Dr Masood Nazir 7 September 2012 “Digital Innovations supporting General Practice”

QIPP Digital Technology Page - 2 Clinical Commissioning Groups Information for success Dr Masood Nazir General Practitioner & Clinical Lead IT - Hall Green Health Information & Quality Assurance Lead – Birmingham Cross-city CCG Clinical Director IM&T – Birmingham & Solihull NHS Cluster Clinical & Social Care Lead IT – NHS Midlands & East SHAs Chair North, Midlands & East SHA Clinical Leads

QIPP Digital Technology Page - 3 W HAT I’ LL COVER ……  Alignment of Technology to Clinical and Efficiency Measures in the Outcomes Framework  Adoption of Existing Technology to underpin Service Change  Digital Essentials: Things to consider that will help your bottom line….. “Why Not?”  What support is being provided nationally to help local delivery? 3

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QIPP Digital Technology Page - 5 Birmingham Cross-city Clinical Commissioning Group

QIPP Digital Technology Page - 6 Our population 597,000 patients 103 practices 108 sites

QIPP Digital Technology Page - 7 Bordesley Green, South Yardley, Small Heath, Acocks Green LCN Bordesley Green, South Yardley, Small Heath, Acocks Green LCN East Birmingham LCN East Birmingham LCN Edgbaston LCN Edgbaston LCN Hall Green LCN Kingstanding & New Oscott LCN Northfield LCN Northfield LCN North East LNC South Birmingham LCN Washwood Heath LCN Information and Quality Assurance Senior Finance Officer Accountable Officer Informatics and LCNs Lay Member Consultant Advisor Nurse Advisor Partnership Commissioning Partnership Commissioning Primary Care Redesign & Quality Secondary Care Redesign Contracting & QIPP Mental Health (x2) Local Authority (x2) Mental Health (x2) Local Authority (x2) Urgent Care (2/3) Elective Care (2/3) Long Term Conditions (2/3) Urgent Care (2/3) Elective Care (2/3) Long Term Conditions (2/3) HEFT x2 UHB x2 BCH BCHC x2 BWH ROH WMAS HEFT x2 UHB x2 BCH BCHC x2 BWH ROH WMAS Lay Vice Chair Local Commissioning Network Chairs Chair of Local Commissioning Network Group Chair Birmingham CCG Board Structure

QIPP Digital Technology Page - 8 Gaining Advantage Business As usual

QIPP Digital Technology Page - 9 Central Care Record projectCloud collaboration tools Asset Management/IT refresh GP Clinical Systems

QIPP Digital Technology Page - 10 “ The more extensive a mans knowledge of what has been done, the greater will be his power of knowing what to do” Benjamin Disraeli

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QIPP Digital Technology Page - 14 RELEVANCE OF TECHNOLOGY TO HELP SUPPORT OUTCOMES TechnologyContributes to 1. Urgent care clinical dashboards Outcome Framework: Enhancing quality of life for people with long term conditions Improving people’s experience of accident and emergency services Reduced number of A&E attendances and the associated ambulance journeys ( Target 10% by 2014/15 ) 2. Risk Profiling Outcome Framework: Reducing premature mortality from the major causes of death Reducing time spent in hospital by people with long-term conditions Enhancing quality of life for people with long term conditions Reduced number of emergency admissions ( Target 20% by 2014/15) 3. Care Co-ordination Outcomes Framework: Ensuring that people have a positive experience of care Ensuring people feel supported to manage their condition Enhancing quality of life for people with long term conditions Improving the experience of care for people at the end of their lives Reduced cost by supporting patients to die at their preferred place of death Reduced number of emergency admissions ( Target 20% by 2014/15) 4.Shared Decision Making - Patient decision aids Outcomes Framework: Improving people’s experience of care Improving patient choice Reduced cost of discretionary surgery where it is clinically appropriate 5. Digital Essentials (Skype Consultations, Online Meeting Services, Managed Print, Digital Dictation, Digital Pens etc) Reduced Running Costs

QIPP Digital Technology Page U RGENT C ARE C LINICAL D ASHBOARDS B ACKGROUND  An Urgent Care Clinical Dashboard (UCCD); displays information in a graphical, user-friendly way helps GP Practices to more pro-actively manage and co-ordinate their patient’s healthcare, especially for the most vulnerable patients and those with long-term conditions.  It provides; near Real-Time information from the local Acute Trust(s) on A&E attendances, admissions and discharges combined with near real-time information from Out of Hours and the Walk in Centre to each GP Practice; enabling a whole system view of urgent care.

