Hall Green Health’s new ‘Check and Cancel’ telephony system optimising appointment management
By Integrated Care Journal
The new ‘Check and Cancel’ feature was integrated into the practice’s existing cloud-telephony system, reducing the number of missed appointments and boosting patient access to GP services.
Hall Green Health (HGH), a large family practice within the NHS Birmingham and Solihull Clinical Commissioning Group, has recently achieved substantial success with the implementation of its ‘Check and Cancel’ system within its Surgery Connect Cloud-telephony framework.
This new approach to appointment management has not only improved patient accessibility but has also significantly reduced administrative burdens and missed appointments (DNAs), a critical issue in the industry.
The need for innovation
With a patient population of approximately 28,500, Hall Green Health, like GP practices across the country, has been undertaking the long journey toward digital transformation. One of the pressing challenges faced by the practice was the inefficiency in managing appointments. Traditional methods, which often relied on phone calls during limited office hours, led to a high number of missed appointments.
According to NHS England, the financial impact of patient no-shows is substantial, with the average nine-minute GP consultation costing £42. In just one month, these missed appointments cost the NHS well over £7 million in the Birmingham and Solihull region. HGH recognised the need for a solution that would not only make appointment management more efficient but also ensure that patients who are not as digitally literate or lack digital access could still easily manage their appointments. The ‘Check and Cancel’ system was introduced in March 2024 to address these challenges head-on.
Implementing ‘Check and Cancel’
The ‘Check and Cancel’ feature was integrated into HGH’s existing cloud-telephony system, providing patients with a 24/7 service to verify or cancel their appointments. This system was designed with simplicity and user-friendliness in mind, allowing patients to navigate the call flow without needing assistance from the practice staff.
Jamal Syed, Operations Manager at Hall Green Health, described the implementation process as swift and seamless. “Within 15 minutes of working out where to put it, it was successfully set up to work with our slot types and tested ready for patients to use,” Syed noted. This quick integration was critical in ensuring that the system could start delivering benefits immediately.
Positive outcomes and impact
The introduction of the ‘Check and Cancel’ system brought about immediate and measurable improvements in appointment management at Hall Green Health. By providing patients with round-the-clock access to manage their appointments, the system significantly reduced the number of missed appointments. In July 2024 alone, 292 appointments were checked, and 92 were cancelled using the system.
The system’s impact extended beyond just reducing missed appointments. It also proved to be a valuable tool in saving time for both patients and staff. Based on average call durations, the system saved the practice approximately 10 hours and 53 minutes in July 2024. “This time-saving aspect is particularly beneficial during the morning rush when the administrative workload is typically at its peak,” Syed added.
Patient and staff satisfaction
The success of the ‘Check and Cancel’ system was not only reflected in the numbers but also in the feedback from users. Of the 26 users who reviewed the system in July, 76.2 per cent expressed their willingness to use it again, and 47.8 per cent reported that the system saved them time; with an overall satisfaction rating of 3.71 out of 5, these early results are promising.
The ability to handle appointment-related queries efficiently and independently contributed to a higher level of patient satisfaction. For many patients, particularly those unable to access digital services during regular hours, the system offered a convenient and reliable alternative. “The significant number of appointments checked and cancelled indicates that patients utilised the system effectively, potentially reducing the number of missed appointments,” said a representative from HGH.
Future prospects and conclusions
The ‘Check and Cancel’ system at Hall Green Health exemplifies the potential of digital innovations in healthcare to enhance service delivery and patient satisfaction. By automating key aspects of appointment management, the system has not only relieved the administrative burden on staff but also empowered patients to take control of their healthcare needs.
Looking forward, the architecture used to build this system provides a strong foundation for future developments. As healthcare practices continue to face immense pressures, the ability to further automate and streamline tasks, particularly those involving patient verification, will be crucial. Hall Green Health’s success with this system highlights the importance of integrating simple, user-friendly digital solutions into healthcare practices to improve efficiency, reduce costs, and enhance patient care.
The implementation of the ‘Check and Cancel’ system at Hall Green Health has not only improved appointment accessibility and reduced missed appointments but also set a new standard for how digital solutions can be effectively integrated into primary care practices and its journey provides a blueprint for other practices aiming to embrace the future of healthcare.
Labour needs a preventative health strategy to transform public health
By Tina Woods
Business for Health Founder and CEO, Tina Woods, discusses the crucial role that business can play in improving the nation’s health, and calls on the Labour government to adopt a shift towards evidence-based prevention.
As the new Labour Government enters its early stages in power, it is increasingly clear that the party has inherited a sick workforce, rising levels of economic inactivity and unsustainable pressure on the NHS.
Tackling our current broken health system requires a long-term, multifaceted approach that shifts the UK’s societal attitude from reliance on the NHS to a culture of prevention. Going forward, creating a comprehensive preventative health strategy should be Labour’s focus.
Laying the foundations for a ‘prevention first’ revolution
Labour’s Health Mission in their manifesto states the aim to “deliver a ‘prevention first’ revolution”, and with the right partners and a clear strategy, this vision can become a reality.
While the ambition to halve heart attacks and strokes, create a smoke-free generation, and reduce health inequality are commendable, translating these goals into tangible policy and action will be crucial.
A preventative health strategy must go beyond individual behaviour change and address the wider determinants of health. This includes creating healthy environments, reforming the food system, and ensuring good work and housing for all. Crucially, it requires coordinated action across government departments, and wider businesses.
Easing pressures on hospitals
The UK’s poor public health is placing immense pressure on the NHS, resulting in many hospitals having far too many patients, with far too long waiting lists.
