Case study summary
Patients with renal failure are getting more time with a specialist consultant thanks to doctors in Tower Hamlets redesigning services around the sickest patients.
Kidney doctors at Barts Health NHS Trust and GPs in the area set up a pioneering virtual e-clinic for GPs so they can send questions on kidney patients direct to consultants for a quick reply reducing outpatient appointments to a fifth and freeing up to time and money for reinvestment in NHS services.
Since it began, waiting times for outpatients have dropped from as much as 15 weeks to just five days for advice, increasing face to face time for consultants and patients for those who most need it.
Dr Neil Ashman, consultant renal physician at Barts Health, worked with Dr Sally Hull, a local GP to develop the system, said: “We were seeing a lot of patients who gained little from seeing a consultant, and instead are supporting GPs to help these patients. We worried it would be more work for GPs but we hope that getting a fast and helpful opinion actually makes things easier.
“I have got to the terrific GPs in our community, and try to help solve problems either in the GP record, or by email or (best of all) by phone; but if we think a patient does need extra care then they can get in to see us far more easily, and into the right specialist clinic. Our team can now focus on men and women on dialysis, or those with more severe kidney disease, where specialists can make the biggest difference.”
Before the pilot started two years ago, patients waited between 55 and 84 days for an outpatient appointment, slashed to five days. Only one in five referrals now comes up to hospital, which could generate savings of up to £1m across North-East London to be recirculated in the local NHS.
Sir Sam Everington, local GP and clinical lead for the North East London Sustainability and Transformation Partnership (STP), said: “We have an ambition to reduce 50 per cent of our outpatient appointments in a similar way because we know patients want to be seen conveniently, quickly and close to home.
“If I have a question for Neil I get an answer in a few days. He can see the GP notes remotely and I can see the important hospital clinical notes from my computer in general practice. If either of us is worried about a patient, we can make sure they go in straight away. All of the clinicians get along well together and are extremely courteous so the system works.”
Built into the system is a computer trigger tool which alerts the GP to falling kidney function.
Initial evaluation of the community kidney service received a positive response from patients as well as GPs and clinicians. In particular, patients reported that they were happy to share their medical records, and that their care was discussed with a specialist without needing to go to hospital.
The service is a good example of the wider NHS working together to put patients at the centre of their care and building services around their needs.
Barts Health has one of the biggest renal services in London, and undertakes about 220,000 dialysis sessions a year. The number of people diagnosed with end-stage kidney disease (and therefore requiring dialysis or a transplant) has been steadily growing in recent years.