Leading change

A practice nurse at Audley Health Centre in Stoke-on-Trent led the implementation of digital applications to support patients to self-manage their long-term conditions (LTCs). This new approach to care has improved patient outcomes by improving compliance with symptom monitoring, improving patient and staff experience as well as use of resources locally.

Where to look

The Long-Term Plan (2019) highlights that digital technology can support the NHS to deliver high quality specialist care more efficiently. Relatedly, the NHS Commissioning Assembly describes Technology Enabled Care Services (TECS) as the use of convenient, accessible and cost-effective telehealth, telecare, telemedicine, telecoaching and self-care in providing care for patients with long term conditions. These services can transform the way in which people can engage in and control their own healthcare, empowering them to manage their care in a way that is right for them. To support its use in practice, the TECS Resources for Commissioners have been developed by NHS Commissioners to help maximise the value of technology enabled care services for patients, carers, commissioners and the whole health economy. Literature and clinical evidence purports that the use of TECS improves health outcomes and supports patients to reverse adverse lifestyle habits and manage their own health journey.

Within General Practice, the General Practice Nurse Ten Point Plan (NHS England, 2017) describes “supporting nurses to lead change and add value through the understanding, identification and use of tools to address unwarranted variation, including developing digital nurse champions within general practice”. At Audley Health Centre, the general practice nurse identified the benefits of introducing technology to the surgery and how advocating the use of digital applications could reduce unwarranted variation in practice regarding symptom management in LTCs.

What to change

Audley Health Centre, as with other practices, were facing increasing demands on capacity, in line with rising patient need and complexities. Within the practice, the practice nurse noted that minimal digital technology was used and that the service operated using more traditional models. Following attendance at digital champion training, the practice nurse identified a gap in current practice where digital technology could be used to advocate patient-centred care and to support the patient to take the lead in managing their own health.

The practice nurse identified areas in practice that could be streamlined through using digital technology. Patient feedback revealed that they were asking for advice using health related digital applications. The practice’s knowledge base could be improved to support this shift. In comparison to other practices (who had adopted real-time digital monitoring using remote processes, with minimal disruption to the patient and their daily routine), the need for change was clear as Audley Health Centre was still utilising primarily paper-based approaches and was also recognising the need to truly empower the patients to be involved in their own condition management.

How to change

The practice nurse and colleagues met with the surgery’s GPs to discuss the use of TECS and how it could support practice. The practice nurses then led the adoption of TECS, each choosing to lead in their own main areas of speciality, including respiratory, atrial fibrillation, hypertension, diabetes and supporting management of housebound patients.

The digital applications for self-management enabled a more detailed and regular monitoring of a person’s health condition than is possible if a patient just attends regular appointments. For one of the applications, clinicians can adjust the settings for each patient, defining when messages should be sent, what information they are asking for and how the system should respond. The digital application then sends regular text messages to patients helping them to monitor their health, sharing information recorded by the patient with the person managing their care. For example, a patient with hypertension could be asked to check their own blood pressure each morning and then to text the results back to the digital application. If the results are outside the agreed limits, the digital application will pass this information on to their clinician, while also suggesting that the patient makes an appointment or speaks to someone on the phone. Clinicians are able to view real time information about their patients at any time via a simple web interface.

Another digital application used supports individuals with long-term conditions to manage their own health. Using computer generated characters, interactive quizzes and information resources, the digital application updates have content designed to help patients with asthma, chronic obstructive pulmonary disease (COPD) and diabetes so far. The digital application can answer commonly asked questions set by patients and answered by the clinical group that developed the digital application. It uses computer-generated characters to demonstrate key points to help manage a condition, such as effective inhaler technique.

Other digital applications used include support with medication reminders, or heart rate and activity level monitoring, as well as recording an electrocardiogram if heart rate appears inconsistent with the activity level recorded.

Adding value

Better outcomes – The use of TECS has improved patient compliance, real-time monitoring and control of symptomatology and enhanced remoted relationships with staff. These all support tailored, personalised care. Long-term health outcomes have improved, as patients are now empowered to manage their health more readily with support from clinicians and the digital applications each step of the way. Nurses and GPs are all using TECS at the practice and promoting it to patients attending the practice so that individuals have choice as to how they want to manage their health and care.

Better experience – Patient feedback has been very positive with patients reporting they found the digital applications a useful resource and were able to increase their knowledge and understanding of their condition at their own pace. Patients like the reminders as an aid to keep control of their health and prefer submitting blood pressure readings via a digital application as they often forgot with the paper method and found it an inconvenience having to keep coming to the surgery. Staff feedback has also been positive with TECS being well received by the nursing team and GPs. It has improved staff experience, with enhanced feelings of a shift towards personalised, patient-centred care and technology supporting them in delivering care.

Better use of resources – TECS has allowed a more streamlined and efficient management process. The number of appointments has reduced as follow-ups can be done via telephone call if appropriate, using the real-time monitoring collated in the digital application. Clinician time can be used more appropriately and time previously spent following up on patients to return their readings has been saved as reminders can be texted. The digital applications have also saved patient time as they can submit information via their smartphones rather than travel to the surgery.

Challenges and lessons learnt for implementation

The main challenge to using TECS has been resistance from some patients – some patients felt that they didn’t need a digital application as they understood their condition well already, and some did not use technology much and preferred to continue with the previous method of doing things. It’s important therefore to remember that TECS doesn’t have to be for everybody but, if it can be used to support patients, it can be hugely advantageous.

Try TECS and see what they can do for you – practice staff’s confidence in the TECS has really helped build confidence in those patients thinking about using it.

Ask for advice if you are not sure as these types of approaches to care are often new to people; remember everyone has varying knowledge and it is important to support each other.

For more information contact

Rudy McKinney
Practice Nurse
Audley Health Centre
rudy.mckinney@northstaffs.nhs.uk