Despite over 95 per cent of the NHS budget being spent on treatment, with little ring-fenced for prevention, preventable conditions like obesity, heart disease, and lung cancer account for a significant proportion of hospital admissions and healthcare costs.
The government should set a target to allocate a specific percentage of the total health budget to evidence-based prevention programmes within 5 years, rising by 2030. Moving more pathways of care into community health will alleviate pressure on hospitals and create a more sustainable healthcare system. To support in setting and managing these targets, Business for Health has partnered with the Office for National Statistics (ONS) to deliver an enhanced ONS Health Index which will be vital in tracking against the Government’s health and wellbeing plans.
Business is essential in prevention
Alongside the NHS, businesses also have a crucial role to play in this agenda, and the Labour government must work to cultivate meaningful partnerships with the private sector.
By creating incentives and frameworks for improving health, small and medium-sized enterprises can be encouraged to do more; exploring legislation, such as making workplace health reporting mandatory for larger companies, is another driver. To support businesses in creating these strategies, the next iteration of the ONS Health Index will include additional data and tools which businesses will be able to use to understand the health of their workforce and customers better.
Looking ahead, business leaders and employees alike will be eager to see legislation and clear targets from the Labour government, accompanied by investment to support a prevention economy. Businesses are essential partners in creating healthy workplaces, promoting active lifestyles, and tackling issues like obesity and mental ill-health.
A prescription for the future
Ultimately, Labour’s health agenda must move beyond short-term fixes and invest in long-term system change. This will require bold political leadership, a willingness to tackle vested interests, and a collaborative, cross-party approach bringing together government, business, communities and individuals. Only then can we build a healthier, more prosperous future for the nation.
Optimising medication management: lessons from an NHS Trust
By Hardeep Bagga
Hardeep Bagga, Director of Pharmacy at University Hospitals Coventry and Warwickshire NHS Trust, discusses how best to manage the implementation of new technology following the success of digitalising pharmacy services.
University Hospitals Coventry and Warwickshire (UHCW) NHS Trust is one of the largest acute teaching Trusts in the UK, comprising University Hospital in Coventry and the Hospital of St Cross in Rugby, and working in partnership with Warwick University Medical School and Coventry University. It has more than 10,000 staff and delivers services across the West Midlands region. This includes hosting region-wide services such as the Coventry and Warwickshire Pathology Network and Bowel Cancer Screening programme.
In 2018, the Trust launched an ambitious target to begin a journey of digitising their medicines management systems, starting with a Trust-wide implementation of Automated Dispensing Systems to drive safe and legislative compliance with storage. At the time, medication storage was time and operationally intensive on pharmacy and nursing teams. The Trust was on a journey to establish Electronic Patient Records (EPR), and it was agreed that a solution was needed to bring together both challenges; improving medicines storage and security to fully leverage the power of a hospital EPR system.
Initially, we had to present a business case within the Trust, which included recognising the external and internal scrutiny required to ensure we had robust medicines storage; assessment of security, nurse-led audit work, as well as acknowledging the impact of medicines handling on Time to Care. A number of enthusiasts supportive of the programme were recruited from ICT, Nursing, Pharmacy and Estates teams.
Following a competitive tender process, we made the decision to partner with Omnicell UK, who provide advanced automation, data intelligence and professional services, in order to transform operational efficiency and improve patient experience in hospitals.
Omnicell initially worked with us on our first stage installation, which included introducing more than 70 Automated Dispensing Cabinets (ADCs) on wards, in theatres and clinics. Such was the scale of the operation that at the time, it was one of the largest and fastest European rollouts.
Unbeknown to us at the time of committing to the project, but we were inadvertently helping to prepare ourselves for the biggest healthcare challenge the NHS has ever witnessed – the Covid-19 pandemic. Since implementation, the Trust has improved management of medicines during shortages, taken waste out of operational delivery of the supply of medicines, informed teams around medicines safety during temperature deviations, and is now progressing towards closed-loop medicines administration.
Project and installation highlights include the following:
All wards and departments have automated dispensing systems for medication storage (72 units in total), including two in pharmacy for controlled drugs and after-hours support.
Medication Safety Officers (MSO) used a live view to track high demand, essential treatment medicines throughout Covid and beyond.
Temperature monitoring gives an overview of real time temperature of all stock areas to support informed decision-making during temperature deviations.
Digital ordering by automated dispensing systems has reduced nurse time handling medicines by using pharmacy team time saved from ordering medicines redeployed to fill cabinets instead of nurses.
Increasing breadth of stock holding as top up occurs thrice or more weekly, rather than just weekly, across the Trust.
Such was the success of the project, that over the entire pandemic, the wards never ran out of stock of essential Covid treatments by utilising this technology.
Essential elements in the change management process
An effective and well thought out change management process was crucial in gaining buy-in from internal stakeholders and in particular, the nursing team who would be day-to-day users and large beneficiaries of the new technology.
The Pharmacy team at University Hospitals Coventry and Warwickshire NHS Trust (9th from left: Hardeep Bagga)
Valuable best practice lessons can be taken from trusts such as ours, to help support the successful adoption of technologies across the healthcare sector. First and foremost, this includes the need to have a solid change management plan in place to drive employee engagement – employees haveto be part of the planning as much as the execution.
Adaptations to technology also tend to go more smoothly when applied from the ‘bottom up’. This can be done by assigning and engaging ‘change champions’ or representatives within different departments. The key overriding factor remains: be the lead on the timeline and rules of the technology, but let your employees decide how to run the show.
