Transforming our multi-clinician Frailty MDT to a completely virtual offsite service came with specific challenges because of the COVID 19 pandemic  i.e. the re-engagement of stakeholders.  Because we already had an established service and designated MDT members it was thought that liaising with them would be straight forward.  However, the challenge came because the COVID pandemic meant that a lot of clinicians were either redeployed, committed to a pan Birmingham Programme to provide urgent assessment and treatment to people to avoid hospital admissions or they did not have the capacity to reengage with the service.  Therefore, a lot of our time was spent re-building rapport and re-establishing relationships to promote the service and publicise the outcomes that were achieved previously from the service. Re-establishing this shared purpose was key to rebuild foundation for success.  In addition to this we had to re-establish the concept of the service which was to contribute to the early assessment and identification and management of individuals living with frailty therefore delivering preventative care to avoid hospital admissions and supporting people living in the community.

The fact that the service would now be delivered virtually was viewed a positive to engage existing and new clinicians to the MDT who commented on the advantages of this in relation to their clinical time.  We also organised internal engagement sessions with our Federation GPs to promote the relaunch and expansion of the service which would not include triage with specialist clinician to replicate the delivery model of our existing Diabetes, CKD and Dermatology clinics. This has consequently resulted in a larger volume of referrals to the service from across the Federation. So this has reinforced the need to set aside ample time in the planning process for stakeholder engagement and understand the different ways that COVID has affected services and the workforce.

Having built the relationship with a range of stakeholders there is a need to understand how they work and their processes and how this will fit into delivering a virtual service. The assessment of each individual referred to the service with moderate and severe Frailty results in the gold standard Comprehensive Geriatric Assessment. This assessment takes 2 hours and generates a lot of information.  To enable a productive and efficient MDT, the cases for discussion were shared with the MDT prior to the meeting for their information and to check their systems to see if the individual is known to them.

One of the voluntary sector organisations were initially overwhelmed with the quantity and the level of medical information.  Because there is an assumption that members have medical knowledge and will understand the details this was overlooked and resulted in emails and further discussions about what is and is not relevant for their organisation to be aware of prior to each meeting.  Also the use of technology and access to delivery of the MDT needed to be considered and agreed prior to arranging the MDT.   Consideration was also given to the governance of sharing the information in a secure way

Now that the process is in place for referrals and assessment the next steps will be the expansion of the MDT to include other stakeholders i.e. Social Services and additional Allied Health Professionals i.e. SALT and Dietician.

We have requested that clinicians give feedback at all stages of their involvement with the service to share good practice.  It is also important at this stage to get feedback from the patients and families about their experience of the service which will help shape the service going forward.  It is planned to use this feedback and patient reported outcomes to further promote the service to all stakeholders to encourage continued use of the service.

The service has highlighted the need for training about frailty which has been requested by the voluntary sector for their link workers i.e. the Social Prescribers and also from community services. A series of training sessions will be arranged with these organisations using the Skills for Health Frailty a Framework of core capabilities.

The project was delayed due to staff redeployment, we have now secured a modified restart of the project for the planning and design to start this month. The goals and objectives remain the same and we have recruited a lead experienced Frailty nurse who is going to help us accelerate the pulling together of the Clinical team and engagement sessions of key stakeholders to provide a strong foundation for success of this project.