General Practice Nursing:‘Make a real difference as a Digital Nurse Champion’

General Practice Nursing:
‘Make a real difference as a
Digital Nurse Champion’

Chair:
Dr Ruth Chambers OBE,
Clinical Chair, Staffordshire STP’s
clinical lead for technology enabled
care services, digital workstream

Enabling practice nurses and
other clinicians to adopt
technology enabled care
services for delivery of care to
patients with long term
conditions & adverse lifestyle
habits

Unlocking the potential of TECS
5

Opportunistic or
purposeful
detection of
dementia
Ongoing
clinical
management
Palliative care
management
Help with
lifestyle habits
& memory
Frailty
Focus on
comorbidities
End of Life:
last months/
weeks (patient
and/or carer)
Palliative care
management
Dementia & Clinical Digital Pathways
Ruth.Chambers@stoke.nhs.uk 4.6.18
Assistive
technology
Advanced
Care
Planning
Support for
family carer of
person with
dementia

Cardiovascular disease prevention – return
on investment (PHE, 2018)
• The detection of diabetes has high costs in the early years, but
saves £31.6bn by 20 years
• Detection and management of CKD saves £1.7bn by year 20
• Detection of hypertension saves £55.5m by year 20; but the
detection and management of hypertension costs £2.8bn by year
20 (as people live longer)
• Greatest savings from prevention, with nurse-led annual review
preventing 325,000 CVD events annually, and 31,000 premature
deaths, saving 1.2bn by year 20

Other interventions
 NHS Health Check saves £463m by year 20
 Smoking cessation shows a Net Monetary
Benefit(NMB) of £6.5bn by year 20
 Weight management has NMB of £1.6bn

Enabling New Models of Care
Interoperabilit
y
ETTF
GPIT BAU
Provider
Digitisation
HSCN
Urgent &
Emergency
Care
Local Health
Records
WiFi
NHS 111
New Models
Of
Care
Online
Consultation
NHS.UK
eRS
P2020
2018
Funding
Information Governance National ProgrammesEnabling Technology
Extended
Access

Making the digital vision happen
Aim – Adopt technology
enabled care as usual
practice
Scope – Which type(s) of technology
will you use to achieve planned
outcomes/ what LTCs will you focus
on?
Resources – Who/what do you need
– equipment, competence, practice
support, online clinical consultation
triage?
Outcomes – Improve patient
/clinical management of long
term conditions/adverse
lifestyle habits -efficiently

The digital nurse as central to the
General Practice Forward View
Karen Storey
Primary Care Nursing Lead
NHS England
Karen.storey@nhs.net

By 2020 General Practice will not exist
as we know it now!!

The vision
“One of the most transformative things that will happen in the
next few years, I think will be the use of clinical systems that
allow the user to be prompted on patient pathways. This not only
gives empowered clinicians with local pathways, but also then
can be used to show unwarranted variation in the same way we
have used prescribing data that is currently available to primary
care. This ‘digital’ revolution will produce one of the biggest
revolutions in patient care”
Prof Nick Harding OBE, FRCGP FRCP
Chair Sandwell and West Birmingham CCG
NHSE Senior Medical Advisor ICS and Right Care

Technology in the 1980s
• Personal computers
• Graphical user interface
• CDs
• Walkmans
• VCRs
• Camcorders
• Video game consoles
• Cable television
• Answering machines
• Cell phones
• Portable phones
• Fax machines

How ready are you for the future ?

“I’m all for progress; it’s change I don’t
like”
Mark Twain

22GP Patient Survey | National report | August 2018 | Version 1 | Public
Booking appointments online
Ordering repeat prescriptions
Accessing medical records
online
None of these / don’t know
Are patients aware of the online
services offered by their GP practice
and do they use them?
Main menu |
As far as you know, which of the
following online services does your
GP practice offer?
Awareness
Two in five (40.6%) were aware that they can book
appointments online, and 37.9% said they can order
repeat prescriptions online. One in eight (12.7%) was
aware that they can access medical records online.
Use
There is a gap between awareness and use of these
services. In the past 12 months, patients most
commonly used online services to order repeat
prescriptions (14.3%) or book appointments (12.9%).
Fewer patients used online services to access medical
records online (3.3%).
78.9%
3.3%
14.3%
12.9%
50.6%
12.7%
37.9%
40.6%
Awareness of online services Use of online services
General practice online services
Which of the following general
practice online services have you
used in the past 12 months?
Base: all patients; awareness of online services (735,717) and use of online services (742,492)

