Telehealth no longer a remote possibility for general practice

Following its success across the UK, NHS Stoke on Trent CCG is running a clinical rollout of advice and interactive Messages (AIM) for health - the Florence SMS texting telehealth service, writes Professor Ruth Chambers.

Professor Ruth Chambers: 'GPs or practice nurses can use the Flo telehealth system to convey interactive and positive information messages texted to selected patients.'

The CCG is making a ‘free’ offer to other CCGs across the country to trial the simple telehealth application, Florence (or Flo).

What’s on offer?

Over the last three years we’ve developed clinical protocols with interactive and information messaging and trialled them in around 25 PCTs/CCGs across the UK – mainly in primary and community care settings (hypertension, asthma, COPD), but some secondary care applications too (heart failure, child asthma, renal, urology, cancer, pain management).

Florence complements the approach taken by the 3millionlives initiative which aims to increase the uptake of telehealth and telecare at scale over the next five years, to improve the lives of at least three million people.

So GPs or practice nurses can use the Flo telehealth system to convey interactive and positive information messages texted to selected patients, to enhance their clinical management. Patients then take more responsibility for their health and wellbeing in line with goals jointly agreed with their GP or practice nurse – the dual management plan is one of the secrets of Flo’s success and we’ve developed examples that practice teams can adopt or adapt for hypertension, asthma, COPD and heart failure.

If your practice was involved you’d select a few of the eight clinical protocols on offer (initial high BP reading, poorly controlled hypertension, medication reminder - hypertension, analgesia, asthma - inhaler reminders for adults or child/parent, smoking cessation - support or just quit).

We’ll fund a CCG’s licence for a year including costs of at least 15,000 patient texts, and help with implementing Flo across each participating CCG.

What’s the evidence that this Florence mobile phone texting service works?

We have just published results of a Health Foundation-funded project describing our experience of using Florence in control of hypertension. We focused on patients with poorly controlled hypertension, but we’ve other options - to confirm hypertension after an initial high BP reading, medication reminders for patients with stable hypertension, or a version for patients who’ve got inadequately controlled hypertension alongside CKD or diabetes, with lower BP goals.

These applications should help to reduce deterioration of long-term conditions and prevent avoidable hospital admissions – so helping CCGs with their QIPP (Quality, Innovation, Productivity and Prevention) targets (see box below for examples mapped to the Outcomes Framework).

How could you get involved in the rollout?

We’ll hold a ‘how to do it’ workshop in each of 10 engaged local area team areas. The workshops will explain the project to interested CCGs and general practice teams, and finalise arrangements to get started. A local health professional telehealth facilitator will be recruited and funded by the AIM project in each CCG to support individual practices in signing up patients and reporting on outcomes.

Each general practice team should recruit up to 50 patients using several of the eight clinical protocols on offer.

So we’ll have up to 30 CCGs with around 600 practices recruiting up to 30,000 patients who use the service for 14-90 days, by summer 2013. The length of time a patient interacts with Flo depends on the purpose.

If you’d like more information email our administrator at – we can send you an application form for your CCG for it to complete as soon as possible (or email Ruth as clinical lead on

AIM: Match of Florence telehealth  with NHS Outcomes  Framework


Eg Indicator / Outcome

Florence telehealth foci

Domain 1: Preventing people from dying prematurely

Reducing premature mortality from major causes of death

Hypertension: poor BP control

Smoking cessation: support; or just quit

Domain 2: Enhancing quality of life for people with  LTCs

Ensuring people feel supported to manage their condition

Hypertension:stable/medication reminder

Asthma: inhaler reminder (adult)

Medication reminder (eg pain management)

Smoking cessation: support

Domain 3: Helping people recover from episodes of ill health

Emergency admissions for acute conditions that should not normally require hospital admissions

Asthma: inhaler reminder (child/parent)

Emergency readmission within 48 hours 

Asthma: inhaler reminder (adult; child/parent)

Domain 4: Ensuring that people have a positive experience of care

Enhancing patient experience

Hypertension: poor control & stable versions

Domain 5: Treating and caring for people in safe environment and protecting them from avoidable harm

Medication ‘errors’ causing serious harm

Medication reminder

Hypertension: initial high BP reading (ie avoid treating someone who has actually not got hypertension)

  • Professor Ruth Chambers is GP clinical director of practice development and performance at NHS Stoke on Trent CCG.

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