as an integrated care service, putting together previously disparate stakeholders into one therapy-area focused group. This kind of collaborative working is likely to become the norm as the NHS Long-term plan, which endorses this way of working, is having a real world impact on health services – only accelerated by the recent government White Paper on integration.
Medtech has two takehomes here; firstly, the establishment of digital technologies in patient pathways – now becoming standard since the pandemic - will have a long lasting and profound affect on the relationship between patients and hospitals. The likelihood is that over the next few years patient numbers in secondary care will reduce owing to a genuine movement towards out of hospital care – not withstanding the current elective care backlog of course.
Secondly, that the stakeholder group of the future – and the decision-making unit responsible for using medtech products – will be one that is digitally connected and digitally enabled.
How can medtech respond? In education, events and sponsorship, there are opportunities here to support this transformative digital agenda, and via Industry’s territory-wide scope and networking ability, there are chances to bring together clinicians by informing them of these latest developments, and the potential benefits to patients, local systems, and the NHS that are available.
