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What is the challenge your project is going to address and how does it connect to your chosen theme?

The current service is hospital based. Patients don’t always see the best person for their needs. The waiting times can be long. This would reduce waits by only seeing the patients we need to in hospital.

We’d love it to be provided closer to home and this would be a shared care service between the GP, healthcare support worker, patients and hospital nurse specialists. It would use triage to determine the correct appointment so as to avoid both unnecessary appointments for the patient and delay in getting them to the right service.

It fit with the NHS long term plan to see patients differently and deliver less face to face appointments.  This approach would move face to face appointments in hospital to virtual triage and telephone follow up.  Patients would only be seen in hospital where absolutely necessary.

What does your project aim to achieve?

To manage patients in the community for possible sleep apnoea.  Patients would complete a questionnaire and use a provided piece of equipment to collect data during their sleep.  This would be sent by the GP practice to the hospital and managed as a virtual appointment (triage).  Follow up would then be by nurses from the hospital on the telephone.

We aim to see patients closer to home and provide a shared care and self monitoring service in line with our transformation strategy and the NHS plan.  It would increase virtual appointments, and reduce unnecessary face to face appointments.  We would be able to manage more patients via telephone (than we currently can face to face) and this would increase the productivity through our current clinic.

How will the project be delivered?

jointly with GPS and the CCG as a new shared care service.  We would aim to pilot this in four GP surgeries to start with – and we have selected those with the highest number of referrals as well as those showing interest in the idea (one pratice has bought an oximeter, but more are required to take this further).

We have established a programme board for outpatient transformation.  The clinical lead nurse for the service has completed a short project summary outlining the idea and has begun conversations with GPs.  We aim to hold a cheese and nibbles evening to gather momentum for the idea and enable clinician to clinician engagement on shaping the service.  We are working with our patient representative on engaging patients.

What and how is your project going to share learning throughout?

fully transferable to other Trusts.  We would transfer the concept to other services within our own Trust, we have already identified a number wishing to explore remote monitoring.

We would be very happy to spread this for adoption in other Trusts.  Our long term aim would be to provide this service to all GP surgeries/patients.  This could be a hub and spoke model in primary care rather than in every practice.

We would want to present this pilot at events and share the learning.  This is a very forward thinking team who have already transformed their service (regular group clinics are held, already remote monitoring patients) so this would be the next step to expand the service.

We are already discussing across three separate CCGs.

How you can contribute

  • ideas for how to negotiate this with GPS and the CCG, any examples of similar ideas. Pathways already defined in this area.

Plan timeline

1 Jul 2019 Scope out concept and idea
7 Jul 2019 Gather quotes from suppliers to understand potential
9 Jul 2019 Share early concept with Transformation Board and Exec lead
9 Jul 2019 Share early concept with Wiltshire CCG
18 Aug 2019 Develop idea into proposal to share with GPs and CCG leads
30 Sep 2019 Present idea in an engagement evening/afternoon
30 Nov 2019 Procure the equipment and software
31 Dec 2019 Communicate with patients, and book appointments
31 Jan 2020 Go live


  1. Love the idea, do you have sleep physiologists involved in the project?

  2. Congratulations on being shortlisted.

    Your project seems to fit with the strategic direction of most Trusts/ Health Boards of moving care into the community , when appropriate.

    It is also highly relevant as we face the challenge of rising obesity in our population obesity, and the effect this has individual lives, and  on NHS services.

  3. Guest

    Christian Subbe 1 year, 9 months ago

    The key for this project is to understand the rapid growth of sleep disordered breathing in conjunction of managing obesity. This is a really good idea as it has synergies with other services located in primary care, prevents fragmentation of patient journey and should have enough volume to make it viable at scale.

  4. Not sure how I can help with your project but am willing. May be some process (pathway) illustrations. I can put them on-line as a iterative development tool.

  5. Hi team,

    I wonder if it’s worth thinking about tariffs and testing the appetite for this? I have learnt from a couple of innovative ideas like this that getting an early conversation going with the CCG about this can be helpful. Sometimes you can negotiate a pilot tariff to test the idea. You tend to need to include economic impact in your evaluation and I also find logging the environmental impact is good too to demonstrate if there are any carbon savings alongside better patient experience outcomes from not having to drive and pay for parking.

    take care and good luck

    best wishes

    Anna 😊

    1. thanks Anna.  Yes we are working in partnership with our CCGs on our transformation programme for OPD and this type of approach is fully supported as part of working differently.  I agree this is very much needed to transform outpatients! thanks for the comment

    2. Things have progressed on the paediatric front - we're in the process of collecting formal data to supplement some qualitative parent feedback and thankfully have an excellent member of our local CCG who previously wrote a business case to set-up home sleep studies. The race will be on!

  6. Wonder if there's any potential link-up with Eleanor Lanning's project on here with regards sleep services?

  7. Sounds fantastic and could pioneer the way for paediatric services to follow suit! I'll be watching this space with lots of interest.

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