One of the many challenges thrown up by the Covid-19 outbreak was the need for GPs across Wales to have a safe method for communicating with patients at home, safeguarding frontline staff and reducing any risk of further transmission.
Technology Enabled Care Cymru (TEC Cymru) is a Welsh Government funded programme hosted within Aneurin Bevan UHB and the team had been working with CWTCH Cymru and NHS Wales Informatics Service (NWIS) to pilot video consulting prior to the outbreak.
As one of the ways the Welsh Government could support patients and clinicians, at the start of March 2020 the Minister for Health and Social Care, Vaughan Gething, commissioned TEC Cymru to roll out the NHS Wales Video Consulting Service to all GPs in weeks.
Following a successful very rapid rollout, the NHS Wales Video Consulting Service was expanded to cover secondary and community care in April 2020, with a further expansion to optometry, dentistry and pharmacy in Autumn 2020.
To help deliver this Service in such a challenging timescale the Digital Health Ecosystem Wales and Life Sciences Hub Wales (LSHW) teams stepped in to help TEC Cymru develop and deliver the communications strategy and activity.
The NHS Wales Video Consulting Service enables healthcare professionals to provide patient consultations over video, taking away the need to meet face to face. The aim was to enable socially isolating patients to continue their access to healthcare professionals and to allow as full a range of health care teams and services such as nurses, consultants, GPs, outpatient clinics and therapy services to continue delivery of care while minimising the transmission risk to all parties. Video consulting could also enable healthcare practitioners who were shielding to be able to work from home and continue to provide essential healthcare duties on the frontline during the pandemic.
In order to deliver the NHS Wales Video Consulting Service, the TEC Cymru team had to ensure that adequate information governance and security measures were in place, as well as providing clinical assurance, best practice toolkits and a library of resources to health practitioners across Wales. With such a rapid rollout to meet an urgent need, providing high quality self-serve information quickly was key to equipping GPs and Practices.
Time was the biggest challenge, as the Covid-19 outbreak meant that the NHS Wales Video Consulting Service needed to be rolled out in weeks, not months as would be traditional for such a big programme with so many stakeholders and practitioners to reach, engage and train.
Sara Khalil, Programme Lead for TEC Cymru said:
“Timescales were very demanding in relation to this project.
“Initially the ask from Welsh Government was to focus upon primary care, specifically to make video consultations available across 405 general practices in 12 weeks by end May 20th. Over a seven-week period, 87% of practices were technically enabled, trained and ‘live’ across Wales.
“However, within a couple of weeks, we were asked to extend the scope to a second phase, to include secondary, therapies and community care services.”
Mike Ogonovsky, Assistant Director of Informatics at Aneurin Bevan UHB and National SRO for TEC Cymru, led the engagement with Health Boards and Welsh Government to make sure the NHS Wales Video Consulting Service would meet as many needs as possible in such a short time, getting buy in from across health and care service in Wales.
“Expectation and pace were huge. The whole team worked under enormous pressure and understood very well why this was so important.
“Before COVID the project was working very well but in a more R&D sense- we had planned to scale up in a year to what is now 10% of VC activity.
“That changed overnight with coronavirus, so this was very much a digital pandemic response.”
Due to the fast-paced and unprecedented nature of the project, the TEC Cymru team needed to expand quickly and bring new skillsets on board. This was delivered through rapid recruitment but also partnering with external organisations such as DHEW and Digital Communities Wales.
DHEW had started working with TEC Cymru in 2019 to develop a joint website as the programmes has many similar aims and activities. DHEW, as one of the programmes hosted by the Life Sciences Hub Wales was able to bring DHEW and LSHW resources to the TEC Cymru team, supporting the development and implementation of a national communications strategy for the roll out of the NHS Wales Video Consulting Service.
Helen Northmore, DHEW Programme Manager said:
“We were due to launch the TEC Cymru part of the website in April or May and suddenly we had a week to get it up to support the rapid rollout of the Service.
“A large part of the DHEW programme for the Spring was focussed on external engagement through events, conferences and projects. It became increasingly clear that Covid-19 would have a significant impact on our programme and planned activities. This meant we could bring the marketing and communications expertise within the DHEW and LSHW teams to support the TEC Cymru team.”
Another challenge the team faced was having to respond to the new working conditions caused by Covid-19 and adapting to the evolving nature of the pandemic. Remote working became the norm, which was a challenge when it came to contacting, supporting and training users of the Service. The level of technical ability and comfort in using new technology varied widely across NHS Wales services and teams and so a strong focus on providing training, self-serve information and case studies was essential.
Collaborative working strategy:
With such a short delivery timescale, and increasing demand for video consulting, the ability to rollout the Service so quickly was only possible because a number of organisations stepped in to work closely together.
TEC Cymru were able to draw on teams from NWIS, Digital Communities Wales, CWTCH Cymru, DHEW and LSHW. There was a can-do attitude from all organisations to work towards this shared, clear objective from the start. As video consulting was being rolled out to GP practices across Wales, the preparations for rollout to secondary and community care was being prepared, creating project teams in each Health Board and identifying key decision makers and influencers across health and care.
TEC Cymru teams worked with clinical leads and programme managers to develop the use cases for video consulting across all the different specialities and services in a Health Board. There were weekly meetings to check on progress, share ideas and develop the Service. The TEC Cymru team also set up an online training programme, which has trained thousands of frontline staff across Wales to help them make the best use of video consulting.
“The project was supported well, the emergency for most created a cohesion and shared vision that had not always been easy to achieve before.