QIPP Digital Technology Page U RGENT C ARE C LINICAL D ASHBOARDS C ASE S TUDY - B ENEFITS NHS Bolton efficiency saving of £300K p.a. from reduced A&E attendance Reduction of emergency admissions by 4.7% in 10/ GP practices covering a population of 6.3 million

KEY Sites with live dashboards Sites in implementation phase Further scheduled dashboard deployments NHS Stoke on Trent and NHS North Staffordshire NHS Devon NHS Torbay NHS Plymouth NHS Tees ( NHS Hartlepool, NHS Middlesbrough, NHS Stockton-on- Tees, NHS Redcar & Cleveland) NHS Gateshead NHS County Durham and Darlington NE Lincolnshire Care Trust Plus and partners NHS Calderdale NHS Northamptonshire NHS Leicester City, NHS Leicestershire County and Rutland NHS Cambridgeshire NHS Peterborough NHS Luton NHS North Essex NHS Suffolk NHS Oxfordshire NHS Southampton NHS Buckinghamshire Central London Healthcare Partnership South Cheshire and Vale Royal GP Commissioning Consortia NHS Merseyside (NHS Liverpool, NHS Halton & St Helens, NHS Knowsley, NHS Sefton) NHS Manchester NHS Central Lancashire Lancaster Morecambe Carnforth & Garstang CCG NHS Oldham NHS Tameside & Glossop NHS Trafford NHS Brighton and Hove NHS East Sussex Downs and Weald Medlinc CCG/NHS Surrey 1. U RGENT C ARE C LINICAL D ASHBOARD I MPLEMENTATION S ITES

QIPP Digital Technology Page - 18 GPADS: GP Acute Data System Accessible via NHS Number from any of the acute activity reports Summary information from the primary care system, including demographic data, primary care diagnoses, acute activity in last six months and biometrics. Patient-specific A&E and inpatient admission reports

QIPP Digital Technology Page R ISK P ROFILING  Risk profiling; predicts the risk of adverse health events such as emergency admission in the next 12 months for individual patients based on their previous primary and secondary care history using a predictive algorithm.  This helps GP Practices; identify patients who are suitable for support by case managers or community matrons who were not previously on GPs radars.

QIPP Digital Technology Page R ISK P ROFILING Case Study- Benefits Used by Devon PCT for case finding and proactive case management Has resulted in an overall reduction in emergency admissions by 4.11% over the last two years

QIPP Digital Technology Page C ARE C O - ORDINATION The Challenge:  Patients with long term conditions, and those approaching the end of their life need support across a range of care settings  Being able to share information about care provided - including care plans and patient preferences, is essential  To develop new national interoperability specifications to support a consistent approach and support wider adoption Case Study:  South West Electronic Palliative Care Co-ordination System (EPaCCS)  Thousands of patients now achieving their preferred place of death, with less than 10% dying in hospital

QIPP Digital Technology Page D IGITAL E SSENTIALS T HINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE ….. “W HY N OT ?”

QIPP Digital Technology Page R EMOTE CONSULTATIONS USING S KYPE / O NLINE M EETINGS  Online Meeting Services (e.g. Skype) are being used to: Replace routine consultations where physical exams are not required Reduce DNAs Increase access to GP or consultation services.  OMS (Skype) is already being used by clinicians to hold consultations with patients from their own homes (e.g. South Devon Healthcare NHSFT) and for Diabetes outpatient follow-ups in Newham, reducing a 30-50% DNA to 16%.  £115K p.a. Estimated saving from community teams at NHS Derbyshire using Online Meeting Services  Guidance is available from the QIPP Digital Technology team that; outlines how to run meetings safely and addresses key Information Governance points presents best practices for running safe meetings using Skype

QIPP Digital Technology Page - 24 Virtual meetings and communication: some days I need a TARDIS “ Eat your lunch, sign prescriptions, answer queries from reception staff, get involved, pay attention and contribute!” CCG Chair Solutions (although not quite as good as a TARDIS): Skype Microsoft Office 365 WebEx and many more... i-Engage – Meetings from Planned Care Solutions using Microsoft Office 365. and RHUB TurboMeeting device for virtual meetings - 60 users 4 month pilot

