Wendy Sunney
General Manager, Staffa Health,
North Eastern Derbyshire PCT
Tel: 07710 362543
Email: wendy.sunney@nhs.net
Summary:
Our aim was to use IM&T to enhance the experience of patients and staff in primary care. Using the example of a real patient with a long-term condition and hectic lifestyle we have introduced technological and other solutions to close the gaps identified in our service and taken it further, providing a multi-media stepping stone for those still technology-shy. We've shown that when investment is made in primary care, it can make a real difference and that the results are valued.
Abstract:
We introduced the following innovations in order to promote self-care and provide infrastructure changes in readiness for Choose and Book.
• Practice website, easily edited as a Word document (and therefore regularly updated), providing links to health information sites. Professionals contributed information about their roles, what services can be accessed, and how to do it. Depending upon the medical system in use, patients pre-register, book appointments and order prescriptions on-line; they can compare practices and will soon be able to access their records. There is also a 4teens section of the website - designed by the local school.
.• The Health Channel – visual information, without commercial advertising, provided by DVD/LCD screen in the waiting room – relevant information from practice, PCT and DH, changed every 2 months
• Automatic Arrival System – offering biometric recognition or touch-screen registration for appointments
• Records kiosk – giving patients access on a touch-screen, through fingerprint recognition, to their records and on-line facilities including Choose and Book and the practice website where other on-line services are available.
• Library – offering a wide range of resources on-site or on order (including books on prescription), linked to the PCT and County Library services. The PCT is providing bar-coding facilities centrally.
This was an example of empowerment at every level. Four practices worked together to design and implement VFM solutions, capable of roll-out to other practices. One practice manager acted as Project Manager. Within each practice the work was championed by one GP and manager and practices were encouraged and supported by the PCT but not directed by them. Practices learned from each other and shared the job of market research and option appraisal. Funding shortages necessitated exploration of partnerships with library services, providing a fruitful link between the PCT and county library to develop a joint directory of voluntary services; between practices and county library in sharing the health leaflet resource; between practices and PCT who are developing a central bar-coding system for the loan facilities. Practice staff were engaged in implementation on-site and marketing to patients. Tremendous help has been received by involving the patient groups.
Our idea was based on a complaint from a patient about how primary care services didn’t fit with his lifestyle. A narrative was woven around his story and used as the basis of the plan for innovation. Patient groups were involved, helping with fund-raising and introducing the systems to patients by running Open Days where patients learn about the wide range of services on offer and look behind the scenes of their local practice. The library developments built on existing patient group work.
The experience of introducing an automated arrival system in one practice highlighted the number of patients coming to the counter to collect prescriptions and this stimulated staff to arrange with the chemist to have prescriptions collected and re-ordered there which was more convenient for patients too. Once time had been freed by these initiatives, the staff took the lead in proposing and organising an automated telephone system which allowed them to rationalise their working practice across 3 sites. Staff are now training as Choice facilitators to enable them to signpost patients to the information they need to manage their health.Before and after questionnaires demonstrated a high level of satisfaction with the automated check-in especially among older people. Staff liked the system a lot too. A patient used a structured interview to evaluate the effectiveness of the programme running on the LCD screens which demonstrated that 85% had absorbed what they’d seen and 32.5% would do something different as a result. Patient interest in the biometric features was obvious from the queues of patients at Open Days. A DVD documentary was made, interviewing patients and staff, for overall evaluation. Staff said they liked the high quality NHS branding the equipment gave the surgery. Two other clusters took part in this Trent initiative (called SMART practice) but similar funding did not accomplish as much.
The evaluations in (e) above is evidence. At the Open Days we conducted an exit poll which indicated a high level of satisfaction and there is good use of the various innovations.
We took into account the different levels of comfort with IT and different learning styles and are providing written and audio-visual materials through the library to complement IT. The kiosk and automated check-ins provide alternative modes of use (e.g. mouse/touch screen/date of birth registration). The staff have been encouraged to use the innovations themselves so that they fully understand the patient experience.
We have made a DVD and created a menu of innovations and are marketing this throughout the local health community as a way to use the incentive money they’ve received for having met Choose and Book targets, promoting it as an asset to deliver Choice. We have also attended various conferences nationwide. This is the first part of the patient pathway in which the patient uses the surgery as a resource centre and we are developing the kiosks for pre-consultation use and in an induction programme for new patients.
We imagined we could bring the ‘Choice’ agenda out from behind the counter into the waiting room and home and uncovered an immense curiosity with the technology. Our learning curve as to how to engage patients in “self-care” is steep but it has taught us that we can take our lead from patients. We’re also tremendously proud that this was led by general practice and it is an example of true bottom-up innovation and collaboration in which the PCT was able to act as supporter and not director. The project has been entered in the GPonline Enterprise Awards.
