Q Exchange

Co-designing the use of NHS Near Me at home

NHS Near Me uses telehealth to provide hospital outpatient appointments in rural NHS facilities. We want to co-design the next step with patients: providing appointments for patients at home

Read comments 31

Winning idea
2018

Meet the team: NHS Near Me

Also:

Michelle Roxburgh, Assistant Head of Nursing, University of the Highlands and Islands
Laura MacDonald, Project Support Officer, NHS Near Me, NHS Highland
Gill McVicar, Director of Transformation and Quality Improvement, NHS Highland

Our idea in a nutshell

Every year, thousands of patients travel from distant locations across NHS Highland to attend out-patient appointments in a central hospital. To be honest, this isn’t good enough: asking patients to travel for several hours to attend a 10-minute appointment is not patient-centred. To improve this, NHS Highland has developed a new service called NHS Near Me. It uses video technology to enable patients to have consultations at a remote site. So far, we have provided NHS Near Me from local NHS facilities (rural hospitals or clinics). The next step is to enable patients to use the service from home. This bid aims to develop the at-home service by co-designing the service with patients in one remote and rural location, namely the Isle of Skye. Specifically, we would use the funding to work intensively with patients before, during and after the introduction of NHS Near Me at home to ensure the service meets their needs.

Our aim

The aim of this project is to adopt the use of NHS Near Me at home in the Isle of Skye with the local community using co-design principles by June 2019. It is well recognised that you cannot just ‘lift and shift’ an intervention from one setting to another (Horton 2016). Despite having NHS Near Me in place in NHS facilities, we don’t know yet how to provide the service for patients at home. The role of context has been well rehearsed in the improvement science literature (Øvretveit 2014; Dixon-Woods 2014; Newbronner et al 2013) therefore further work needs to be undertaken to understand the next part of our service development. Changing the way out-patient appointments are delivered so that patients are supported to utilise video consultations from home is challenging – it involves redefining roles, assumptions, as well as putting in place processes and infrastructure that support the use of NHS Near Me.

How we would do it

Stage 1: Exploring the idea – public information session and focus group to present the use of NHS Near Me to patients/public. Provide rationale for the intervention and evidence of its use from previous Near Me clinic experience. Record a facilitated discussion on assumptions, fears, understanding, opportunities and threats. Identify patients/public members interested in assisting. Conduct focus group interviews with public members to gather initial ideas, thoughts and concerns. (0-3 months)

Stage 2: Ideation workshop – present the intervention and describe which components are fixed (i.e. the technology) and flexible (how the local community can best use it). Hold a facilitative workshop to co-design a process flow map for Near Me. Generate ideas for adapting and testing. Test various steps in the process. Use PDSA cycles for testing and learning. Arrange a focus group interview with public members to gather patient experience and inform further testing and spread within Skye. (3-6 months)

Stage 3: Implementation – the final process will be agreed at an open forum with public members before implementation. Conduct a focus group to gather experience of implementation and the use of Near Me. (6 – 9 months)

Stage 4: Dissemination – Prepare report with the public for dissemination. Write a 3 monthly blog to both inform and learn from the Q community. (9-12 months)

To see if the new service works, we would measure the number of patients using the Near Me service at home. But more importantly, data from patient experience focus groups will aid understanding of the intervention and implementation process.

What’s the benefit?

Patients

The ultimate benefit is to give patients easy access to specialist care. By engaging patients in developing the NHS Near Me at-home service, we think the service will better deliver what patients need. Although we will initially focus on a rural community, offering telehealth services helps patients in urban locations too, for example by reducing the need to take time off work to attend appointments.

Organisation

We anticipate cost saving to NHS Highland for reduced travel for both patients and clinicians, and reduced waiting times. Reducing travel will also reduce NHS Highland’s carbon dioxide emissions which will contribute to the Scottish Government aim of a 42% reduction in greenhouse gas emissions by 2020 (Scottish Government 2018).

Q community

Learning from our experience could aid other Q members to implement use of telehealth within their communities. We plan to write a 3-monthly blog to both inform and learn from the Q community. We believe the learning can be applied not just to hospital outpatient appointments in other NHS organisations, but also to other clinical situations, for example, primary care and out of hours care. A clearer understanding of patients’ views on the use of video consulting in NHS appointments could be useful for many services. Our materials, such as standard processes and patient resources, would be useful for others implementing something similar.

How you can contribute

We need advice and tips on successful use of co-design of services
We need some critical friends to challenge the idea to help improve it

Reviewer feedback

This is a great project because…

The challenge the team are working on has wide applicability for others. There is a strong emphasis on co-production with a focus on implementing technology sensitively rather than on building the technology itself.