23GP Patient Survey | National report | August 2018 | Version 1 | Public
Base: all patients excluding those who hadn’t tried (234,144)
Use of GP practice website
One in three patients (35.5%) had tried to use their GP
practice’s website to look for information or access
services.
Nearly two in three patients (64.5%) had not tried to
use their GP practice’s website.
Ease of use of website
However, of those who had tried to use their GP
practice’s website, over three quarters (78.3%) found it
easy* to use. Over one in five (21.7%) did not find it
easy**.
Do patient’s try to use their GP
practice’s website, and is it easy to
use?
*Easy = ‘very easy’ + ‘fairly easy’
51.2%
Fairly easy
27.1%
Very easy
6.6%
Not at all easy
15.1%
Not very easy
How easy is it to use your GP practice’s website to look for information or
access services?
GP practice website
Main menu |
’**Not easy = ‘not very easy’ + ‘not at all easy’

 GPN
leadership
development
 GPN educator
network
 GPN
conferences
 Nurses Voices
Network
 NHS Jobs
collaboration
 Hubs work to
increase
placements by
20% by 2020
 Induction
template
 Student
network
 Return to
practice
programme
 Integration
with PHE ‘All
our Health’
 Single
information
hub for
GPN/HCSW
 GPN Digital
ambassadors
 National
clinical
protocols
 National GPN
workforce
engagement
 Workforce
online toolkit
use
 Workforce
demographics
and planning
 GPN/HCSW
Education
programme
 ACP
Development
programme
 Advanced
practice
support
 GPN
Apprenticeship
scheme
 Nursing
Associates
 GPN Bank
 Digital
Supervision
 Supervision
Model
The GPN10PP
National
Programme

Action 6: ‘Embed and deliver a radical
upgrade in prevention’
Digital GPNs, health prevention and
health promotion
We are working with PHE and have extended our commission
on the pilot with Stoke CCG. We are rolling out the project to four
STP areas where we will create digitally enabled practice nurse
champions. This project is underpinned by the All Our Health
platform and examples of good practice will be shared through
the Leading Change Adding Value Framework.

Four GPN Regional Delivery Boards
• Jane Clegg, NHS England
• Therese Davis, HEELondon
• Sharon Haggerty, NHS England
• Jean Hayles, HEENorth
• Alice Webster (Hazel Watson), NHS England
• Pauline Brown, HEESouth
• Vivienne Stimpson, NHS England
• John Clarke, HEEMidlands and East

Budget: £15m
Year
1: Nil
Year
2:
£3m
Year 3:
£4m
Year 4:
£4m
Year 5:
£4m

GPN10PP Progress to GPN 2020
Workforce Target
FTE Sep-15 Mar-16 Sep-16 Mar-17 Sep-17 Mar-18 Jun-18 Sep-18 Dec-18 Mar-19 Sep-20
Indicative
target
Variance
(Sep 20-
target)
England Actuals 15,398 15,753 15,827 15,528 15,800 15,889
Plans 15,896 15,912 15,942 15,995 16,072 16,473 16,398 75
North Actuals 4,642 4,772 4,796 4,730 4,822 4,856
Plans 4,880 4,874 4,880 4,876 4,883 4,920 4,933 -13
Midlands and East Actuals 4,882 4,992 5,041 4,953 5,031 5,101
Plans 5,035 5,007 4,989 5,001 5,016 5,109 5,194 -85
London Actuals 1,916 1,907 1,885 1,808 1,807 1,812
Plans 1,838 1,877 1,917 1,956 1,995 2,231 2,050 181
South East Actuals 2,243 2,297 2,279 2,256 2,308 2,314
Plans 2,313 2,322 2,324 2,326 2,339 2,373 2,402 -29
South West Actuals 1,715 1,785 1,826 1,781 1,833 1,807
Plans 1,829 1,831 1,832 1,835 1,838 1,840 1,820 20
4400
4600
4800
5000
Sep-15
Sep-16
Sep-17
Jun-18
Dec-18
Sep-20
4600
4800
5000
5200
5400
Sep-15
Sep-16
Sep-17
Jun-18
Dec-18
Sep-20
North M&E
0
1000
2000
3000
Sep-15
Sep-16
Sep-17
Jun-18
Dec-18
Sep-20
London
2100
2200
2300
2400
2500
Sep-15
Sep-16
Sep-17
Jun-18
Dec-18
Sep-20
South East
1600
1700
1800
1900
Sep-15
Sep-16
Sep-17
Jun-18
Dec-18
Sep-20
South West