A good way to start, as we did at UHCW, was to encourage internal stakeholders to make a list of their wishes and goals from the project at the outset. This was supported by a clear communication and adaptation strategy which emphasised the value and usage of digitalising and automating pharmacy services, and the impact this would have on internal teams, as well as our patients. This helped to ensure the implementation process went smoothly and served to remind us all of the end goal when at times, the project ate into our time or we hit a bump in the road.
It’s important to work closely with your technology partners to ensure effective communication. Omnicell was key to understanding our workflow, mapping this out to ensure systems benefited the way we work, as well as providing ongoing education and training. As partners on the project, the post ‘go live’ support, which included floor walking and handholding for ‘live day’ and the week afterwards, was imperative.
The project is by no means complete and currently we are working towards a key milestone which will be to link the ADCs and our robotic dispensing system to Oracle-Cerner. This will mean that our patient record system will provide a live/real-time view of what’s stocked in cabinets, as well as streamlining workflow and retrieving medications. All with enhanced security and removing process waste to support closed-loop administration.
More recently…
Further enhancing the Trust’s technology adoption, we recently installed two large dispensing robots in pharmacy – Tom and Jerry – with a joint capacity to hold more than 50,000 packs of medication. Importantly, they have allowed for the automation of nearly two million medication transactions which were previously ‘hand-picked’. The time saved allowed a skill mix change within the department, releasing time for Medicines Management Assistants (MMAs). As a result, MMAs are now working directly on wards, and utilising automated cabinets to improve patients’ medication journeys. Dedicated medicines returns units have helped drive the better use of medication and recycling of stock medication at a ward level. The impact has been staggering, saving large amounts in waste prevention.
In addition, all ward stock medication top-ups are now fully automated; the ward ADC sends a message to the robots at 6am and all ward boxes are picked and packed by the robots before the staff come into work. This process previously required manual picking and an accuracy check by another senior colleague, but is now fully automated.
The Pharmacy team last year celebrated winning the CEO Team Award at the Trust’s Outstanding Service and Care Awards (OSCAs), which is positive recognition of its digital transformation.
Digital staffing initiative unlocks flexible working for London medics
By Integrated Care Journal
Thousands of junior doctors in London are to gain access to greater flexible working, following the introduction of a new digital staffing initiative being launched by Barts Health NHS Trust to tackle workforce pressures.
From September, more than 4,000 medics working across the Bart’s Health NHS Trust will be invited to join a new ‘digital staff bank’, which has been designed to make it easier for approved clinicians to pick up vacant shifts and work flexibly across each of the trust’s hospital sites.
The platform will enable the trust to instantly broadcast vacant shifts to a vast network of approved medics. Clinicians who are registered with the bank will then be able to apply for their preferred shifts via a connected app.
Use of the digital staff bank – which is being delivered in partnership with doctor-led staffing specialists Patchwork Health – will reduce time-intensive administration for staffing teams, by making it quicker and easier for them to source temporary workers. This will help them to reduce reliance on external agencies to fill vacant shifts, while giving clinicians greater control over when and where they work.
A connected data analytics tool, Patchwork Insights, will also give workforce teams at the trust access to a wealth of metrics and reporting capabilities generated by staff bank activities. It will surface valuable insights on staffing trends from across the trust, including the number of vacancies, shift fill rates, and pay rates across departments and sites. This will provide increased oversight and help the trust to deliver improved data-driven staffing.
The digital staff bank is being rolled out across the trust’s five main hospital sites: St Bartholomew’s, The Royal London, Mile End, Whipps Cross, and Newham. Following this initial roll-out, the initiative is set to expand to support additional clinicians and increase workforce collaboration in the capital.
John Simon, Head of Temporary Staffing at the Trust, commented: “The Trust is quite excited to partner with Patchwork on this innovative platform which will enhance the working experience of our staff and by extension, benefit patient care. We are encouraged by the positive results seen by some of our neighbouring organisations and look forward to a productive partnership.”
Dr Anas Nader, Co-Founder and CEO at Patchwork Health, commented: “We’re delighted to be working in partnership with Barts Health NHS Trust to support more flexible, sustainable staffing through the creation of this bespoke digital staff bank. Initiatives like these are paramount to supporting clinician wellbeing and boosting retention, while helping NHS teams weather rising workforce pressures and keep services running in line with patient demand. They are vital to building a strong, healthy and happy NHS workforce for future generations to come. We’re excited to continue innovating to support this with Barts Health NHS Trust, alongside our other fantastic NHS partners.”
Prioritise patient safety in design and rollout of EPR systems: report
By Integrated Care Journal
New report sets out emerging patient safety concerns relating to the implementation of electronic patient record systems in the NHS and calls for patient safety considerations to be at the heart of the design, development and rollout of EPRs.
A new report from Patient Safety Learning, a charity and independent voice for improving patient safety, has called for changes to the process of developing and rolling out electronic patient record (EPR) systems, emphasising greater prioritisation of patient safety and experience. The report, Electronic patient record systems: Putting patient safety at the heart of implementation, is based upon the observations and insights from a group of experts convened for a roundtable in June 2024 by Patient Safety Learning.
EPR systems collate patient data, including medical history, test results, clinicians’ observations and prescribed medications, from various sources, making it easier for healthcare professionals to access patient information. EPRs can vary from covering a single GP surgery, a single specialty area, or multiple areas within an NHS Trust serving hundreds of thousands of patients.
