The new NHS models of care and a shortage of GPs are forcing a fresh approach to healthcare service design. GP networks throughout the UK are introducing federated healthcare services to share resources. Using interoperable IT systems to share patient records is one of the secrets of success. What else must GP networks consider?
1. Understand your dreams
Make sure you understand what you want to achieve. What is your priority? Try to stay focused and avoid derailing the project by adding unnecessary complications. Key questions you must answer include:
- Where will you provide the service - at GP practices, local care hubs or in the community?
- Who will patients see - GPs, practice nurses, clinicians or carers outside of general practice?
- What does success look like? Think about your specific key performance indicators (KPIs) such as the number of patients using the service. You could use measurable benefits like fewer hospital admissions or a reduction in referrals.
These measures will help you track progress and show the success of your service.
2. Information and technology
The NHS 5 Year Forward View describes a collaborative digital health service. Primary care is becoming the focal point of multi-specialty healthcare teams. Clinicians working in shared care and federated services need instant access to the medical records for any patient they might see.
Years ago, this meant moving all GP practices onto the same clinical system, but that is an outdated view. GP federations can now share patient records from a mixture of existing GP systems. This is interoperability, enabling different computer systems to exchange information. It is cheaper and less disruptive than forcing unwanted and unnecessary system changes.
However, the possibilities of interoperable systems go way beyond sharing patient records:
- Clinicians can add information and send it to the patient's registered practice
- Receptionists at every member GP practice can book patients into federated service appointments
- Standardise data entry and decision support across all clinicians
- Use medical apps like Vision Anywhere to provide mobile access to shared records
- GP networks can report on patient health and outcomes for the service
There's a lot of potential, so where do you start? Write a plan that describes who needs access to patient records and the elements of patient records they need to see. Include other details about how technology can contribute to a successful service.
This will help you brief and select your IT partner.
3. Hearts and minds
You must get buy-in from the clinicians and their colleagues that will provide the service. Hold awareness and training sessions to communicate the service benefits. These sessions should include discussing confidentiality and information security. Your IT partner will be able to help with this.
Staff training is important too. Everyone involved should understand new processes and know how to use new or updated IT systems. You could also develop scripts so patients get a consistent message at all touch points.
Once the service is operational, hold regular feedback sessions. It's likely that you will be able to refine processes and improve your new service. Patients and the people providing the services are best-placed to suggest these changes.
4. Public engagement
Advertising the service will help to let patients know about it. Opportunities include bus shelters, the back of buses and local radio or papers. You could ask a local dignitary such as your MP to launch the service.
You should also tell local stakeholders about the service and associated changes. Depending on the service this might include acute trusts, walk-in centres or pharmacies.
5. Dreams come true
Data is your friend. Track progress against your KPIs and see if your service is meeting expectations. Be prepared to make changes and alter your approach if necessary.
One thing is certain. There will be unexpected opportunities to build on your service. This is especially true if this is your first foray into interoperable systems. Take things one step at a time and prioritise your next moves by quantifiable measures.
Interoperability in action
The Richmond General Practice Alliance (RGPA) was the first GP federation to have end-to-end interoperability. They have an extended hours appointment service that runs from 8am to 8pm, seven days a week. Patient information from Vision and EMIS systems is available to GPs providing the service. Any information they add during consultations goes back to the IT system at the patient's registered practice. During one year 15 percent of the population of Richmond used the service. This was possible thanks to an interoperable solution provided by Vision.
Dr. Neil Jackson is a GP in Twickenham and a board member of the RGPA. He recently shared his first-hand experience of setting up the RGPA's federated appointment service. Click below to watch a recording of his webinar.