General Practice
Nursing
Ambassadors
@GPNSNN

Embracing the digital revolution

Thank you
Karen.storey@nhs.net
@kstorey63
@GPN SNN
#GPN10PP

www.england.nhs.uk
Personalised care: central
to technology enabled
care
Michelle Mello - Clinical Lead, Personalised Care, NHS England
General Practice Nursing – Make a real difference as a digital
nurse champion, 20 November 2018

www.england.nhs.uk
The Code – Nursing & Midwifery Council
Prioritise People
Listen to people and respond to their preferences and concerns
• work in partnership with people to make sure you deliver care effectively
• recognise and respect the contribution that people can make to their own health and wellbeing
• encourage and empower people to share decisions about their treatment and care
• respect the level to which people receiving care want to be involved in decisions about their own
health, wellbeing and care
• respect, support and document a person’s right to accept or refuse care and treatment, and
• recognise when people are anxious or in distress and respond compassionately and politely

www.england.nhs.uk
NHS/social care
professional = 5-10 hrs
in a year
Self management
= 8750-55 hrs in a
year
For people with LTCs,
usual management = self management

www.england.nhs.uk
If you live with LTCs, managing health and
wellbeing is work/burden
Managing
my
condition(s)
Managing
the impact
of my
conditions on
my
psychosocial
wellbeing
The work of
• Changing lifestyle
(to manage
condition and
prevent disease
progression)
• Adhering to
medication
• Attending medical
appointments and
co-ordinating care
The work of
• Adjusting to
and
developing
control over
changing
identity and
social role

www.england.nhs.uk 37
Living with LTCs (3 or more)
6-13 per day
7-9 days per month
health related activity
Moriaty et al, 2018

Social care concepts
of personalisation
and choice
Health care
concepts of person
centred care
Personalised care
Personalised Care: what is it?

www.england.nhs.uk
What is personalised care?
People having choice and control over decisions that affect their own health and wellbeing within
a system that harnesses the expertise, capacity and potential of people, families and communities
in delivering better outcomes and reducing health inequalities. This incorporates:
. whole population
approaches to
supporting people of all
ages, and their carers,
to manage their
physical and mental
health and wellbeing
and make informed
decisions when their
health changes
a proactive and
universal offer of
support to people
with long term
physical and mental
health conditions to
build knowledge,
skills and
confidence through
supported self-care
and community-
centred approaches
Intensive
approaches to
empowering
people with more
complex needs to
have greater choice
and control over
the care they
receive

100%
30%
5%
Specialist
People with complex needs
Targeted
People with long term physical and
mental health conditions
Universal
Whole population
Comprehensive Model for Personalised Care
All age, whole population approach to Personalised Care
Empowering people, integrating
care and reducing unplanned
service use.
Supporting people to build
knowledge, skills and confidence
and to live well with their health
conditions.
Supporting people to stay well
and enabling people to make
informed decisions and choices
when their health changes.

www.england.nhs.uk
So why aren’t we doing it?
• “We’re doing it already”
• “We don’t have the right tools”
• “Patients don’t want it”
• “How can we measure it?”
• “We have too many other demands and
priorities”
• Lack of implementation strategy
• Other system incentives drive in opposite
direction

www.england.nhs.uk
• People with learning disabilities die 15-20 years earlier than the general
population, as do people with severe and prolonged mental illness
• Clinicians and people routinely overestimate treatment benefits by 20%
and underestimate harms by 30%
• Only 40% of adults report that they have had a conversation with a
healthcare professional in their GP practice to discuss what is important to
them
• Only 7% of adults have been given (or offered) a written copy of their care
plan
• 84% of GPs say that their workload is unmanageable or excessive and
can prevent quality and safe care
And….

