The case for change in the way outpatient care is delivered is not new. In 2018, a review by the Royal College of Physicians stated that the traditional model of care in outpatients was no longer sustainable. This was followed by the NHS Long Term Plan commitment to reduce up to 30 million outpatient appointments over the next five years through the transformation of services and digitally-enabled care. As the NHS transitions to recovery alongside Covid-19, returning to traditional outpatient models is not an option. New models of care and use of technology will be required to connect clinicians with patients safely and sustainably.
Elective services were largely shutdown as part of the initial Covid-19 response, but this created positive change. The need for social distancing meant many outpatient appointments were converted to virtual - either by telephone or video consultation. This covered a range of specialties ranging from ophthalmology to respiratory and extended to A&E departments where virtual consultation was used for triage and other services.
As trusts re-start their elective programmes with a larger backlog – there is a 52 per cent increase in the number of patients waiting more than 18 weeks for surgery in April 2020 than in February 2018 -and reduced capacity, they should be looking at actively embedding these positive changes. As part of the Covid-19 response, all NHS providers were granted access to video consultation technology as a means to reduce the number of face-to-face appointments and the risk to both staff and patients. As we start to look to the future and our new normal, there is an opportunity for trusts to embed a ‘virtual consultation first’ mindset for all patients.
There are four key areas they must focus on:
Harness enthusiasm of early adopters to create digital champions
As with all technology adoption, there will be a clutch of people who are champions of digital change and want to be first to use the technology. The challenge is moving from one individual using technology to a wider change in the service model. This means creating a group of digital champions and supporting them to be advocates of change. This should include clinician-to-clinician engagement, sharing of use-cases and rapid, easy-to-access training, product support and troubleshooting available at the times.
Make the change easy and clear for staff and patients
A formal programme to roll out video consultations will be essential to ensure the engagement of staff and patients. This programme will need to include a clear roadmap for initial phased implementation at each specialty level.
A clear communication strategy for patients and clinicians to reassure and inform on the adoption of new ways of accessing clinician care will be key. For clinicians, the information provided by the Royal Colleges to move to virtual consultation was key to adoption. Building on this, it is important to share new use-cases with clinical teams so that everyone is informed on the latest scope of the technology.
For both patients and staff, a great success has been the creation of a practice space, which enables all users to simulate a consultation to be more comfortable holding the appointment remotely by enabling the user to practice how this would work.
Increase the capability of video consultation technology to optimise uptake
So far, we have seen video consultations used to replace routine face-to-face appointments. However, there are more ingenious approaches that could stretch the capability of what video consultations can offer, and further reduce the risks to patients as they seek treatment alongside Covid-19 recovery. For example, it could extend beyond traditional outpatients focus, to include pre-operative assessments via video. This could minimise risks for patients awaiting surgery and lessen the risk of delays to major operations.
For patients who still need face-to-face appointments, video consultation still has a role to play. It could support social distancing through the creation of virtual waiting rooms with patients only entering the hospital when they are called straight into their appointment. This could eliminate or significantly reduce the need for physical waiting areas, therefore reducing the risk of virus exposure.
Continue to review successes to make deployment sustainable
Positive patient experience will support the adoption of video consultations. Therefore, building in mechanisms to regularly gather responses will be key to evolving virtual services quickly. Early feedback has highlighted a need to refine booking processes to optimally stagger patients and minimise their waiting time to ensure user experience is positive.
Regularly measuring the impact of a shift to virtual consultations will also guide its evolution and ensure sustainability. A clear baseline and set of metrics should be established at clinician and specialty level to monitor adoption and identify areas of further improvement. It is also important to use the data to ensure the anticipated efficiency of virtual appointments is being enabled and if it isn’t there is then the opportunity to review the support, training and investment to ensure it is optimised.
Codifying positive change
There have been positive changes to elective care during the Covid-19 response, with the national outpatient programme forecasting the completion one million video consultations by the end of 2020/21. While impressive, this is still less than one per cent of all outpatient appointments so an opportunity to build on this progress exists. As trusts now move from response to recovery in elective care there is a clear opportunity to look at the use of video consultation to provide a framework to enable change and create the much-needed additional capacity.