Our Digital Journey

The Castle Medical Group is a large GP practice, located in Clitheroe, Lancashire, supporting a practice population of around 14,500 patients. The practice serves a mainly rural community based in a semi-rural market town. The practice clinical workforce includes eight GP partners and a Salaried GP alongside a team including: two Advanced Nurse Practitioners (ANP), five Practice Nurses and two Health Care Assistants. Ancillary staff of secretaries, administrative staff and a Practice Manager complete the team.

Dr Russell Robb is a GP Partner and the current Clinical Director for the Ribblesdale Primary Care Network. He has worked at the practice for 18 months and engaged in the Digital Exemplar Programme.

Why did you engage with the Digital Exemplar Programme?

When Castle Medical Group embarked on their digital journey the practice was exploring the possibilities of delivering healthcare to patients through a range of nontraditional options, recognising the emerging challenges to traditional primary care through alternative providers.

To improve patient access the practice wanted to examine how they could make better use of digital to support video consultations with patients. In doing so they identified the challenges in how best to deliver more digital services.

The most significant of these challenges was convincing practice staff that a digital system could work in a 1970’s building with limited room availability to incorporate new systems. It was recognised that the GPs, nurses and administrative staff needed support and guidance in developing their confidence to utilise their existing IT skills in a different way, to make them more comfortable with using digital technologies for patient care.

Running alongside this was the challenge of convincing patients to consider a consultation in a non-traditional manner. For many patients this would be a leap into the unknown. The practice highlighted a cohort of patients, aged 20-60 years who don’t necessarily have an equal opportunity to access healthcare. Whilst also recognising that it could help with the younger generations who are more ‘IT savvy.’

The practice had also been looking to engage with the GP Retention Programme, looking at how GPs could work differently to support GP retention with options like working from home using digital technology.

Implementing Digital Solutions

Dr Robb arrived at the practice 18 months ago and brought with him a dual screen set up to allow for video consultation. A primary action was to ensure other GP colleagues were equipped with a similar dual screen and webcam set-up to provide the practice with the IT platform to embrace a move to digital consultation.

Like other practices across East Lancashire there are some issues with broadband but the practice recognise that this requires a long-term solution for the area and the limitations were not significant enough to impact on the move to digital.

The practice then embarked on providing training for reception staff in relation to what can and can’t be done via a video consultation. With the support of the Exemplar Programme they developed protocols and pathways to address any governance issues relating to the use of digital, drawing on guidance and examples of how other practices had addressed governance.

Initially the practice tested the Visconn clinic system to allow patients the opportunity to have a digital consultation but found challenges with this system. The practice then moved to the Accurx software, finding this to be very user friendly and agile.

Through Redmoor Health the practice received a Remote Video Consultation Unit (RVCU) which allows them to deliver group clinics or meetings through Visconn in the practice meeting room.

Why Digital?

Implementing Digital Solutions

Dr Robb arrived at the practice 18 months ago and brought with him a dual screen set up to allow for video consultation. A primary action was to ensure other GP colleagues were equipped with a similar dual screen and webcam set-up to provide the practice with the IT platform to embrace a move to digital consultation.

Like other practices across East Lancashire there are some issues with broadband but the practice recognise that this requires a long-term solution for the area and the limitations were not significant enough to impact on the move to digital.

The practice then embarked on providing training for reception staff in relation to what can and can’t be done via a video consultation. With the support of the Exemplar Programme they developed protocols and pathways to address any governance issues relating to the use of digital, drawing on guidance and examples of how other practices had addressed governance.

Initially the practice tested the Visconn clinic system to allow patients the opportunity to have a digital consultation but found challenges with this system. The practice then moved to the Accurx software, finding this to be very user friendly and agile.

Through Redmoor Health the practice received a Remote Video Consultation Unit (RVCU) which allows them to deliver group clinics or meetings through Visconn in the practice meeting room.

Digital Solutions

Hardware

  • Laptops
  • Desktop PC
  • Dual screens
  • Web-cams
  • Remote Video Consultation Unit

Software

  • EMIS
  • Visconn
  • Accurx

Support

  • Digital Exemplar Programme
  • GP Retention Programme
  • NHS England
  • Redmoor Health
  • Local Primary Care Network
  • Integrated Care System

Impact of Digital Solutions

The practice has realised that the way many people seek healthcare needs to change because the traditional model is not sustainable. This was brought to light by the Covid-19 pandemic and through early engagement in the Digital Exemplar Programme, meaning the practice was well positioned for managing the crises. The simple provision of laptops to staff ensured that those who needed to ‘shield’ have been able to maintain their workload from home, ensuring the practice continues to operate at capacity and the GPs and Nurses were able to seamlessly move to more video consultations.

Utilising digital technology through total triage has helped the practice in many ways. It has helped reduce footfall into the building and therefore allowed admin staff to prioritise other work and reduced face-to-face consultant time. In turn, this has helped to increase staff resilience and enabled the practice to maintain a high standard of patient care.

Enabling GPs to work from home when required and hosting meetings online has led to savings in terms of time (not having to commute). This also has a positive environmental impact. It provides nurses and other clinical staff such as GPs the ability to flex their day.

Whilst there has been a slight reduction in patient DNAs, the main impact has been that a digital DNA allows the GP to move swiftly onto the next patient rather than having to wait for someone to turn up. From an administrative workload it makes it a lot easier to reengage the patient and it has freed up considerable administration time.

Key Messages

Build confidence of the people utilising digital

This can be achieved through training and support and through providing opportunity for the team to use the software regularly and get comfortable with it under guidance.

Utilise the resources available to you

There are a growing number of resources available to support digital primary care including online video support. There are a growing pool of digital champions embedded in CCGs or developed through the Digital Exemplar Programme who have access to policies and pathways and who are available to support you on the journey.

Be Brave, be bold

Embrace the opportunity offered by digital consultations because it will inevitably produce favourable outcomes for both the practices and patients.

Accept the limitations

Digital consultations are not the answer for everyone. Identify and accept the limitations with video consultations. Sometimes you do need to see a patient for physical examinations and reassurance. But don’t use this as a blocker for utilising digital where appropriate.

Acknowledgment

This case study was developed through interview with Dr Russell Robb. GP Partner at The Castle Medical Group.

You can view Dr Robb’s video case study here.

To speak more about the digital journey at Castle Medical contact: russell.robb1@nhs.net

Author

The case study has been written independently by Mike Parker Progress Health Partnerships

Contact: mike.parker@progresshp.co.uk

Redmoor Health

Contact: hello@redmoorhealth.co.uk

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