CCM Demonstrators –

Deliverables, Evidence and Mainstreaming

National CCM Cop April 22nd 2010

Roger Richards, Mark Kingston

High Impact Change - Approach and experiences of Virtual ClinicsAn exploration and discussion on the nature and impact of ‘Virtual Clinics’ in providing care

Mark Kingston - CCM Demonstrator National Team

The Triple Challenge

ReducingTreatmentTimes

Reduced Resources

Increasing Demand

CCM Demonstrators –

Deliverables, Evidence and Mainstreaming

National CCM Cop April 22nd 2010

Roger Richards, Mark Kingston

Virtual Approaches

Joint Review model i.e. a consultant attends a GP practice to discuss challenging or complex cases identified by the practice Examples1 & 2

Advice Service model i.e. GP seeks specialist opinion through letter, email or telephone Example 3

Secondary Care led Review model i.e. specialist analyses notes of patients on waiting list/new referrals to expedite decision making Examples 4 and 5

What should a consultant do - consult more, see less of everything slowly, and more of some things quickly?

• One year Joint Review project – part of ICC• 5 GP practices in one neighbourhood• Virtual and live clinics in GP practices

• MDT - Consultant, GP, DSN, Practice Nurse, Dietician• Full audit/evaluation plan (see CCMD EP 5)

Cardiff & Vale Diabetes Virtual Clinics

• Shift from live (c.45mins pp) to virtual approach (c.10mins pp)• Expanding remit of virtual clinics

•Poor control/patients in secondary care/triage for live clinics•Type 1 and Type 2

• +ve feedback - integration of SC/PC, education, patient benefits• Full results March 2011

•

Wrexham Virtual Clinics – Diabetes

• 8 month Joint Review pilot aiming to rationalise and triage referrals, and improve PC/SC mutual knowledge and understanding

For more detailsCCM Demonstrator Learning Paper 13 Year 2 case studies report

Wrexham Email Clinics• 10 week Email Advice Service pilot - • 12 participating practices across Wrexham and Flintshire• 5 Specialties• 5 day max response

CCM Demonstrators –

Deliverables, Evidence and Mainstreaming

National CCM Cop April 22nd 2010

Roger Richards, Mark Kingston

Wrexham Email and Virtual Clinics

3.3

3.1

4.2

4.2

0 1 2 3 4 5

Improved the experience of my patients within local health services.

Improved my knowledge of the subjects involved

...facilitated better communication between primary and secondary care practitioners.

Helped breakdown barriers between primary and secondary care.

Email

CCM Demonstrators –

Deliverables, Evidence and Mainstreaming

National CCM Cop April 22nd 2010

Roger Richards, Mark Kingston

Wrexham Email and Virtual Clinics

4.5

4.6

4.6

3.3

3.1

4.2

4.2

0 1 2 3 4 5

Improved the experience of my patients within local health services.

Improved my knowledge of the subjects involved

...facilitated better communication between primary and secondary care practitioners.

Helped breakdown barriers between primary and secondary care.

EmailVirtual

ABMU ENT Secondary Care led Review

“‘Virtual Clinics’ have reduced unnecessary follow-up reviews in the ENT department at the Princess of Wales Hospital. The effect of this change of practice has benefit for both patients and hospital. By adopting the ‘Virtual Clinic’ philosophy outpatient waiting lists will undoubtedly reduce.”

Activity• Six month review (2009/2010) by ENT clinicians to assess need for follow up appointments for..

a. ENT patients having outpatient imaging investigations - (169 patients)

b. ENT ‘long waits’ – (288 patients)•Patients and GPs informed by letter +/- telephone of normal investigation results or if change to planned ENT follow-up

ABMU ENT Secondary Care led Review

• 3320 minutes of actual ENT clinic time saved• Reviews fully embedded in practice• Further research estimated 75% less follow-up clinic appointments

Telephone Email Letter Fax

50 GP Practices275,000 patients

Patient Problem, Query, or Concern

Single Point Entry & Signposting

SpecialistCardiology

Clinics

One-StopCardiology

Clinic Possible Testing

Virtual Diagnosis, decision or plan by Cardiology ConsultantCommunicated by telephone, email and/or letter

Cardiology Virtual Clinic

CCM Demonstrators –

Deliverables, Evidence and Mainstreaming

National CCM Cop April 22nd 2010

Roger Richards, Mark Kingston

OverallConsistent with models of integrated working and shared careImprove access to specialist opinion Speed up patient journeysEvidence of efficiency savings and reducing OP appointmentsApplicable to different conditions

ConsiderationsClinical leadershipRequires behaviour changes (i.e. advice seeking)Governance arrangementsFurther work needed to support mainstreaming e.g. on waiting times, patient outcomes, cost savings