Their introduction into the NHS was identified as a key priority in the Department for Health and Social Care’s 2022 policy paper, A plan for digital health and social care, and as of November 2023, 90 per cent of NHS trusts had introduced an EPR.
However, the report outlines that there are significant patient safety risks associated with planning, implementing and using EPRs, as well as concerns around incident reporting.
The report explores several instances where avoidable harm has occurred due to poor implementation or usage of EPR systems. These include an example where a four-year-old received 10 times the intended dose of a coagulant on five separate occasions due to an undetected prescription error recorded on a medicines EPR system. Another incident, which resulted in a National Patient Safety Alert being issued in 2023, occurred when an EPR system being used in the maternity departments of at least 15 NHS trusts was found to be overwriting existing patient record data with new information and displaying incorrect safeguarding data, putting maternity patients at risk.
In another case from February 2024, a Coroner’s Prevention of Future Deaths report highlighted how a new EPR system contributed to the death of Emily Kate Harkleroad, a 31-year-old woman who died of a pulmonary embolism after delays in treatment at Country Durham and Darlington NHS Foundation Trust. The report found that “errors and delays in [her] medical treatment resulted in her not receiving the anticoagulant treatment that she needed, and which would, on a balance of probabilities, have prevented her death.”
The report offers ten principles for consideration for the safe implementation of EPR systems:
There should be robust standards for ensuring safety in EPR implementation and operationalisation. These standards should be accompanied by strong quality assurance and accountability mechanisms.
Patients should be engaged and involved in each stage of the implementation and delivery of EPR systems.
EPR system implementations should be planned and delivered as major organisational change programmes, not simply technical IT projects.
Healthcare professionals and those who will be the primary users of EPR systems should be involved in each stage of their design, planning and implementation.
There should be Board-level and senior leadership champions for EPR implementation programmes. These staff should be properly trained and experienced with the expertise to guide, support, and if necessary, challenge.
Communities of practice in EPR system implementation should be established to share knowledge, provide support and access to guidance.
Human factors experts should have a central role in EPR implementation, from design through to product selection and operationalisation.
Clinical Safety Officers, who play a key role in the success of EPR implementations, need to be expertly trained, resourced and supported.
Incident reporting and investigations should capture EPR-related safety issues and this should inform improvement in the future design and implementation of EPR systems.
Learning from EPR implementations should be shared transparently and widely across the healthcare system to ensure that risks are mitigated and managed, and to inform safety improvements. This relates to both NHS and independent sector organisations as well as with suppliers and procurement staff.
Commenting on the report, Patient Safety Learning Chief Executive, Helen Hughes, said: “EPR systems have significant potential to improve patient care and treatment. However, we are increasingly seeing cases where poor implementation of these new systems results in direct and indirect harm to patients. If we are to fully realise their benefits, patient safety must be at the heart of their design, development and rollout.
“To ensure the safety of EPR systems, it is vital that patient safety incidents associated with them are reported and acted upon. We need more transparency in reporting and sharing knowledge, of both errors and examples of good practice.
“We hope that this report can kick off an informed and transparent debate about these issues, leading to action that supports the safer implementation of EPR systems and reduces avoidable harm.”
ONS and Business for Health partner to enhance the ONS Health Index
By Integrated Care Journal
The Index will capture a wide range of health inputs, including wider societal and economic determinants, to fill the evidence gap on the interplay between health, business and work and encourage businesses to take responsibility for their impacts on health.
Business for Health and the Office for National Statistics (ONS) have announced a collaboration to develop the next iteration of the ONS Health Index – a tool to support businesses, local authorities, integrated care boards, and government on decisions to ‘invest for health and economic growth’ and inform the Treasury on the economic case for prevention.
The ONS Health Index, last published in summer 2023, measures health in its broadest terms and seeks to understand how it is changing over time. It tracks health in clinical terms (i.e. the prevalence of certain conditions), but also looks at the wider social, economic and environmental drivers of health, together with personal circumstances.
Building on these measures, the enhanced ONS Health Index will include additional data and tools relevant to businesses and their practices. These could range from capturing direct health impacts on employees and customers, to environmental impacts of a company’s products. This will increase the understanding of the interplay between health and business and work life and fill an important evidence gap. For example, it could be used at a local level to help measure corporate progress against key health and wellbeing aims.
More broadly, the additional business themed metrics will inform strategies around the link between health and wellbeing and workforce productivity, and the role of health within the Environmental Social and Governance discussion.
Business for Health, a business-led social venture, in collaboration with Lane Clark & Peacock (LCP), have identified demand from businesses and organisations for the continuation and enhancement of this tool to define their role in the economy and wider society.
They will engage with businesses to develop the next iteration of the Index that provides high-value data on the health and well-being of the nation, including the workforce. One of the key goals will be to encourage businesses to understand and take responsibility for their impacts on health. To this end, the next iteration of the ONS Health Index will seek to bring businesses into its core audiences and provide health-relevant data to the public that measures the impact of businesses on population health.
These additional data will aim to highlight key determinants influencing employee health, and in doing so, inform business decision-making and support organisational and corporate culture with health at its core.
With the UK’s general population currently facing significant health challenges, leading to long term economic inactivity and pressures on the health system, the enhancement of the ONS Health Index will enable focus on facilitating system change to improve health and wealth outcomes. This is vital for enhancing the health and economic resilience of the nation.
Tina Woods, CEO and Founder of Business for Health, said: “There is a clear need from businesses to receive better data on the role of health within wider workforce planning. The link between corporate culture and individuals’ physical and mental wellbeing is irrefutable and our role on the new ONS Health Index will act as a crucial tool in understanding how businesses can improve, report and measure their impact on health linked to economic growth.”
