Northumbria Healthcare NHS Foundation Trust

What was the problem?

Northumbria Healthcare NHS Foundation Trust (NTIMS) delivers both physiotherapy rehabilitation and advanced musculoskeletal (MSK) practitioner and GPwSI clinics across the North Tyneside region to patients who have musculoskeletal ailments. The service functions as a conduit between primary and secondary care. It is delivered at North Tyneside General Hospital as well as in community and primary care locations, with the main hospital being the hub site of the service.

The musculoskeletal service was working in a fairly traditional way with a combination of face-to-face consultations and telephone appointments across all clinics. This created some difficulties as some patients had particularly lengthy journeys to receive their musculoskeletal care. This was compounded by limited parking space at our hospital site which was also an additional cost for patients. We found that a large proportion of telephone consultations were not an effective use of time as patients were not always available to answer our calls.

The outbreak of COVID-19  meant that our traditional methods of working were no longer a viable way of managing patient care needs, and with a backlog of patients from appointments that had to be cancelled as well as patients who were still coming into the service we had to consider new ways of working to meet these needs in a timely, safe and effective way.

What was the solution?

Northumbria was part of the NHS England and NHS Improvement video consultation pilot so already had access to the video consultation platform, Attend Anywhere. Following the announcement of a nationwide lockdown on 23 March 2020 to slow the spread of COVID-19, the trust fitted all of the Outpatient Department consultation rooms with hardware capable of facilitating video calls. We included our MSK Hub into this supply to ensure we had the kit we needed.

The service contacted the Video Consultation Project Lead, who alongside our trust video conferencing team, set up our waiting room as well as registered all the members of the team within the space of a few hours. Following a number of trial calls between team members, we went live with video consultations that same afternoon. One of our more technically proficient staff members successfully tried this with a few patients from their clinical list.

What were the challenges?

One of the greatest challenges was the learning curve for all staff from running a traditional service in the morning to being able to offer meaningful video consultations in the afternoon. There were no process templates to refer to that were immediately accessible and so we created a whole new process and patient flow for patients who were to be offered video consultation as part of their MSK care.

Administrative staff designed a new flow of contacting patients, offering choice and informing them how the video consultation platform worked.

Clinicians also needed to be familiar how to use the platform. They needed to know how to effectively run video consultations, the advantages and limitations, and how to document the consultation robustly. This new way of delivering care took some fine tuning, from the allocation of calls to the consultation process itself. This surprisingly included needing knowledge of the principles of lighting. Many of our consultation rooms have a window behind the clinician and initially, we had partial silhouettes of clinicians, interfering with patients’ view. We have since taken steps to resolve this.

As a clinical team, we had extended skillsets from SystmOne, change management and patient flow as well as clinicians sitting on national boards who had access to a number of clinical colleagues who were going through similar change and had access to resources about making the most of video consultations.

What were the results?

By the end of day one, we had workflows for both administrative and clinical staff and carried out a few, ad-hoc live calls with patients. From this, the workflows were tweaked, and patients were contacted to offer them a face-to-face (to be carried out once COVID-19 restrictions were lifted), phone or video appointment. Initially, these were offered on a sessional basis but as more patients came online, and in planning for the long-term solution post COVID-19, we offered timed appointments for both phone and video calls.

Surprisingly, as change often creates a feeling of unrest, all of the clinicians could see the value of video consultations, both from a responsiveness to need basis and for the additional visual cues that a video consultation can give.

Despite some technical difficulties, mainly with patients’ connection, there have been some helpful, enlightening and often amusing visual assessments over the video consultations which have definitely added a new layer of depth to remote consultation.

Approximately 40% of patients have accepted a video consultation over other methods to date and the responses of these patients have been very positive. Many patients have also said they prefer having a video consultation over a telephone call. We have even had several octogenarians effectively using video consultations, this was a surprise but reflective of how technology is becoming an integral part of life, for patients of all ages.

The use of video has supported us to all but clear our backlog of patients who had either had an appointment cancelled or who were waiting to be seen, and should allow us to start with an almost clear slate once we are beyond the current COVID-19 challenge.

What were the learning points?

It is important to:

• Have a team that is committed to providing the best service they can in challenging circumstances and are willing to consider change.
• Have an IT team that can be responsive to the needs of the service.
• Identify and utilise the extended skillset of team members to work on all facets of the change and co-ordinate efforts.
• Have a team member to co-ordinate the collective efforts into a standard operating procedure as a baseline and template for ongoing improvements.
• Nurture an environment where positive change can happen quickly.

Next steps and sustainability

We are developing our post COVID-19 recovery plans and intend to now use ‘digital-first’ as the default method of contact to reduce physical attendances at the hospital but also to address some of the more longstanding issues of patient travel and parking difficulties. This will dovetail into the trust’s plan of achieving its ‘Miles Less Travelled’ targets for patients, given our trust covers such a large area.

Our in-team lead has also created an User support group via Microsoft Teams, inviting established services as well as those keen to come on board to help co-ordinate efforts, share good practice, learn from our challenges and share useful resources and documents created by other teams. The aim is to have consistency of application and hear stories of inspiration and innovation which help to drive positive change.

Want to know more

Please contact Kristin Moat, Advanced Musculoskeletal Practitioner, Northumbria Healthcare NHS Foundation Trust at Kristin.moat@northumbria-healthcare.nhs.uk.