Harnessing technology to support service innovation

In an earlier blog Dr Shera Chok, Clinical Associate in the new care models programme, a GP in Tower Hamlets Together vanguard (@TH2GETHER) and Director of Primary Care, Barts Health NHS Trust discussed the importance of relationships within a clinical community. This time she looks at communications technology, a key facilitator for change.

As a clinical associate I’ve discussed a number of Tower Hamlets’ initiatives involving information technology with various other vanguards, and they’ve been so well received that I thought I’d share them more widely.

Barts Health, the Clinical Commissioning Group and the Local Medical Committee asked hospital and primary care clinicians across Tower Hamlets what changes would make their jobs easier and, not surprisingly, better communication was raised as a key issue.

In response to their feedback we’ve now developed a range of channels to help them share data and speak to each other. These channels include direct telephone lines, secure ‘’ email addresses which allow hospital clinicians to provide advice to GPs, and our new health information exchange (HIE), which is an electronic portal between acute and primary care IT systems.

I believe HIE is one of the most exciting developments at the interface between acute and primary care and it gives clinicians access to a shared record. Clinicians love it as it’s easy to use; it saves time and improves safety. It also offers patients a more seamless service, as practices can now access their hospital appointment dates, letters and results.

The award-winning Barts Health AIRS (Access Issues Resolution) team also helps patients and practices resolve any problems around outpatient appointments, letters and reports. This team has had excellent feedback from patients and practices as they respond rapidly and resolve issues before they escalate.

The diabetes team at Newham Hospital recognised that the traditional model of routine follow-up outpatient care was inflexible for patients in many ways.

They wanted to develop new ways of communicating with patients that fit into today’s lifestyles and are now second nature to younger generations – with 40 per cent of people in Newham aged under 25, the local population is the youngest in the UK.

A new system of using the online communication platform ‘Skype’ for video consultations has been introduced by the team and since then Dr Shanti Vijayaraghavan, Consultant Physician, and her colleagues have completed more than 1,650 ‘virtual’ appointments.

As a result, the ‘did not attend’ rate (where people miss their appointments) has dropped from 28 per cent to 13 per cent and patients have said they feel much more at ease and in control of the consultation process when talking online in a physical environment of their choice.

Patients also report a better relationship with clinicians and say that managing their diabetes is becoming much more of an equal partnership.

Led by Dr Neil Ashman, Renal Consultant, and Dr Sally Hull, academic GP, the Barts Health chronic kidney disease virtual outpatient pilot was launched last year and now operates across three boroughs. To kick it off, I brought acute clinicians, clinical commissioning group leads and academic GPs around the table to develop a new integrated pathway that:

  • is managed in primary care by secondary care clinicians and GPs, reduces unnecessary referrals and increases discharges from secondary care
  • increases skills in chronic kidney disease management within primary care
  • improves safety and the patient experience for patients, with reduced waiting times and proactive screening for patients at risk
  • reduces costs to the NHS.

If a GP suspects a patient has a problem with kidney function they can now contact  a specialist at the virtual clinic electronically and then manage the patient in the community or make a specialist appointment if needed.

In the first six weeks the waiting time at Barts Health for a specialist renal opinion dropped from 64 days to five days, and only 50 per cent of referrals went on to need an outpatient appointment.

Support is available from the new care models programme national team to help vanguards implement innovative new ways of working, and harnessing technology is one of the key ‘enablers’.

Dr Shera Chok

Dr Shera Chok is a GP in Tower Hamlets Together vanguard and Director of Primary Care, Barts Health NHS Trust.

Shera is a GP in Tower Hamlets, a member of the Tower Hamlets multispecialty community provider vanguard and Director of Primary Care at Barts Health. Her role involves bringing a primary care voice and perspective to the largest acute trust in England, shaping their clinical strategy, listening to our GP partners, improving patient safety, delivering new models of care and building relationships with primary care and CCGs. Shera is also a member of the national Independent Reconfiguration Panel which advises ministers on NHS reconfiguration, and a Clinical Associate with NHS England’s new care models team.

Shera’s MBA and MA in Inter-Professional Education focused on patient experience and clinical leadership. She won a Nuffield Trust Fellowship on cross-organisational learning and studied at the Harvard Kennedy School, Harvard School of Public Health and the Institute of Health Improvement (IHI) in Boston as part of the prestigious NHS Executive Fast Track Programme. She has worked in Sudan, Indonesia, Laos and Greece as a clinician with leading NGOs.