Lord Bethell, Former Health and Innovation Minister and Chair of Business for Health, said: “We are delighted to be working with the ONS and LCP to develop the next iteration of the ONS Health Index, which will differentiate itself by allowing companies to understand and define their social purpose alongside measuring their economic contribution.”
Jonathan Pearson Stuttard, Head of Health Analytics at LCP, said: “There is a need for employers, businesses and industry partners to work collaboratively with the government to ensure that long-term health challenges are tackled with the urgency that is required.”
Dr James Tucker, Deputy Director of Health, International and Partnerships, Office for National Statistics, said: “The importance of high-quality data to inform strategies and reporting on the health of our workforce is crucial. Working with businesses as core users of the next ONS Health Index will be key in accessing granular data from businesses to feed into the index and provide relevant health data.
NHS staff say new tech could help 18.6 million more patients a year get treatment, reveals new report
By Integrated Care Journal
Survey of 1,000 NHS staff finds that while progress has been made on digital integration and maturity within the NHS, millions more patients could benefit from further adoption of technology.
New research from Virgin Media O2 Business has found that three in five (61 per cent) NHS staff believe new digital solutions could help at least 18.6 million* more patients receive treatment annually. Surveying 1,000 senior decision-makers in public healthcare across the UK, the Bridging the digital gap in UK healthcare report shows nearly two fifths (38 per cent) believe that new digital tools could help the NHS to reach 3-5 per cent more patients each day – potentially benefitting at least 51,000 more people daily.
Technology is recognised as a key enabler of positive change in the health sector. According to the report, digital technologies, like electronic health recording and Internet of Things (IoT) devices for monitoring vital medicine, could significantly reduce the workloads of frontline staff and decrease patient waiting times, as noted by 4 out of 5 (86 per cent) NHS staff members surveyed. Nearly a quarter (23 per cent) of surveyed healthcare workers, ranging from clinical to admin and IT roles, believed that technological improvements could drive at least a 5 per cent increase in patient consultations, potentially helping up to 31 million additional people per year.
Since the introduction of integrated care systems across England in 2022, there has been significant digital progress building on wider integration approaches across the devolved nations. Nearly all (98 per cent) respondents acknowledged this has positively influenced hospital technology adoption in their locality. A further 51 per cent of staff felt that there has been significant progress in the standardisation of digital systems since January 2023.
With NHS structures varying across the UK, a clear regional divide persists as respondents identify varying levels of digital maturity. Over four-fifths (85 per cent) of surveyed staff in London, Belfast and Edinburgh agreed that current connectivity solutions in their area are effectively supporting efficient patient care. Yet, this number dropped to 65 per cent of staff in the South East, South West and Yorkshire and the Humber.
Mark Burton, Health and Social Care Lead, Virgin Media O2 Business, said that: “The introduction of integrated patient care has already had a positive impact on digital progress across the NHS. However, our findings demonstrate there is still a huge untapped opportunity to use technology to drive operational efficiencies for patients and staff across the UK.
“As the NHS becomes increasingly digital, prioritising digital skills and confidence for staff, fostering open communication and adopting a strategic approach to technology investment will be critical to continued progress. Public-private partnerships can help here, playing a significant role in delivering robust connectivity for an NHS that is ready for anything.”
Virgin Media O2 Business currently works with 174 NHS Trusts & Boards, representing about 70% of all those in the UK, to develop and deliver core connectivity solutions. These solutions allow teams to drive efficiencies within the NHS to enable a smoother delivery of patient care.
To further support frontline staff with efficiency and patient waiting times, Virgin Media O2 Business recently launched its ‘Care-ready Connectivity’ suite of health solutions in a move to help tackle the digital gap in British healthcare. The telco has also committed to partner with the UK Government and charity, Supporting Children with Diabetes, to donate recycled smartphones to help children of low income families access technology so they can monitor their blood glucose levels.
Learn more about Virgin Media O2 Business’ support for the sector here.
*Based on The King’s Fund’s findings: In total there was an estimated 1.7 million patient contacts with GP, community, mental health, hospital, NHS 111 and ambulance services in 2023/24. To calculate this for a 3 per cent annual increase, the sum is 1.7million daily interactions x 0.03 x 365
Study of digital self-management service evidences a 50% reduction in A&E attendances for COPD patients
By Integrated Care Journal
A study of a COPD digital supported self-management service delivered in Hull has achieved a 50 per cent reduction in A&E attendances and admissions for patients, resulting in significant savings for the local NHS Trust.
The study team were evaluating the Lenus Treat: COPD Supported Self-Management Service and have released early evaluation data, alongside an economic model, which indicate the service is both less costly and more effective than standard care.
COPD (chronic obstructive pulmonary disease) is a long-term progressive lung disease, which causes narrowing of the airways, making it difficult to breathe. It affects more than 1.7 million people across the UK, with almost 30,000 dying from it annually. Exacerbations caused by COPD are the second most common cause of emergency hospital admissions, accounting for 1 in 8 of all UK hospital admissions. The disease is predicted to cost the NHS £2.5 billion each year by 2030, largely because of the expense of these emergency admissions.
In Hull, emergency admissions for COPD patients over the age of 35 are nearly twice the national average, with 259.2 admissions per 100,000 compared to the national figure of 133.5 in the last available records during the pandemic. The city is one of the 20 most deprived districts/unitary authorities in England, with some neighbourhoods among the most deprived in the whole country according to the ONS.