How can technology help?

“Public-facing digital services should support and
empower people to stay healthy and independent
for longer.
This will include, among other things, secure online
access to clinicians, personalised and relevant
health information, and digital tools and advice that
meet the growing expectations of consumers.”
Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care,
Vision for Technology in Health and Social Care - October 2018

How digital empowers people
We will empower people to participate in their health and care using digital services
that enable choice, meet their needs, target prevention and offer a personalised
experience, through:
• Convenient access to trusted advice and easy interaction
with the health and care system using their technology
• Giving people informed choice and control of their health
and care
• The use of digital tools for self-care and staying well
• Remote monitoring of their health data so that problems
and risks can be identified and managed early
• Shared care and support planning

Supported self management
Digital apps & wearables, PHR, online
peer support groups, patient activation
measuring
Enabling choice
E-Referrral Service, NHS.uk
Personal health budgets & integrated
personal budgets
Resource Allocation System, e-
marketplace for care
Shared decision making
Informed through NHS.uk, NHS App,
Personal Health Record
Social prescribing and
community-based support
Online resource directories, referral and
follow-up
Personalised care and support
planning
Shared digital care records with
Personal Health Record
How Personalised Care can be delivered digitally

Further information
https://www.england.nhs.uk/personalised-health-and-care/
@Pers_Care
@NHSPHB
@mhsmello
#personalisedcare #futurenhs
48

Paul Vaughan, Director of Nursing – Transformation, NHS
England /Karen Storey, Primary Care Nursing Lead, NHS England
Leading Change, Adding Value: a
framework for nursing, midwifery and
care staff
Digital GPN Conference
20 November 2018 #Lead2Add

Huge professional opportunities in all times of change
Transformation, as set out within the Five Year Forward View is being delivered so we have
health and care services that can adapt to the future.
We recognise that we cannot rely on the traditional solutions to some of our major
pressures and we need to think differently moving forwards and use our leadership to
narrow the gaps that exist in health and well-being, care and quality, and funding and
efficiency.
 As nursing, midwifery and care staff we are now applying
the same importance to ‘quantifying’ and ‘measuring’ the
outcomes of our work as we do to demonstrating the quality
and compassion that we are recognised for.
 By bringing the same focus to measuring the ‘triple aim’
of improving experience, outcomes and use of resources
involved in our work we are able to clearly demonstrate the
professions’ contributions to the FYFV and the wider system
going forwards.
#lead2add
www.england.nhs.uk/leadingchange

Leading Change, Adding Value: aligned to the
Five Year Forward View
Modern
Workforce
Empowering
Patients
www.england.nhs.uk/leadingchange #lead2add

Leading Change, Adding Value: a framework for
nursing, midwifery and care staff (2016)
LCAV supports the professions to
look at reducing ‘unwarranted
variation’ - where standards of
care are not equal - and how we
can make sure that by seeing
where inequalities exist and
changing them – that everyone
can receive the same highest
standards.
#lead2add

Co-production approach has translated into a co-
implementation approach across health and care sectors
#lead2add

Leading Change, Adding Value e-Learning tool
• The tool aims to help explain and de-mystify the approach to:
• Identifying and addressing unwarranted variation in practice;
• support staff to deliver the Triple Aim outcomes of better
outcomes, better experience and better use of resources.
• The Leading Change, Adding Value e-learning tool can be accessed
here https://www.e-lfh.org.uk/programmes/leading-change-adding-
value/ by all nursing, midwifery and care staff wherever they work,
whatever their role.
• A pdf version is also available.
• Watch a short film from the launch event:
https://www.england.nhs.uk/leadingchange/lcav-in-
action/capabilities/
#lead2add

LCAV Atlas of Shared learning
The ‘Atlas of Shared Learning’ demonstrates the quantifiable
contribution the professions have made to transformational
change at national, regional and local levels for patients,
individuals and populations:
https://www.england.nhs.uk/leadingchange/atlas-of-shared-
learning/
 Interactive repository of quality assured written case
studies and as relevant accompanying films.
 Demonstrating how nursing, midwifery and care staff have:
a) Led and contributed to narrowing the 3 gaps in the Five Year
Forward View;
b) Identified and addressed unwarranted variation;
c) Delivered the triple aim outcomes;
d) Applied the same importance to quantifying outcomes as we
do to the quality of care we deliver.

