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Scottish self-care and health information improvements with patient relationship management

Capita Clinical Solutions : 08 November, 2013  (Application Story)
Flexible patient relationship management system is at the core of the NHS 24 telephone and online health service adopted in Scotland
Scottish self-care and health information improvements with patient relationship management

NHS 24 is Scotland’s national telehealth and telecare organisation. It provides a range of online and telephone-based health services for people in Scotland. It offers out of hours support and comprehensive up-to-date health information and self-care advice where and when people need it.  

Established as a Special Health Board on 6 April 2001, it launched a year later and was aimed at becoming the gateway to out of hours services for the whole of Scotland, triaging and signposting patients to the most appropriate form of care available within their local area. During the past decade, patients have been able to call upon a pool of 1,200 specialist clinical experts, including nurses, call handlers, dental nurses, pharmacists, mental health nurse advisors, health information advisors and special phone line advisors.

NHS 24 receives 670,000 visitors to its website each year and 1.5 million calls – equivalent to almost a third of the Scottish population. Since its inception, it has received over 13 million calls in total. On its busiest day in the last ten years, the service received 17,560 calls – about the same as the population of the University town of St Andrews.

The NHS strives to provide high quality care that is safe, effective and focused on patient experience and clinical need. It also aims to work across organisational boundaries and in partnership with other bodies in the interest of patients, local communities and the wider population.

With that in mind, launching a new phone and online service required a robust, comprehensive, easy-to-use and flexible patient relationship management (PRM) solution. In essence, NHS 24 needed a system that could support a wide range of activities. This included staff being able to manage calls from patients requiring a broad range of assistance and signposting to locally available services, while also providing accurate clinical information for call handlers. The system also operated using algorithms to support clinical specialists and a website to question and pinpoint health issues, as well as the ability to integrate with patient record systems across a number of service providers.

The ultimate test that such a system would face was the tough targets that NHS 24 needed to meet. This meant ensuring 90 per cent of patients who required emergency care were transferred to the Scottish Ambulance Service immediately and 90 per cent of all calls being answered within 30 seconds. This was in addition to helping to reduce the pressure on A&E departments by providing self-care advice by telephone and a comprehensive web service and ensuring less serious calls could be referred to primary care or home care help.

NHS 24 turned to Capita’s Clinical solutions team to meet these demands owing to its proven track record and ability to meet the stringent requirements of operating a health service on a national scale.

Capita’s Clinical solutions team provided a bespoke PRM solution for NHS 24 in partnership with BT, which remained the basis of the service for over a decade. Rarely does a single solution have the longevity and flexibility to do so.

The solution based on the IntefleCS platform comprises a number of key elements. These include the ability to capture caller information while prompting staff to ask specific questions, leading to diagnosis via powerful and constantly refined decision support algorithms. These features allowed callers or web visitors to be referred to the appropriate service quickly while also – in the case of the call centre – creating a health record that was forwarded to the patient’s GP or other NHS Scotland health providers.

Central to the safety and efficiency of the service was the quality assured clinical content. This was specifically customised for use in Scotland in a process known as the ‘Airth process’ which involved the Royal Colleges in Scotland.

Capita has continued to work closely with NHS 24 to update the clinical content and align to new guidelines and service experience. Capita has also worked with NHS 24 to embed its own clinical content for use by other skill sets and to deliver specialist services.

Technical development has included links to the CHI record (Scotland’s secure central patient record) to enable verification of key patient demographic information. Meanwhile the seamless interface between the PRM and other health records meant information was shared quickly, but securely with the health care professionals.  

The implementation was a complex process involving coordination between Capita, its partners and NHS 24. This was carefully managed to avoid the associated challenges of such a project. To mitigate the potential risks associated with introducing new technology in a clinical setting, the PRM went through an extensive testing and roll-out process to allow fine-tuning. Along with the Airth process, this ensured the most effective outcomes and optimum safety for patients.

Within about two years of launch, the PRM system had supported the management of one million calls, while consistently delivering high-levels of in and out-of-hours care to the Scottish population.

Gill Stillie, Chief Operating Officer of NHS 24, says: “We wanted a stable solution that remained so even under huge pressure either online or over the phone. We needed it to offer staff the very best in clinical content, supported with complex algorithms allowing patients to be dealt with to a very high standard. It was also vital to capture and securely share patient records. The Capita Clinical solutions system met all of these requirements – and continued to do so for over a decade.”

From a patient perspective, it was vital that the PRM system supported their call, but was invisible to their experience. “A patient – especially if they’re distressed – just wants help. With that in mind, the technology needs to support them in getting that help while working hard in the background, unnoticed. In the time we’ve used the PRM, it has always remained invisible to patients thanks to its stability,” she added.

Members of staff found the PRM easy-to-use and its longevity has created a familiarity that has supported better outcomes for patients. Combined, these outcomes have helped NHS 24 meet its targets.

According to the latest figures from May 2013:

* 98.4 per cent of calls to the service were answered within 30 seconds, against a target of 90 per cent

* 99.98 per cent of GP priority calls and 99.98 per cent of GP routine calls were responded to within the target timescales

* 100 per cent of dental calls were responded to within 45 minutes, against a target of 95 per cent

* 95 per cent of calls to the Health Information Service were answered within 60 seconds against the target of 80 per cent

* An average of 0.003 per cent of calls resulted in a complaint, against a target of less than 0.01 per cent

Importantly, NHS 24 continued to support the national target to reduce A&E attendances by providing 34 per cent of patients with self-care advice, against a target of 30 per cent. During the same period, NHS 24 also converted 79 per cent of non-serious or life-threatening calls to primary care or home care outcomes against a target of 75 per cent . This is vital if the NHS is to maintain high-quality service at a time when there is greater demand on the service than ever before yet funding is under pressure.

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