However, researchers at Hull University Teaching Hospitals NHS Trust (HUTH), part of NHS Humber Health Partnership, have discovered early signs that offering patients Lenus Health’s digital support service, can reduce hospital admissions, with further potential to decrease the amount of time patients spend in hospital each year.
The Dynamic Rose study, funded by the Small Business Research Initiative (SBRI), recruited more than 100 patients from HUTH following an admission. Patients were then provided with a digital service to help them to recognise and self-report their symptoms, access self-management resources, and to directly communicate with the clinical team if there was cause for concern.
This potentially helped patients to identify when they were at early risk of exacerbation, so appropriate interventions could be actioned by clinicians, informed by the data captured from the patient, and shared in the service’s clinical dashboard.
Significant reduction in hospital admissions
In addition to the 50 per cent reduction in A&E attendance, interim results of the Dynamic Rose study also indicated a number of other impressive benefits as a result of the Lenus Treat: COPD Supported Self-Management Service. These included a reduction in hospital admissions of more than 50 per cent after the first month and a sustained reduction in hospital admissions of 45 per cent after three months compared to historic controls.
As part of an independent health economic evaluation undertaken by the York Health Economic Consortium funded through the project, the digital support service was modelled to be more effective and £1,749 less costly than standard care, per patient per annum.
By addressing the healthcare needs of COPD patients effectively, the digital support service from Lenus Health approach has been shown to improve patient outcomes but also reduce unscheduled healthcare resource use.
Paul McGinness, CEO of Lenus Health, said: “These results demonstrate that providing care teams with the right digital tools to virtually manage patients can improve health outcomes and release clinical capacity back into the system by reducing unscheduled hospital admissions. Our service was designed with patients and clinicians to align to their needs. It provides a supporting ‘digital hand on the shoulder’ of patients, while not being onerous for care workers to monitor and intervene when risk rises.”
Prof Michael Crooks, Respiratory Consultant at HUTH, said: “One of the characteristics of COPD is periods of worsening symptoms, called exacerbations. COPD exacerbations are a common reason for hospital attendance, admission and negatively affect sufferers’ quality of life. The Dynamic Rose study has provided early additional evidence, that builds on the work in Glasgow, that Lenus’s digital service can help to reduce the frequency of COPD exacerbations that require hospital treatment and admission. This has great potential to maintain patients’ wellbeing and also free-up valuable hospital resources.’’
Allyson, a 61 year-old patient using the service in Hull, said: “My confidence has increased since I’ve come under the team and on the app, it makes me more thoughtful, and I tend to not push it any more. Since I’ve learnt the breathing techniques, started filling out my daily questions, thinking about my condition, it has made a big difference. I’ve never gone so long without an antibiotic.”
The Lenus Health collaboration with HUTH follows a study with similarly impressive results of a 50 per cent reduction in hospital admissions and respiratory-related occupied bed days for participants at NHS Greater Glasgow and Clyde in Scotland. Full results and evidence from Hull will be published in clinical journals in due course.
Harnessing innovation to deliver medicines optimisation at scale
By Meera Parkash
In this case study, Meera Parkash, Clinical Facilitator, Population Health Management at Optum UK, discusses how medicines optimisation can help free up pharmacy capacity and deliver key improvements to population health management.
At a time when the health system is urgently seeking new ways to cut costs, improve outcomes and reduce health inequalities, there are three areas where medicines optimisation can make an important contribution.
The first is non-adherence to medicines. It is estimated that half of all patients are non-adherent to their prescribed medication, costing the NHS £500m every year. The second concerns over-ordering and over-prescribing. About £300m worth of medicines go unused each year, and around half of this cost is believed to be recoverable. The third and final relates to adverse drug events (ADEs) in primary care, leading to hospital admissions. An estimated 72 per cent of ADEs are avoidable, costing the NHS £100m every year.
Traditionally, clinicians have had to manually search for patients who may need changes to their medication approach. This is extremely time-consuming and may not always be accurate if the data being used is out of date.
Population360® changes this. By integrating fully with clinical systems, it automatically finds and presents opportunities to improve medication safety, non-adherence and cost-effectiveness all in one place – transforming the speed, accuracy and scale of these processes.
Other prescribing decision support tools focus mainly on acute prescriptions and can only process them one patient at a time, whereas Population360 can proactively manage an entire patient population for an ICS at once. It does this by providing safety and adherence alerts for high-risk cases while surfacing lists of patients who may benefit from medication changes.
In light of resourcing pressures on pharmacy teams – which limit the number of structured medication reviews, programme switches, or high-risk drugs monitoring they can undertake using traditional methods – Population360 frees up capacity and helps them cover more ground. This demonstrates that it can be an important enabler for delivering medicines optimisation strategies at scale.
Evidence of success
Working with a GP practice covering 10,000 patients, Population360 flagged opportunities to save £82,376 through simple medication switches and recommended 1,171 patients for an adherence or safety intervention over a three-month period.
Based on these, a single pharmacy technician successfully reviewed 16 patients in less than 30 minutes, actively booking tests for 14 patients and initiating a patient consultation and de-prescribe for another.
Another pharmacist reviewed all female patients prescribed sodium valproate based on a targeted clinical rule. The pharmacist contacted patients, reminding them to follow up with their consultant to ensure Annual Risk Acknowledgement Forms were up to date (most of which were not) and contraception was in place.
Both examples demonstrate clinicians working proactively, supporting structured medication reviews, and closing important gaps in care.
