Over the last 12 weeks, we’ve heard from 50 people implementing video consultations in different NHS organisations across the UK and Ireland. As the learning and insight project comes to an end, this is the final blog of the series. We’ve summarised the learning logs from 27 participants, reflecting on the achievements since COVID-19 hit, and what is needed to build on this work in the future.

Key themes

This blog highlights five factors that have enabled the implementation and scaling of video consultation services in such a short period of time and five priorities for further action to ensure lasting change and improvement:

 Factors

• Extraordinary efforts of staff
• Supportive teamwork and productive new relationships
• Shared learning and iterative improvement
• Management enabling staff to act and autonomy within teams
• Focus on quality and patients’ needs.

Priorities

• Action on digital inequalities
• Evidence of impact and effective use
• Training and support for staff
• Development of video consultation platforms
• Embedding it with standard processes and practices.

When there is clear direction from leadership, organisational buy-in and pressure to get a piece of work done, my NHS organisation can be agile, resolve governance issues quickly and move at a rapid pace

Factors that have enabled progress in the face of unprecedented challenge

Although well-documented already, it is worth reiterating how remarkable the speed and scale of progress around video consultations has been over the last three months. As one participant noted in their learning log, it has been “one of the strangest times we have ever, and may ever again, experience”. This time has also shown what health services can achieve, and how quickly they can change when all parts of the system prioritise a common goal.

The key factors underpinning the changes that participants highlight are:

• Extraordinary efforts and commitment. Many participants described the last few months as “exhausting” with a “relentless” workload. Although participants describe enormous pride in what they have achieved for themselves and patients, there is no doubt that a key factor underpinning the positive changes are long hours and discretionary effort from staff, which are not sustainable.
• Teamwork and new relationships. A supportive and caring team culture has helped many staff to adapt well to new ways of working: whether remote working generally or becoming familiar with video consultations. Participants also described new and different relationships between senior management, project teams, IT teams and clinical teams that have been hugely rewarding and will benefit future work; and there is a sense that people’s different levels and range of expertise have been well used and respected.

It’s been great for developing even more good relationships across the organisation. I love collaborating positively with people. Such a nice way to work

• Shared learning. Participants reflected on the importance of learning cultures to enable people to innovate, iterate and learn while so much was – and continues to be – unknown. This includes learning within and across organisations, via clinical networks and frequent internal meetings and communications, making time for reflective practice within teams and externally, including through their contributions to this project.
• Organisational leadership. As reflected in the first blog, many participants have described positive management that has enabled them to act and given more autonomy and authority to teams to progress with this work and make change quickly.

I feel lucky to work with colleagues who always go the extra mile for their clients and are open and keen to share ideas and resources. I would have previously considered us to be a relatively cautious group but this has shown that we have been agile enough to change quickly and effectively.

• Quality and patient focus. This focus has helped iterative improvement and continued growth. Most teams have now integrated patient and staff feedback processes and iterated their work based on this feedback. Although not the norm among participants, some have successfully engaged patients in co-design.

Priorities for the future

The key priorities participants identify for the future are:

• Action on digital inequalities. We explored a broad range of concerns around inequalities in an earlier blog. While recognising that there are many factors that affect inclusion and access to healthcare, it’s clear that digital exclusion remains a key concern for many.
• Robust evidence to inform the development and future use of video consultations. Understanding how, and in which circumstances, video consultations can and should be used for appropriate, effective and safe care alongside face to face, phone and other remote care pathways now and in the long-term remains a live question for many. This will need clinical services to adapt outcome measures to ensure they are appropriate for video consultations, and for shared learning to remain a priority as the evidence emerges.
• Training and support for staff. Some roles have and will change significantly, placing different demands on staff’s time and skills. High-quality training, support and resources are needed to increase skills and capabilities for engaging patients effectively via video.

The commitment of front line staff to serve their patients has been impressive. Although this has led to tension when the video consultation has not delivered what was hoped, it has been a key force driving change in video consultations (and other new ways of working).

• Development of different video consultation platforms. Connectivity and functionality issues with certain platforms are a continued source of frustration, and it affects quality and engagement with video consultations. These issues will need to be addressed alongside other digital infrastructure issues (such as Wi-Fi connectivity and access to equipment). More work is needed to understand whether it is appropriate for different organisations and services to use a range of platforms with different functionality and usability benefits, or whether more consistency and standardisation would be beneficial.
• Embedding video consultations as part of standard practices and processes. While increased autonomy has been a key enabler of the rapid change in many services, there is a call from some participants for more standardisation in the future. This includes greater consistency from commissioners and national organisations for how remote care pathways are supported, funded and governed, and making sure there is an ‘even playing field’ in skills and capabilities across different organisations. For the few participants whose work covers more than one organisation, their experience highlights the differences across organisations in terms of IT policies, infrastructure or digital capability that can hinder or enable this work. These organisational differences run the risk of widening inequalities linked to access (such as the postcode lottery of whether good quality remote care is offered) and make integrated, place-based, person-centred care much harder.

My bigger worries are considering how the future is going to look for our service and patients and also how different my job is likely to be. I never wanted a job role that meant I would be sitting in front of a computer all day and this is what my days look like now.

Through this insight project, we have learned a lot about how the remarkable changes of the last few months have been achieved. There is clearly continued enthusiasm for video consultations to play a long term role in care. At the same time, participants have reflected on a series of fairly consistent concerns around the future role and sustainability of video consultations. Without careful and considered action at this stage to address the five priority areas articulated in this blog, there is a danger that the full potential of video consultations will not be realised.

This project has provided us with a wealth of information and we will be taking some time to reflect on what has been learnt. Watch this space for a short summary from across the twelve weeks that will include key recommendations on successfully implementing video consultations and undertaking large-scale change projects.

With thanks

We are enormously grateful to all the participants in this project. They have generously shared open, honest and thoughtful insights to enable us to capture and take stock of the ups and downs of this work over the last 12 weeks, despite having incredibly demanding workloads. Thank you!

Read the previous blogs from this project on our initial insights, building for the long term, continued progress, improving quality and tackling inequalities and shifting gears.