We have been exploring the use of video consultations via Skype since 2011 for patients who do not need to physically come to the hospital and attend an appointment.
Some of the specialties using these video appointments include Diabetes, Endocrinology, HPB ( hepato-pancreato-biliary) Cancer and Haematology and there are a number of clinical teams interested in trying this for their patients. The team has developed significant expertise and shown improvement in health outcomes, efficiency and improved patient experience.
Outpatient services can be difficult for many people to attend and do not always meet the needs of patients. This often leads to high rates of non-attendance at appointments and poor patient engagement, resulting in poor health outcomes and greater use of emergency care, plus rising costs. With people living longer, many with multiple long-term illness and complications, care models need to be more flexible and responsive.
Research has shown that using remote video outpatient consultations rather than face-to-face review with patients in hospital has the potential to address some of the well –recognised problems with current outpatient care. However, implementing video consultations within routine practice in the NHS is challenging.
About the project
Our team was selected by the Health Foundation, an independent charity, in October 2017 to be part of a £3.5 million improvement programme. The Scaling Up Improvement programme supports seven projects in the UK to take their proven healthcare innovation and make them work at larger scale to have a positive impact on patient outcomes.
Our project builds on the work we have done so far and examines how we can work with a range of local and national partners including local commissioners, NHS England, NHS Digital and Microsoft to scale this up locally and nationally and develop standardised national level policy for the practice. The work will be evaluated by academic leads at the Nuffield Department of Primary Care Health Science at the University of Oxford.
The project team will create a virtual consultation unit within Barts Health which will facilitate local spread and national roll-out of virtual consultations by supporting sites who are interested in using this type of consultation. The unit will provide clinical, technical, management and administrative expertise; demonstration clinics so that teams can observe virtual consultations in real time; workshops; and an online forum and resource directory. The project team’s ultimate aim is to create a national network of sites who can learn from each other’s experiences.
Working with national-level decision-makers, the project team also aims to develop a national policy around the use of video consultations, including tariff, technology, governance and staff training. The team will also work with a technology provider to test the various options for web consultations.
Patient case study
- Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, Hanson P, Campbell-Richards D, Ramoutar S, Collard A, Hodkinson I, Greenhalgh T.Advantages and limitations of virtual online consultations in a NHS acute trust: the VOCAL mixed-methods study. Southampton (UK): NIHR Journals Library; 2018 Jun. Health Services and Delivery Research. https://www.ncbi.nlm.nih.gov/pubmed/29939519
- Greenhalgh T, Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, Hanson P, Campbell-Richards D, Ramoutar S, Collard A, Hodkinson I. Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res. 2018 Apr 17;20(4)https://www.ncbi.nlm.nih.gov/pubmed/29625956
- Shaw S, Cameron D, Wherton J, Seuren L, Vijayaraghavan S , Bhattacharya S, A’Court C , Morris J, Greenhalgh T .Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project.http://www.researchprotocols.org/2018/7/e10913/
- Greenhalgh T, Vijayaraghavan S, Wherton J, Shaw S, Byrne E, Campbell-Richards D, Bhattacharya S, Hanson P, Ramoutar S, Gutteridge C, Hodkinson I, Collard A, Morris J.. Protocol: Virtual online consultations - advantages and limitations (VOCAL) study. 2016 BMJ Open 6: e009388 https://www.ncbi.nlm.nih.gov/pubmed/26826147
- Morris J, Campbell-Richards D, Wherton J, Sudra R, Vijayaragahavan S, Greenhalgh T, Collard A, Byrne E, O’Shea T. 2017. Webcam consultation for diabetes: findings from 4 years of experience in Newham. Journal of Practical Diabetes. 2017. Vol 34: 45-50.
- Morris J, Campbell-Richards D, Wherton J, Shaw S, Vijayaragahavan S, Greenhalgh T, Sudra R, Collard A, Byrne E, O’Shea T. Virtual webcam clinics: Benefits and challenges. The Newham experience. Diabetes Care for Children & Young People. 2016 Vol 5 (3):105-110.
- Vijayaragahavan S, O’Shea T, Campbell-Richards D, Sudra, R, Morris J, Byrne E, Greenhalgh T. DAWN: Diabetes Appointments via Webcam in Newham. British Journal of Diabetes & Vascular Disease. 2015. Vol 15, 123-126.
Meet the team
- Sir Sam Everington: Chair of Tower Hamlets CCG
- Bob Gann: Specialist Advisor CQC, Digital Inclusion Lead – NHS Digital, Junction Digital Consulting
- Dr Charles Gutteridge: Chief Information Officer, Barts Health NHS Trust
- Luke Readman, Chief Information Officer East London Health & Care Partnership
- Prof. Trisha Greenhalgh: Professor of Primary Care Health Sciences, Nuffield Dept Primary Care Health Sciences, University of Oxford
- Dr Sara Shaw: Sociologist, Nuffield Department Primary Care Health Sciences, University of Oxford
- Dr Harpreet Sood: Associate Chief Clinical Information Officer at NHS England and NHS Doctor
- Paul Thomas: Digital Advisor, Microsoft
- Dr Joseph Wherton: Research Fellow, Nuffield Department Primary Care Health Sciences, University of Oxford
- Dr Chrysanthi Papoutsi: Research Fellow, Nuffield Department Primary Care Health Sciences, University of Oxford
- Dr Shanti Vijayaraghavan: Clinical Lead, Diabetologist, Barts Health NHS Trust
- Dr Joanne Morris: Project / Research Manager, Barts Health NHS Trust
- Alice Morrisey: Project Manager, Barts Health NHS Trust
How can NHS Organisations get involved
We are supporting other NHS organisations in the set- up of video consultations. At present we have a list of expressions of interests from NHS Trusts. Although we can’t support all trusts to the same level, we do want to make as many of our resources as possible available to others to share the learning.
If organisations have more specific queries not addressed in the resources we have provided below, we can be contacted for further information.
- Business Case for Virtual Consultations [docx] 77KB
- Using video conferencing for patient/service user consultations [pdf] 102KB
- Service patient information leaflet for Skype appointments [docx] 89KB
- Skype guidance short doc [pdf] 234KB
- Video Consultations How To Guide [pdf] 754KB
- Jo Morris: Research/ Project Manager Barts Health: Joanne.Morris@bartshealth.nhs.uk
- Alice Morrisey: Project Manager Barts Health firstname.lastname@example.org