The lead pharmacist at the GP surgery said: “It (Population360) gives us these patients very, very quickly and we can review them and take appropriate action – some of these patients are hard to reach people which is also an advantage.”
To see how Optum advances medicines optimisation (MO) and to learn more about proactive prescribing at scale, please click here.
Vic Townshend: ‘Whole person’ understanding is reliant on intelligence-informed decisions
By Ameneh Saatchi
Vic Townshend, Programme Director for Population Health Management (PHM) at Lincolnshire ICS, speaks with Public Policy Projects’ Ameneh Saatchi.
Building capacity and capability for population health management (PHM) is perhaps one of the single most significant enablers of truly integrated care and ambitions for England’s 42 integrated care systems (ICSs). But while every ICS will place significant priority on establishing comprehensive PHM, immediate service pressures and restricted resources have led to mixed results across the country.
In Lincolnshire, the ICS has established the Lincolnshire ICS Population Health Management Programme, which uses a ground-breaking person-level linked dataset, recognised as one of the most extensive in the country. The Lincolnshire Joined Intelligence Dataset covers 100 per cent of the local GP registered population. It encompasses a range of data sources, including primary and secondary care, adult social care, elective waiting lists, deprivation indices, social vulnerability and isolation measures from the Office for National Statistics, Census data, and community asset registers.
This initiative originated with the NHS England sponsored Population Health Management development programme, which allowed for the system to test what PHM offered and supported the first linked dataset to be created for a proportion of the county’s population. Other systems do have linked datasets, but there are none currently known that have the same extent of sources and population coverage.
“I worked closely with the Director of Intelligence and Analytics [Katy Hardwick],” says Vic, explaining that the team entered a partnership with Optum UK, to build the first ever linked data set in 2019, which initially covered about 30 per cent of the population. “This gave us data joined at the personal level, allowing us to see a person’s journey through health and ill-health and how they interacted with services across Lincolnshire to support their needs.”
The data science tool employed by Lincolnshire ICS focuses primarily on measuring health and care utilisation across different contexts, emphasising unit of activity and associated indicative costs. Traditional metrics, such as length of stay are incorporated, offering a comprehensive view of resource utilisation. Moreover, the tool’s versatility allows for customised presentations of intelligence, enabling users to tailor insights to their specific needs. Insights into health inequalities are facilitated by comparing cohorts of individuals, shedding light on variation in outcomes and contributing to high quality decision-making.
In addition to traditional metrics and the sources listed above, the Lincolnshire dataset also encompasses prescribing and medicines utilisation data, facilitating a holistic, system-wide understanding of health and care activities, service utilisation and outcomes. The dataset captures activity from all community, acute and mental health services, drawing from data recorded in trusts’ National Minimum Data Sets. This ensures seamless integration of data, irrespective of where individuals receive treatment – even if that treatment is outside of Lincolnshire ICS.
In healthcare, intelligence-informed decision-making stands as a crucial factor in navigating complex systems effectively. Vic emphasises the importance of this approach, highlighting how linked data allows for a comprehensive understanding of the impact of interventions across healthcare settings.
“The linked data set allows us to identify where opportunities are for intervention and change [and] where we’re doing well,” Vic explains. “What it doesn’t tell us is what we should do with it, but it starts to prompt leaders to ask the right questions… there’s nobody in our system that just has diabetes, which brings into question why we are providing services for diabetics in silo when they have more than one long-term condition and are subject to many other wider determinants of health, such as deprivation.”
This enhanced visibility helps stakeholders to identify both direct and indirect benefits and drawbacks of interventions, leading to better-informed decisions.
“The linked data set allows intelligence-informed decision-making, [meaning] we can now see the impact of our actions across our organisational borders and identify indirect benefits and disbenefits. So, we can track how changes in general practice are improving outcomes across other services, or vice versa.”
The inclusion of indicative costing within the linked data set also provides insights into resource allocation and workforce interactions. This allows for a more subtle understanding of how resources are utilised within the healthcare system, facilitating efficient resource management and optimisation.
Evaluation plays a pivotal role in assessing the effectiveness of interventions and changes in healthcare delivery. Vic underscores the necessity of robust evaluation, encompassing both qualitative and quantitative measures. However, Vic also acknowledges the challenge of maintaining the usability of the linked dataset while incorporating qualitative elements, emphasising the need for flexibility in its development and usage.
“Intelligence-informed decision-making becomes your North Star; you’re all following the same intelligence that steers in the same direction, wherever you work within the system. It has allowed us to robustly evaluate qualitative and quantitative outcomes, so it’s not just about what we can measure in the dataset, but working with personalisation, understanding what outcomes are important to people.”
Overall, the linked data set serves as a valuable tool for identifying opportunities for intervention and making informed decisions that lead to improved outcomes for patient and wider health system.
Vic’s journey into PHM stems from a diverse background, transitioning from the RAF as a meteorology officer, to a decade in general management in healthcare, to change management in complex systems. A keen interest in data analysis has been the nexus between various positions throughout her career.
More recently, Vic has begun addressing performance improvement challenges in healthcare, focusing on the interconnectedness of prescribing practices and care pathways. As Director of the Population Health Management programme in Lincolnshire ICS, she emphasises the need for comprehensive, intelligence-informed decision-making in healthcare leadership, seeing it as pivotal for driving systemic change and improving outcomes. For Vic, PHM represents a transformative tool with the potential to fundamentally change healthcare systems and improve outcomes for all.