QIPP Digital Technology Page - 25 ”In a nutshell, Office 365 enables me to be productive when I'm on the move. Like many of my colleagues, I have a wide range of roles in additional to my clinical duties, which involves working from different locations. Office 365 allows me to be paper-free, and ultimately more efficient; using my iPad I can always access the latest version of any file, at any time, from almost anywhere. There are no admin boundaries and crucially Office 365 safe, secure and intuitive to use. It's a brilliant communication, and collaboration, tool which will grow with our changing priorities and ways of working. I can't recommend it highly enough to all my clinical colleagues across the CCG." GP and CCG Information Lead

QIPP Digital Technology Page THINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE….. “WHY NOT?” Digital Pens £1235 per pen p.a. savings within maternity setting NHS Portsmouth estimate £212K p.a. Savings across their maternity services Cloud Storage Sandwell and West Birmingham CCG: Office 365 provides a Real-Time collaboration Hub to 60 staff. Delivered savings of £781 per month per 3 person virtual meeting, and £146 per board meeting. Simple Tele-health: Provides a text-based tele-health reading, advice and reminder service led by NHS Stoke-on-Trent Extended diabetes study validates pilot findings: Flo reduces clinical time by 60% and increases meds compliance by 80%. Online Access to GP Records Dr Amir Hannan is a GP in Hyde, UK. Developing a "Partnership of Trust" between patient and clinician, he has enabled over 11% of his patients (more than 1,300) to access their GP electronic health record on-line Provides all LTC patients with a clear understanding of the relevant pathway using Map of Medicine.

QIPP Digital Technology Page THINGS TO CONSIDER THAT WILL HELP YOUR BOTTOM LINE…..”WHY NOT?” Managed Print Unified delivery and management of printers, scanners and copiers for an organisation. Savings of up to 30% off the cost of printing Central Lancs Care Trust reports a return on investment after just 3 months and current savings running at over £50K per month. Green IT – PC Powersaving To provide all Informatics Merseyside Partner Organisations with a unified PC Power Management product. Over £100k savings delivered post implementation. Return on Investment achieved within 5 months. Telemedicine Interactive healthcare, allowing consultations with physicians live over video or capture images and data for diagnosis and followup later. Six acute trusts and seven PCTs across Lancashire and Cumbria expect savings of £1.8 million annually Digital Dictation Saving of £69K from 11 radiologists in 5 months. Salford Royal FT on track to deliver benefits over £500K p.a.

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QIPP Digital Technology Page - 29 W HAT SUPPORT IS BEING PROVIDED NATIONALLY TO HELP LOCAL DELIVERY ? The QIPP Digital Technology Team have produced;  Implementation guide and toolkit for the Urgent Care Clinical Dashboard  Technical & Information Governance guidance on risk profiling solutions  Guidance for electronic sharing of care plans, with a focus on LTCs and End of Life care  Guidance for patient registration and authentication to online services  Digital Essentials brochure – that NHS organisations should be looking to exploit  Factsheet & Information Governance guidance on using Skype for online consultations / meetings  Procurement guidance for online meeting services  Website with Interactive Map of local informatics initiatives

QIPP Digital Technology Page - 30 N EW FUNDING TO SUPPORT SHARING OF INFORMATION  The Information Sharing Challenge Fund – a new fund announced on 31 st August.  Available to local NHS organisations to develop new patient care improving and information sharing digital services e.g. Clinical Dashboards.  Three categories of award: 1.New Stuff – totally new solutions 2.Development – by a new supplier 3.Rollout  To assist with application process webinars are being held in September challenge/ challenge/

QIPP Digital Technology Page - 31 NHS TREASURE MAP Innovations – Promote, Share & Spread your GEMS

QIPP Digital Technology Page Mobile Working Sharing Information Education

QIPP Digital Technology Page - 33 S UMMARY  Digital innovation has a key role to play in supporting General Practice  It’s not new – much of this already exists…there is low hanging fruit  GPs to consider role of digital technology as part of service change  National enablers and case studies already available to assist with adoption.

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