By the time of the event we encourage the project team to think more about…

The team should connect to other teams working on this challenge to ensure they are benefiting from their experience. Some things to consider would be the practicalities of implementation and how they can share their learning more broadly beyond the scope.

Comments

Helen Kay Pye 20 Sep 2018

this is brilliant news !

well done

keen to keep in close contact about progress and help with any connections for work we have underway in our rural settings

thanks

Helen
Clare Morrison 24 Aug 2018

Thanks very much for setting this up, I'm really looking forward to it
Matthew Mezey 24 Aug 2018

Want to learn more about what Coproduction is - and isn't? Want help and advice with your own improvement project's co-production challenges?

Do join next month's zoom video call with Q's Coproduction SIG and Coproduction expert Carol Munt.

To register go here: https://q.health.org.uk/event/what-is-coproduction-and-how-can-you-make-it-work-for-your-improvement-project-with-carol-munt-zoom-call-14-sept-12-30pm/

Bring your challenges!
1. Matthew Mezey 24 Aug 2018
  
  NB Q's Coproduction SIG has organised this video call after Michelle Beattie - a member of the 'Co-designing the use of NHS Near Me at home' team - noticed that there are at least 10 'Q Exchange' short-listed projects using co-production.
  
  Michelle wondered: "Is there a smart way to connect us all, perhaps via this SIG, to share and learn from each other (as opposed to replying to each individual project)?"
  
  Do join the call!
Louise Wilson 21 Jul 2018

Great to see this project short-listed - so many patients in remote, rural and island settings can benefit from this approach and indeed can benefit those in urban settings as we focus on the elements of a consultation that generate patient value.
1. Clare Morrison 23 Jul 2018
  
  Thanks very much for your support Louise. Yes, we've been focused on the remote & rural settings but actually there are many benefits in urban settings too. These benefits aren't just about travel - one of the less obvious benefits is around enabling patients to have family members with them at appointments, both in the same room but also as an additional video participant at a different location.
Clare Morrison 20 Jul 2018

Absolutely delighted to have been short-listed - thank you so much to everyone involved in developing, commenting on, supporting and reviewing this idea.

Thank you to the reviewers for the feedback, we are very keen to learn from others working on similar projects and will contact other teams before the September event.
Clare Morrison 18 Jun 2018

Hi Susan and Owen

Thanks very much for your comments. It would be great to learn from you both.

We have some experience of providing patients with remote appointments with pharmacists via the Pharmacy Anywhere service, but that had limited uptake of video calls due to poor internet connectivity (patients tended to opt for phone appointments instead and that worked really well, but there is an advantage of a video call). Also, the systems that support Pharmacy Anywhere are in primary care so are very different to the hospital systems in NHS Near Me.

Clare
Owen Hughes 12 Jun 2018

Hi Clare,

We are already offering clinical appointments via Skype here in rural mid Wales. We work with people who have long term health conditions and has already saved us and the people who use our services many travel miles. As I write a colleague is following up a client who is on holiday in Italy. The opportunities are endless!!!

We'd be happy to share our experiences particularly if it means you not having to go through the same long winded processes as we have had to.

Best wishes,

Owen
1. Michelle Beattie 31 Aug 2018
  
  Hello Owen
  
  I would be keen to hear your experiences of using Skype for remote appointments. Could you spare a few minutes to discuss sometime soon?
  
  Thanks
  
  Michelle
Susan Bishop 7 Jun 2018

Hi Clare, great to see this and Rosie's prompt to the Barts work. Our context is mix of rural and urban too, so we have your challenges of internet connectivity, making it as easy to use as possible and clinicians maybe not seeing benefits. Starting out to explore now use in an integrated health and social care team for assessment, so keen to share learning at some point. Wondering if you have already done this?
Clare Morrison 23 May 2018

Thanks very much for the offer Tom, that’s really appreciated. I think you are right that there would be an application in Wales and I would suggest for any rural location - so hopefully our application would result in useful learning for services in rural areas across the UK
Thomas John Rose 23 May 2018

Clare, My sister lives in mid Wales and has recently had to travel to Liverpool for short appointments. Your application would be great for her. If you need any process mapping done for your project just give me a shout. Regards Tom
Clare Morrison 22 May 2018

Hi Rosie

Thanks very much for your reply, from your link I found the project website and they have just published the findings: https://www.jmir.org/2018/4/e150/

