Having coped with the first wave of the COVID-19 crisis, the NHS now faces a significant challenge in protecting and supporting the most vulnerable patients. In addition to the estimated 2.4 million individuals waiting for scans or treatment as a result of disruption to services during the pandemic, many vulnerable patients were not able to access regular care for ongoing conditions.
Primary care not only faces a deluge of demand but 43% of doctors also fear regulatory or criminal investigation if patients come to harm because of delays to referrals and reduced NHS services during the pandemic.
How can primary care providers identify those vulnerable patients with chronic conditions who need priority access to treatment? From missed review appointments to those whose conditions have not been identified during the crisis and hence not yet been referred for further exploration or treatment, how can doctors avoid an escalation to a clinical safety concern?
Primary care teams need to rapidly prioritise their most vulnerable patients to ensure they are seen quickly and receive access to the right care and treatment. The good news, however, is that many practices had already embraced innovative, multi-disciplinary team working prior to COVID-19, creating proven models of care that will play an essential role in managing and safeguarding vulnerable patients in the future.
Three Step Process
To protect vulnerable patients, there are three essential steps: identification, caseload management and consistent information recording and sharing.
- Identification: Locate vulnerable patients to ensure high risk individuals requiring priority attention are not lost in the backlog.
- Manage caseload: Organise and share workload, working across organisations and within teams maximise skill sets and resources. The collaborations that have been achieved during the COVID-19 response provide a strong foundation for new models of cross-practice activity.
- Share information: Conduct reviews at scale, in a consistent manner, across multi-discipline teams, sharing information and resources to ensure those with the greatest need receive priority attention.
The value of this collaborative, focused approach has been demonstrated for some time at Cwm Taff Health Board, where a multi-disciplinary team has been working across GP practices to manage patients with a number of long term conditions. 46 of the 54 GP practices use our Vision clinical system and 8 use EMIS, supporting a total of 400,000 patients. All practices use Vision Anywhere, our secure app that provides healthcare professionals with 24/7 access to patient records on the device of their choice to provide a cross organisational view of patients.
In tandem with the single view of all patients provided by Vision Anywhere, practices are using Outcomes Manager, our cloud based platform for population level healthcare, to identify cohorts of patients, specifically those in need of a review.
Vision Anywhere and Outcomes Manager are used across 54 GP Practices under Cwm Taff Health Board to provide a cross organisational view of all patients. These solutions have been used throughout COVID-19 by multi-disciplinary care teams to prioritise patients, manage caseloads and consistently record consultations back to the patients GP record, all whilst working remotely.
Effective Collaboration & Recording
With patients identified, Vision Appointments can be used to create and manage cross organisational appointments. Multi-discipline team reviews can take place via video conference – with everyone using Vision Anywhere to view and manage the caseload from any location. Any information added using Vision Anywhere is automatically updated within a practice’s clinical system, whether it is Vision or EMISweb. In addition, templates can be set up using Outcomes Manager, driven from the clinical record and presented in Vision Anywhere, to ensure a review is consistent and the right information is recorded for each patient.
The caseload can also be distributed to clinicians and pharmacists across an area – an approach that has been embraced by West Kent Health for several years both to support patients with diabetes and provide out of hours appointments across the area. Vision Anywhere allows practices to collaborate to design new pathways, enable healthcare professionals to manage their caseload while ensuring the practices’ clinical systems are up to date.
“Using Vision Anywhere and Vision Shared Appointments West Kent Health is improving accessibility to the right services at the right time.” Haydyn Williams, Senior Administrator, West Kent Health.
As primary care moves into the recovery phase following the first COVID-19 wave, the pressure is on to manage the patient backlog and ensure vulnerable patients are identified, reviewed and managed effectively. Given the unequal impact of the pandemic on primary care services, it is important to enable practices to come together to share the workload effectively, whilst retaining control over each practice’s patient records.
As Gian Celino, Clinical Director for Cegedim UK, concludes, “This is an opportunity to build on the innovative work that took place before COVID. Outcomes Manager helps to both find patients and ensure that distributed work is carried out consistently. Vision Anywhere allows practices to organise and plan the caseload, then to share and collaborate, irrespective of clinical system, to make and update records. Together with Vision Appointments, practices can follow the three steps – identification, case load management plus consistent information recording and sharing – required to prioritise care towards those most in need over the next few weeks and months.”