Primary Care Networks across the nation are preparing to hit the Long Term Plan deadline for making online consultations available and introducing a digital-first option by 2021. However, there’s a long way between having your virtual clinic platform ready-to-use and transitioning into making it an integral part of your service and an effortless choice for your registered patients. Dr Martin Godfrey, GP and Clinical Network Lead at Lambeth, London, is preparing for the virtual clinic launch in his CCG and he visited two primary care centres in Sweden to find out how they implemented their virtual clinics and what can be applied to the NHS.
Dr Martin Godfrey is a believer in digital transformation and his CCG is proactively preparing for the Long Term Plan deadline for online consultations. In this spirit, he visited Närhälsan and Bra Liv nära, two primary care centres in different Swedish regions to discuss their lessons learned and assess how they can be applied to a CCG NHS locality. We followed Martin in his meetings with Charlotte Lundholm, Development Leader, and Dr Gudrun Greim, Business Manager and Medical Advisor at Närhälsan Online in Västra Götaland, Sweden’s largest county, and Dr Ulf Österstad, District Physician and Head of Operations at Bra Liv nära, in Jönköping, the early adopter in digital healthcare. Not only did we find that healthcare in the UK and Sweden are similar in many ways, but we left with Dr Godfrey’s actionable checklist of what a CCG in NHS can employ to start rolling out their virtual clinics smoothly and efficiently, both internally and externally.
1) How to filter the right patients
Not all patients and cases are suitable for online consultation and this is both to be expected and normal. A virtual clinic is a complement to face-to-face consultations. Identifying the patients and medical conditions that are suitable for online consultation is a great first step. Is it a skin condition or a common cold? Is it a mental health concern? Which issues are suitable to send to your virtual clinic? The answers to these questions are a great first step for filtering both suitable patients and the staff that will start your virtual clinic.
For the second step of this process, it’s essential to outline whether the patient can fulfil the technical requirements. Do they have access to digital tools? Can they use them? Are they willing to? Charlotte Lundholm listed the three main questions the staff at Närhälsan Online have been asking patients before redirecting them to the virtual clinic:
- Do you have access to the internet?
- Do you have an online identification/NHS Login?
- Do you have a smartphone?
All the points identified from the two steps above can comprise a first assessment questionnaire, which will do wonders for filtering the cases correctly and efficiently. Both Bra Liv nära and Närhälsan Online have their own lists of conditions and technical questionnaires in their respective intranets, easily accessible and prominently displayed in their virtual clinic pages.
Furthermore, once the patient has entered your virtual clinic, your platform itself can facilitate filtering. For example, dynamic forms can automate that process by displaying your questionnaire and redirecting the patient to the correct resource.
2) How to introduce your virtual clinic
Now that you have outlined which cases are suitable to be distributed to your virtual clinic, you can start sending in the patients. Närhälsan Online followed an effective strategy with multiple benefits: They introduced their virtual clinics starting with a few centres and redirected patients over the phone using their filtration questionnaire. Charlotte Lundholm advised:
Create practice ambassadors with a checklist of questions
In the NHS setting, this strategy starts with the very first line in the system, the receptionists. Train your receptionists on how to filter the cases, equip them with a medical and technical questionnaire to locate suitable patients, and enable them to redirect the patients to an online consultation. This strategy allows healthcare providers to start on a small scale, assess the demand and their flows, and adjust as more patients come in. Dr Godfrey noted in his list:
Train the receptionists in what questions to ask in order to root a suitable proportion of patients into online consultations. That’s going to be critical.
3) “Let the patient be the motor” – How to generate demand
Once the front-line staff are prepared and equipped to redirect the patients, it’s time to allow in the first set of patients to determine the demand. This may come in contrast with two common inclinations that may seem intuitive at a first glance but are far from optimal: a) Introducing online consultations with follow-ups from the outset, and b) creating a broad awareness of the new service e.g. through advertising, and trying to get all patients on board at the same time.
If the inclination is to add a few online consultations following up from a routine face-to-face ‘list’ or after telephone consultations, I can understand that this won’t work: The doctors don’t like it because it seems like a lot of extra work. Make online consultations available in the booking process. Have an virtual clinic available as part of your offer, distributed from a receptionist. Create online consultations as an alternative to face to face consultations, not as an addition at the end of a busy clinic.
Dr Ulf Österstad of Bra Liv nära was adamant on how empowering patients to access the virtual clinic is key to success. As he said, the whole point of a virtual clinic is not about video meetings; it’s about having easier access to healthcare. Hence it is crucial to have a simple, easy platform that the patients really want to use – and reuse. It’s about having the right flows, that make it easy for suitable patients to reach out to their healthcare providers in a way that is more efficient for both parties. Ulf also confirmed and reassured that patients themselves know what a good topic for an online consultation is, and once they are aware of the digital option, they seek it out. The latest report from the Jönköping County confirms Ulf’s conviction.
