The NHS is under pressure to deliver more effective services without increasing the burden on the healthcare budget. As care needs change and the number of people living with long-term conditions rises, commissioners and providers are seeking a solution that can mould and modernise the NHS to ensure a more efficient, effective model of care that supports patients by enabling them to manage their own conditions.
Here we take the viewpoints of two south London GPs who have deployed a telehealth programme. Each considers the impact and success of their programme, and what they see as the critical factor in that success.
Dr Raza Toosy is a GP in Wallington, part of the Southern Consortium. He was previously chairman of the Sutton Commissioning Group, which provides services to 124,000 patients, and vice-chairman of the LMC in Sutton and Merton.
The notion that patients should be providers of their own care enables them to contribute to their management.
All too often there is a gap between the vision and the application of holistic services, and time and again we have found that when considering the effectiveness of patient care, the system fails when patients do not engage or are unwilling to change, despite help from service providers.
The aim of our project was to bring together providers from health and social care, and mental health services, to discuss patients jointly, with the aim of improving care provision. The project involved the Sutton Commissioning Group, which provides services for more than 24,000 patients through seven GP practices.
The project consisted of two pilots, which were run alongside each other. One pilot focused on integration and collaborative work by a multidisciplinary team. The second was a joint project between social services and the Sutton Commissioning Group, exploring the implementation of telepods by a group of patients with conditions such as COPD or heart failure.
The telepods are designed to record BP, oxygen saturations, temperature and weight at regular intervals throughout the day. About one-fifth of patients on a caseload were provided with a Tunstall telehealth system.
Over a 12-month period, the project prevented 24 unnecessary hospital admissions, equating to about £55,000 in savings.
Dr Saeed Chaudhary is a GP at Thornton Road Surgery, Croydon, clinical lead for Telehealth Croydon, and a practice lead for Telehealth Croydon, supervising its implementation at three practices.
Long-term conditions currently account for more than 70% of England's primary and acute care expenditure, and with the number of people with these conditions likely to rise by 23% in the next 25 years, commissioners and providers need to find a solution that will deliver more services without impinging on the healthcare budget. Telehealth could be the solution they are looking for.
I believe there are three key aims of telehealth - to reduce unplanned hospital admissions, lessen growing pressures on GP resources and most importantly, improve patients' quality of life.
To deliver these objectives, telehealth needs to work at the practice nurse level, with systems in place to support nurses taking on the challenge of managing patients by telehealth.
Our project involves 50 Mymedic systems from Tunstall, with a nurse from each practice acting as clinical lead for patients at that practice.
If a patient feels unwell, the GP or nurse has access to vital signs and the consultation can be carried out by telephone, saving time and inconvenience for the patient and the clinician.
In terms of the results of our telehealth implementation, we have already covered the costs of the equipment and saved a further £900 since August 2011. Having made these early savings and 'paid for' the equipment, I expect our savings total to increase significantly. I would summarise critical factors for telehealth success as follows:
Integration Communication among service providers is key for successful telehealth deployment and service providers have experienced better outcomes with input from a multidisciplinary team. Providing a suitable platform for discussion ensures patients remain the top priority, while motivating them to be providers of their own care.
Patient selection Successful telehealth programmes depend on the positive experiences of the patient, which is why thorough patient selection is important. Service providers can ensure patients are suitable through the use of risk stratification, home visit records and input from GPs or nursing staff.
Clinical responsibility Nursing staff play a key part in determining telehealth project success because they are on the frontline of care. Their involvement frees up GP appointments and makes use of their expertise, particularly beneficial in the management of long-term conditions.