A common cause of frustration for anyone working in the health service is the ad hoc approach taken to delivery of care by digital means. When we talk about digital care, the focus often goes on the technology, as if simply rolling out a new tech solution will bring about the change needed.
Sadly, because the frontline workforce is frequently looked upon as an afterthought, with little investment in digital skills and training, practices are left with obsolete equipment sat in consulting rooms or solutions that place more pressure on clinicians in an already stretched health service.
It is for this reason that across the West Midlands, in collaboration with the West Midlands Academic Health Science Network, NHS England and external digital experts, we’ve developed a digital exemplar programme for primary care. This is based on seven key principles, underpinned by a suite of resources and training, with the aim of creating a frontline NHS environment through which innovation and access to technology can prosper.
These seven principles will in turn create the environment necessary for our network of ‘digital practices’ to thrive.
Helping ‘digital practices’ thrive
The principles are based on ‘seven Cs’: competence, capability, capacity, confidence, creativity, communication and continuity.
Each practice on our exemplar programme will be supported in planning their use of digital technology with clear metrics in place to help them judge the value of what they wish to do. The programme will also help practices to understand the time and investment needed to undertake a new digital approach properly and the outcomes that can be achieved or strived for.
The seven Cs are:
1. Competence. This relates to any practitioner, manager, patient, carer or citizen’s ability to use or implement a range of modes of delivery of technology-enabled care services (TECS). Without the skills required to use the technology from either the clinician or the patient it is difficult to embed any form of technology.
2. Capability. Clinicians, managers and patients need to be able to adopt best practice in the use of TECS and act on advice and information. A good example is the use of Skype. For us to use Skype in the West Midlands we had to spend a considerable amount of time working with colleagues in information governance. We needed to ensure that anyone using Skype not only understood the technical aspects, but also the IG and medical indemnity process.
3. Capacity. This is one of the most important factors when developing an environment within which digital care can thrive. This isn’t just about senior staff possessing the skills in isolation – this is about changing internal processes so that staff on the frontline are given the time and confidence to innovate. There must be protected and prioritised time for initiating and participating in remote delivery of care and it should be regarded as a key part of a person’s role. There also needs to be support at a strategic level. We’re currently working with a team of national educational providers to develop a suite of online tutorials to help staff gain the skills to use digital in a cost- and time-effective manner.
4. Confidence. Practitioners and managers need to be confident that the organisational infrastructure is in place, underpinned with a code of practice that includes the reliability and validity of equipment. Patients also need to be confident that using technology is an integral part of clinical best practice and that their clinician will access and act on messages or interchanges. The use of technology must never be seen as a cheaper or short-cut treatment, but as adding value to the patient’s care.
5. Creativity. Once you begin using TECS the creativity will come from your staff. When they begin using different types of technology they will identify new opportunities. Some examples of initiatives developed by staff in the West Midlands include closed Facebook groups for patients with specific long-term condition, medication reviews using Skype.
6. Communication.There is little point innovating if we don’t share what we have achieved. We have developed a learning website and e-bulletin where we share all our documents and have been running action learning sets across for clinicians. The West Midlands programme is taking the learning from our Staffordshire programme and scaling that up across a bigger footprint.
7. Continuity. If we are serious about change and want our practices to be equipped to face the challenges of the next 10-20 years continuity is vital. Using TECs isn’t a quick fix. Some of our outputs will be realised years from now so we need to be in this for the long haul. Sharing knowledge and skills is key. We’ve run training with patients with long-term conditions and will be developing further training and support and upskilling across the voluntary sector to embed those skills across our long-term condition networks.
Developing a network of digital practices
So now that we have the blueprint outlining the direction of travel, how do we intend to get there? By creating our programme through involving health professionals and practice managers in our action learning sets we have a support package that we believe can help us achieve a network of digital practices.
We’re careful not to place too much expectation on the practices, although they understand that by being part of the programme they will benefit in the long run.
Our learning website, video tutorials, online toolkits and action learning sets are being offered across the region and are already oversubscribed. Practices that are willing to innovate want some recognition for what they are doing and the digital quality mark that we have developed will do just that.
By doing this, we believe our region will become a rich environment for the tech sector to invest their time and ideas for delivery of care and at the same time help address some of the health challenges we face.
This is not a programme that is confined to the West Midlands. We’ve already discussed the approach with likeminded people in other regions as well as with NHS England so it is certainly something that can be replicated elsewhere.
The patient lies at the heart of what we are doing and so long as practices are committed to achieving the seven Cs we believe that there are few limitations as to what they can do to improve the use of a range of modes of digital delivery across primary care in their area.
- Dr Ruth Chambers is clinical lead for West Midlands Academic Health Science Network’s Long-term Conditions Network, GP and clinical chair Stoke-on-Trent CCG, clinical lead for technology enabled care services for Staffordshire STP’s digital workstream.
- Marc Schmid is director of Redmoor Health and digital advisor to the Long Term Condition Network of WMAHSN.