Read the full story of how Bra Liv nära set up their digital practice with Visiba Care.
Introducing your virtual clinic to your registered patients is merely one side of the story. In an ideal scale-up situation, the internal rollout runs parallel to the external, and here’s how you get the people in your organisation on board.
4) How to allot the right leadership
The leader of your digital transformation project is the driver of success. As Charlotte Lundholm of Närhälsan Online says:
It is a challenging role that requires someone passionate, knowledgeable, committed to success and motivated by her/his conviction to the positive outcome.
Project leaders need to be supported unconditionally from top-down and trusted from bottom-up. They should be equipped with all the facts and information about the platform of choice and the process and general knowledge on change management. They should also be believers in digital transformation, to be able to convey its benefits and inspire the entire organization. Finally, project leaders should be determined to see the project through, able to pinpoint every milestone to celebrate, motivate themselves and others and encourage its progression.
5) How to manage digital transformation expectations
As Dr Godfrey and Charlotte Lundholm remarked in our previous post, the road towards digital transformation may be bumpy before the process is put in motion. After all, resistance to change is common, especially in large and stable organisations like the NHS. Nevertheless, there is a winning combination to manage expectations and get the staff involved and onboard.
A pragmatic mindset does wonders in this process. Dr Godfrey advises leaders who drive digital transformation to expect negativity and prepare to challenge it. He continues:
Addressing negative attitudes puts a lens of normality on negativity and stops these staff from becoming too defeatist in the early days.
Charlotte Lundholm explains how to address this issue, advising digital transformation initiators to reply with data and stick to the facts instead of jumping to an antagonizing stance. Dr Ulf Österstad added another perspective. Digital healthcare is far from a threat as it enables healthcare professionals to have more local ownership and strengthen their power to affect what they do. This is an important and motivating theme to highlight to all professionals involved before the project starts to roll out.
6) How to staff appropriately and set your booking system
One of the most difficult challenges is how to staff your virtual clinic. How many healthcare professionals do you start with? How many slots do you offer and how far in advance? Of course, the goal is to achieve the sweet spot where there are just enough available time slots for patients to book and having the right amount of staff to see them. No one wants to see doctors just sit there waiting for patients. Dr Godfrey asks:
How do you construct a booking system that ensures that if the patient wants to speak to someone online they can do it, but equally, you aren’t having doctors and nurses completely overloaded or worse, just sitting twiddling their fingers, waiting for someone to go online. It needs to be a bookable service that is manned appropriately.
This is where all your external rollout comes into play. Starting with a limited and suitable number of patients allows a controlled overview of the demand, which then allows you to manage your supply of GPs staffing the virtual clinics. Start with maybe one practice in your PCN and scale using the same process, to more. The benefit here is that you can pull resources regardless of the centre, so you can start with a core group of GPs who want to work online and add to that.
Dr Gudrun Greim, Business Manager and Medical Advisor at Närhälsan Online, painted the picture of how they administered the staffing of their virtual clinics. Närhälsan decided to offer slots for online consultations up to 3 days in advance. They started their virtual clinic with 10 doctors performing 200 online consultations a month. Every healthcare professional performing online consultations is employed within Närhälsan and they have to work physically at a primary care centre to qualify for online duty. With diligent scaling and quality monitoring, primary care centres in the entire county today perform 500 online consultations per week, alongside their physical practice!
7) How to optimise your virtual clinic
It is the case with every digital transformation that testing, assessing and adapting will bring the project to a larger scale in a smooth and fault-resistant way. Major, long-term planning and a broad introduction strategy are much more likely to result in a flawed service that has been outlined based on assumptions; Set-in-stone numbers may work for one type of organization or one type of patients, but not others. This way, scaling allows you to create a virtual clinic that is tailored to your demand, your resources, and your way of what you the virtual clinic needs to be within your workflows.
The solution here is close consideration, constant assessment of current practices, workflows and demands, and frequent, small changes. If a patient group is showing enthusiastic demand, add more resources; if a patient flow is not popular, remove resources; if another flow is too popular, add another functionality. Constantly learn and review and as Martin conclusively said:
Monitor the demand and then reassess.
Finally, be prepared for a long-ish process. It will take several months before your virtual clinic becomes an organic part of the primary care reception – and it should! A scalable, tailored digital transformation requires an easy and intuitive tool, small, responsive and steady steps, fixation on the end-goal, and of course, determination to make digital healthcare as great as possible – for the patients and the healthcare providers. Most importantly, start your journey and allow the stakeholders to take your virtual clinic where it needs to go!