The inequality challenge
Intelligence Leads and Chief Analysts working within ICSs will have increasingly important roles in navigating the complexities of health inequalities. Such roles require skill sets that can play a crucial role in generating intelligence to inform various inquiries regarding clinical care outcomes, health and wellbeing, and wider determinants of health. By fostering relationships with them, healthcare professionals can gain access to previously untapped data sets or intelligence that can address longstanding questions or concerns.
While population health itself is not a new concept, the current level of focus being placed on PHM requires significant new infrastructure support, the need for which may not yet be universally recognised within individual health systems. Therefore, she advises initiating discussions with intelligence teams to explore existing available data and infrastructure.
Vic stresses the importance of incorporating intelligence specialists or analysts into discussions alongside clinicians and decision-makers. This tripartite arrangement ensures that data-driven insights inform decision-making processes effectively, leading to more informed and impactful strategy.
Wound care from the lens of population health management
Vic underscores several key priorities essential for improving Wound Care outcomes:
Consistent documentation on electronic systems
Vic emphasises the importance of developing consistent documentation of wound care activities on electronic systems across frontline services and at strategic level. This consistency ensures accurate data collection that is crucial, not only for clinical records, but also for evidence-based decision-making and outcome evaluation. This is something Lincolnshire ICS will be working to develop further, as Vic identifies a challenge in ensuring consistency across local teams to capture all necessary data for wound care. Addressing this challenge is fundamental for systems to improve efficiency and workforce challenges in the community but may require additional resources and strategies to improve documentation practices.
Personalised care approach
Vic discusses the need to personalise wound care, highlighting that different individuals may require different approaches based on their specific needs and preferences for self-care. This personalised approach ensures that care is tailored to everyone’s circumstances, improving overall outcomes.
Training and applying best practices
Ensuring that clinical teams involved in wound care across various organisations are trained in, and consistently utilise, best practices. This helps standardise care delivery with the aim of adhering to established standards and protocols and improves overall quality of care.
Evaluation and continuous improvement
Establishing mechanisms for evaluating the effectiveness of changes made in wound care practices and processes. This iterative approach to improvement allows for ongoing refinement and optimisation of care delivery. This involves identifying what works, what doesn’t, and adjusting accordingly to continuously improve care delivery.
Communication and engagement
Vic underscores the necessity of effective communication and engagement strategies to drive change and improve outcomes for individuals. Engaging the workforce and the population is essential for raising awareness about available treatments and promoting better understanding of wound care options.
Extending pharmacy services – the pros and cons
Vic acknowledges the potential of community pharmacists in wound care as they are in the heart of communities, close to the patients, and can have a further role in early intervention. But she raises concerns about the sustainability and consistency of extending their roles. Vic highlights challenges such as increased workload, inconsistent sign-up to extended services, and competing priorities within the pharmacy profession.
Vic also provides recommendations to apply population health management techniques to diabetes care for comprehensive support
Vic asserts the need to shift away from treating diabetes as a standalone condition and to instead adopt a holistic approach that addresses individuals’ overall health needs. She advocates for integrated care models that offer comprehensive support, ensuring that individuals receive assistance beyond diabetes management alone. This approach aims to improve overall health outcomes and reduce the likelihood of complications associated with diabetes, such as leg ulcers and amputations.
Empowering prevention strategies
Furthermore, Vic highlights the importance of prevention strategies in combating diabetes. She stresses the need for a cohesive and proactive focus on prevention, encompassing primary, secondary, and tertiary prevention efforts. By investing in preventive measures and proactive interventions, such as health and wellbeing initiatives and collaborations with voluntary sectors, individuals can be empowered to manage their diabetes effectively and avoid frequent visits to healthcare providers.
Personalised care: addressing individual needs
Lastly, Vic underscores the significance of a personalised approach to diabetes care. She advocates for a strengths-based conversation that empowers individuals to take charge of their health while ensuring that healthcare systems meet their personal needs. By tailoring care plans to individual circumstances and preferences, healthcare providers can address inequalities and deliver more effective and meaningful support. This collaborative approach involves engaging individuals in decision-making processes and considering factors such as housing, employment, and social support to create sustainable and equitable healthcare services. Figure 1 below demonstrates how population health analytics tools can improve outcomes and efficiency.
Figure 1: Population Health Management Tools, the bridge between the person and the system strategy (click to englarge)
Conclusion
Vic emphasises the critical need for consistent documentation of wound care activities across all levels of healthcare delivery. This ensures accurate data collection, essential for evidence-based decision-making and evaluating outcomes. Additionally, she underscores the importance of a personalised care approach, recognising that individual needs may vary significantly. Training in best practices, continuous evaluation, and effective communication and engagement strategies are identified as key priorities to drive improvements in wound care delivery.
However, a significant challenge arises from the inconsistent capture of data by community nurses. This gap in documentation poses a barrier to comprehensive data analysis and evidence-based decision-making. Addressing this challenge will require focused efforts to improve documentation practices and ensure that all relevant data are captured accurately. By prioritising efforts to enhance data collection consistency, healthcare providers can strengthen the foundation for effective wound care delivery and evaluation.
What’s next?
Diabetes and wound care are the second and third highest expense to the health system respectively, and impact millions of people in the United Kingdom. Public Policy Projects is launching the second part of its Diabetes Care programme in the autumn of 2024 called ‘Holistic approaches to diabetes care – treating the whole patient’. Vic Townshend will be presenting on 2nd December, in London at the PPP Wound Care conference.
Contact Ameneh Saatchi, Director of Market Access for Diabetes and Wound Care, should you wish to learn more about these programmes: ameneh.saatchi@publicpolicyprojects.com
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