Meet the team
Portfolio GP, Clinical Director Primary Care West Hampshire CCG, Honorary Research Fellow Academic Unit of Primary Care Southampton
European Academy Allergy and Immunology ,Southampton University
- England - Wessex
Consultant Pharmacist & EHRS Patient Safety Lead / Senior Honorary Lecturer / Director, CMORE
UCLH NHS Foundation Trust
- England - London (North, East and Essex)
- Prof M. T. Krishna (Consultant Allergist) Joint Co lead
- Dr Ravishankar Sargur (Consultant Immunologist)
- Ben Pain, IT Royal College Physicians
What is the challenge your project is going to address and how does it connect to your chosen theme?
1 in 4 British people have an allergy. There is an unmet need for allergy services in the NHS leading to long waiting times (several months to a year!), lack of equitable access and suboptimal care. Some parts of the UK do not have a local allergy clinic and patients travel long distances to consult with a specialist. Undergraduate training in allergy is poor. The basic principle underpinning good allergy practice involves good history taking. A high proportion of referrals to adult allergy services are for ‘spurious allergy’, ‘allergy mimics’ or for relatively straightforward allergies. Allergy tests are not performed routinely unless an allergy is likely. Hence, tele-allergy lends itself as an excellent triage tool to screen referrals. Whilst tele-allergy is promising, further research is needed to define referral pathways, standardisation, governance, outcome measures, safety and its acceptance amongst patients and healthcare professionals.
Allergy, the unmet need, RCP (2003)
What does your project aim to achieve?
- Conduct a feasibility study to explore facilitators and barriers for a tele-allergy service
- Involve and seek feedback from patients & relevant stakeholder’s regarding tele-allergy and develop quality outcomes, governance framework, referral pathways and estimate cost saving
Methods: Conduct tele-allergy clinics in 2 regional centres involving 3 scenarios – antibiotic allergy, chronic urticaria and allergic rhinitis. 10 patients from each scenario (30 per/centre) will undergo tele-consults. A behaviour science expert will interview 15-20 patients to explore facilitators and barriers. 2 focus groups sessions with relevant stake holders in primary and secondary care will be conducted to explore study objectives. Decision analytic modelling will be implemented to study the current allergy care pathway to investigate the potential cost-effectiveness of tele-allergy.
Benefits: An equitable, cost-effective service. Reduction in wait times, time off work and travel.
How will the project be delivered?
The investigators comprise a very experienced, highly skilled multidisciplinary team capable of delivering this project. The centres have high throughput of allergy patients. Prof Krishna is a clinical academic, clinical lead for the RCP allergy accreditation programme (IQAS) with relevant experience in standard setting, QI/QA and has led multiple national audits. Drs Jani and Angier are Q members. Dr Jani is a senior pharmacist and an expert in behaviour science Dr Angier is a GP with an MSc in allergy. Dr Sargur is a senior clinical immunologist holding an MBA in health service management. The team has a strong publication record. We plan to involve a health economist.
Ben pain from the RCP has offered to help with technical advice if needed.
The investigators are fully committed to quality improvement, are experienced in conducting tele-allergy consults and have liaised (and will continue to work closely) with patients, patient organisations and stakeholders across the country.
What and how is your project going to share learning throughout?
Whilst this a speciality-specific project, it involves a number of generic elements as building blocks including use of telemedicine, engagement with patients and relevant multidisciplinary stakeholders to explore facilitators and barriers to introduce a new service model, constructing a ‘fit for purpose’ patient-related outcome measures (PROMs) and a robust governance framework. This experience is invaluable moving forward for developing other projects on its shoulders! Equally, the investigators will learn from previous Q projects to help succeed in this study.
Importantly, this project involves antibiotic allergy, and specifically creates an opportunity to tackle ‘spurious penicillin allergy’, which is a global health problem, costing millions of pounds each year for the NHS and is of great interest to all disciplines and in all areas of health service who are impacted by this
Learning could be shared via updates and twitter and a blog.
How you can contribute
- We will liaise with the Barts hospital team who were previous award winners to roll out telemedicine and also Newham diabetes to look at lessons learned.
- We can participate in Q exchange activities.
- We have shared this idea via twitter and had helpful feedback and will continue to do this with updates
- IT expert Ben Pain is helping us
- We are interested in linking with networkers and critical friends who can help spread the word but also challenge us constructively
- The Q community ideas on how this could help with drug allergy and how this affects the Q community at the moment would be helpful.
- We would value promotors of our ideas via twitter and other platforms to help champion the work.
- Any members who can act as fixers pointing us to resources and answering specific queries.
- If Q members would like to collaborate now or in the future, we would benefit from this.
- Strategists who can link to the wider context and policy would be helpful.
|30 Sep 2019||: Stage 1: Planning with PPI and stakeholders|
|2 Dec 2019||Tele-allergy clinics, patient recruitment and qualitative|
|1 Apr 2020||Implementation PDSA|
|3 Aug 2020||Dissemination|