“There is usually a greater appetite for certainty and absolute agreement nationally, but this time agile and good enough became the new normal.”
"From the outset, we worked closely with all the partners, and it was wonderful to see that everyone had a sense of a shared objective.”
Alongside the rollout, the DHEW and LSHW team developed and co-ordinated an awareness campaign, to ensure healthcare professionals practices across Wales were aware the NHS Wales Video Consulting Service was being rolled out and what this would meant for their GP Practice, clinical team, outpatient clinic or community care service.
“We developed press releases, created stories for TV and print media, launched the website and built a strong social media presence.
“Our first priority was to get the message out to GPs and the public quickly to make sure that GPs knew this service was coming as the first phase of rollout. We were developing toolkits, how to guides and best practice. We wanted to make sure GPs knew where to get more information, as well as raising awareness and providing information to patients who would suddenly be offered a video consultation and might be unsure about what that would be like.
“We quickly developed a comms strategy which outlined our key messages, how and where we would communicate and who the key stakeholders were. We set up a Twitter account, as that was a key communication channel for GPs and health professionals, as well as identify key influencers. The expansion into secondary and community care used the same strategy but was a different and much wider audience.”
“So many people and organisations helped us by providing case studies, sending out information and talking about the NHS Wales Video Consulting Service in their social media comms. It really felt like a team effort across the whole of the NHS and social care.”
The rollout of the NHS Wales Video Consulting Service has been a huge success – the first video consultation was held on 16th March and by August over 30,000 consultations had happened through the NHS Wales Video Consulting Service.
The service’s dedicated website has had over 15,000 hits and more than 2,500 individuals had been trained to use the video consultation service.
Thanks to the effective collaborative approach, feedback from both patients and healthcare practitioners has been extremely positive, and uptake has exceeded expectations.
Patients who have had video consultations have been very supportive of the system, with 92% of patient’s rating this new way of working as excellent, really good or good. Clinicians using the service agree, with 85% giving an excellent, really good or good rating.
“The work Digital Communities Wales have done is incredible – over 95% of care homes have been contacted, offered devices and training to use the service and over 200 homes have had training from the DCW team in just over two months.
“All of the statistics are incredible, it’s been an incredibly fast paced rollout to meet urgent clinical and patient need.”
"Early Adopter services went live from mid-April 20th and by August over different 100 specialties are using VC”.
“The uptake and spread of services across secondary and community care has exceeded all of our expectations, with new specialties being added each week and the number of consultations increasing exponentially.”
Mike proudly said:
“We have increased scope dramatically and exceed our own targets. We have also shown that multi-organisational collaboration can really work.”
One of the most evident successes achieved in the project, was the speed at which digital transformation can be adopted when supported by effective and informed collaborators.
“One hundred percent of GP practices were offered training in how to use the service within five weeks – that alone is a huge achievement. It delivered a huge transformation in the way GP services can be delivered to every patient in Wales – at a time when we all needed to limit face to face interaction it meant that you could still see your GP.
“This project has really demonstrated how rapidly digital transformation can be adopted throughout the healthcare system in Wales, when there is a critical need and you bring together a great team.”
Collaboration between partners was also highlighted as a significant factor in enabling the project’s successful outcome, quick implementation, and wide-spread adoption.
“This was a great example of mutual respect and trust within teams and the wider network. Everybody went above and beyond sacrificing a great deal of personal time in order to hit targets and exceed expectations.”
Helen said the level of collaboration was impressive. She said:
“It’s been a truly inspiring experience to see how everyone has come together and worked towards rolling this service out to people as quickly as possible, no matter what their ‘day job’ is, or who they work for. It’s been truly a Wales-wide team across health and care to deliver this incredible project.
“There’s been immense trust, belief and support not just within the team but across clinicians, patients, care homes, family members, everyone. There has been nothing but a culture of ‘how can we make this work’ as we are all clear on why being able to offer video consultations is important right now.”
Sara highlighted that the project was a good example of best practice on several fronts, including clinical leadership from within the programme and across NHS Wales, iterative development, and bringing together
“motivated, creative and constructive people who made enormous efforts to make this work”.
“We consistently drew on data driven reporting to inform how we can continuously improve the service. We also made evaluation a priority from the outset, again informing how we could strive to do better, make evidenced-based decisions and tailor the service for users.”
TEC Cymru’s Research & Evaluation team have had an incredible response from both patients and professionals. To date they have received over 13k survey responses and conducted over 140 interviews. This valuable evidence base will inform how digital transformation can add value to the way services are delivered.
Following the success, the first couple of phases of rollout, the NHS Wales Video Consulting Service is being piloted in new areas. The Welsh Government has approved the roll out of the next phase to community pharmacies, optometry and dental services, with development of clinical toolkits for each of these underway.
“The recent approval to expand the service to community pharmacies, optometry and dental services will mean that primary care services will continue the implementation over the coming months.
“Secondary and community care continues to grow rapidly in size and breadth of applications.”
The Welsh Government has also supported the ability to have video consultations in care homes, providing additional funding to Digital Communities Wales for 1,100 devices. This enables residents to see their GP and include their family in those consultations. Some GPs have been making the most of the technology, using the NHS Wales Video Consulting Service to hold ‘virtual rounds’ seeing multiple patients in one session.
Sara’s final thought –
“Ultimately, we hope that this new way of working will be here for the long term and provide an accessible, convenient and efficient means to deliver healthcare.”
For more information on the work that TEC Cymru does visit their website.