It's a very interesting project because there are significant parallels with what we have found in the initial development of NHS Near Me, which to date has been about providing outpatient consultations by video at a remote clinic within an NHS facility (rather than to patients at home). So key issues the study highlights include the infrastructure and the systems required (eg, how a patient "arrives" in a virtual clinic and is checked in by reception). It notes: "This study has, in some way, revealed and explored the challenges to establishing video outpatient consultations as a real-world service. Overcoming those challenges will not be easy, but further in-depth case studies in both comparable and contrasting settings are likely to enrich our understanding. As more health care organizations make the strategic decision to introduce video consultation services, research could explore the collaboration and mutual learning that occurs between them and test approaches to supporting that interorganizational interaction." I hope our learning from the first stage of NHS Near Me could already be such a case study.

The big difference between our setting and that of this study is the level of internet connectivity. It notes: "Our finding that, in contrast with concerns raised by previous authors, the technical quality of Skype interactions via available broadband in London was almost always adequate affirms a recent study by others of 4G mobile technology."

Unfortunately we don't have anything like that level of internet connectivity in the rural Scottish Highlands. Therefore, a key contribution we hope our project would make to this agenda is to consider how this barrier can be overcome.

Thanks very much for highlighting this very useful project
Clare Morrison 22 May 2018

Thanks very much for your support Rachel
Rosie Graham 21 May 2018

There is a Scaling Up Improvement Health Foundation project led by Barts Health NHS Trust called ‘Scaling up virtual consultations across the NHS – implementing, evaluating and sustaining improvements’.

Barts Health NHS Trust has been exploring the use of video consultations via Skype, and the impact on patient attendance rates, patient satisfaction and efficiency savings. They have developed significant expertise in the area and have produced standard operating procedures, information governance and technical guidance documents, and protocols for setting up and running virtual clinics.

I thought this might be of interest. You can find out more about this project here:

https://www.health.org.uk/programmes/scaling-improvement/projects/scaling-virtual-consultations-across-nhs-%E2%80%93-implementing
Rachel Hignett 21 May 2018

Fantastic idea - this would have such a huge impact on improving the quality of so many patients’ lives in remote areas. Love the video! Good luck Near Me team!
Paula Scullin 18 May 2018

This is a fantastic project which helps patients directly and public health by reducing the carbon footprint of assessing patients. There is huge potential for spread.
1. Clare Morrison 18 May 2018
  
  Thanks very much for your support, you are absolutely right about being able to reduce our carbon footprint through this service
Fiona Mitchelhill 18 May 2018

A great project and hopefully you get the funds to build on this, rurality in the North of Scotland is a challenge for the people who live there and are in need of healthcare. This has the potential to make a big impact for people and which could be spread across the North Region. Good luck
1. Clare Morrison 18 May 2018
  
  Thank you so much for your support. I think telehealth offers us a huge opportunity to improve services for patients in rural areas
Jennifer Wilson 17 May 2018

This is a great project Clare ! The video is fantastic ?
1. Clare Morrison 17 May 2018
  
  Thank you so much, I will slow the video down a bit but glad you liked it
Rosie Cooper 17 May 2018

A hugely valuable piece of work with the potential to accelerate the implementation & spread accross other parts of Scotland and further afield as you sharing your experience & learning. Equally a enormous boon to the people in the Highlands. Good luck.
1. Clare Morrison 17 May 2018
  
  Thanks very much for your support Rosie, hopefully there will be learning from this that would be useful for you in Grampian.
Calum McGregor 17 May 2018

Great idea! Good luck with this
1. Clare Morrison 17 May 2018
  
  Thanks very much for your support Calum
richard walsh 17 May 2018

Fantastic idea to co design accessible service. A QI programme we can learn from internationally
1. Clare Morrison 17 May 2018
  
  Thanks very much Richard, we would be delighted to share the learning with you
Laura Ryan 16 May 2018

a brilliant idea. The video is v v good. Gives correct messages. It does play the words quickly... maybe a little shower would be good. Also could there be a browsealoud facility so it can be narrated. Finally is best me different/related to “attend anywhere” ?

Laura
1. Clare Morrison 16 May 2018
  
  Thanks very much for your comments. I will slow the video down - we were keen to keep it short and therefore better for social media, but I suspect I have gone too far, a few extra seconds to slow it down are needed. I could add a narration too. Useful advice, thank you.
  
  Yes, NHS Near Me is powered by Attend Anywhere but we have given it our own brand to explain the whole service/system for remote consultations we are introducing rather than just the video consulting part itself.
  
  Thanks again, Clare