LCAV National Research Portfolio
• A National LCAV Research Portfolio is being developed in
close collaboration with the Council of Deans of Health
(CoDoH) and other partners, to support the implementation of
Commitment 7 and to further increase the visibility and impact
of nursing and midwifery research.
• A short term task and finish group has been established to
support the development of the portfolio.
• Aims:
• Strengthening the academic credibility of the LCAV
framework;
• Supporting implementation of completed nursing and
midwifery research in practice;
• Signposting to any gaps in nursing and midwifery-led
research
#lead2addwww.england.nhs.uk/leadingchange

Commitment 10
“We will champion the use of technology and informatics to improve practice,
address unwarranted variations and enhance outcomes.”
We will meet this commitment by:
• Developing the skills needed in a technology-literate workforce
• Advocating technologies that may assist in reducing unwarranted variations in care
• Leading as early adopters of technology to improve health and enhance efficiency
• Empowering and supporting individuals to improve health and self-manage care
• Using technology to manage workflow more effectively such as mobile working.
#lead2add

Digital Case Studies
• Telehealth – Airedale NHS Foundation Trust
There was unwarranted variation in rising numbers of acute
admissions and Emergency Department (ED) attendance from care
homes, which could lead to unnecessary distress and avoidable
hospital stays. Nurses established a Digital Care Hub after successfully
running a telehealth service for prison inmates. The new Hub provides
24/7 healthcare advice, support and now
training for staff who care for people in their own
homes, care homes and nursing homes to ensure they
receive high quality care closer to home.
#lead2add

Imperial College NHS Trust - Releasing time to care enabled by
technology
The practice of documenting patient information on
Paper often resulted in a fragmented approach to the
recording, visibility and access to information and ease
of escalation of patients at risk of deterioration. Nurses
and midwives provided leadership as local champions
implementing bedside vital signs monitors. An electronic patient record was
implemented, supported by a handover page showing a patient's latest National Early
Warning Scores (NEWS) score. Handheld devices have been used to reduce
documentation time with decision support at the bedside. This enabled 600 nursing
hours to be released within its pilot phase and has meant nurses across the teams are
able to see data as they need when they need so responding to patients needs
quicker.
#lead2add

West Suffolk NHS Foundation Trust - Medic Bleep
Nurses and midwives within West Suffolk NHS Foundation Trust led key
elements of the implementation of a smartphone communication app,
which has significantly improved the efficiency of communication, patient
experience and safety of their services, releasing staff resources to spend
more time with patients.
The digital app has freed up nursing capacity by 2,536 twelve-hour shifts
per annum. On average the app has saved nurses ten minutes per take
home medication prescription and eleven minutes per patient review,
equating to a saving of twenty one minutes per shift.
#lead2add

Barking, Havering and Redbridge University Hospitals NHS Trust
- Child Protection Information Sharing (CP-IS) using smartcards
The Deputy Chief Nurse responsible for safeguarding and harm-free
care at Barking, Havering and Redbridge University Hospitals NHS Trust
(BHRUT) identified an opportunity to use new digital technology to
introduce electronic Child Protection-Information Sharing (CP–IS) to the
Trust. The process is quicker and more efficient. Any child with
particular safeguarding needs can be quickly identified by the Trust
whenever they are registered as a patient.
#lead2add

Need to demonstrate:
 The nursing, midwifery and care staff (‘we’) contribution to the
FYFV, national programmes of work and other key policy initiatives
such as All our Health, Shape of Caring and Getting it Right First
Time;
 How we are closuring the 3 gaps;
 How we are identifying and addressing unwarranted variation;
 How we demonstrate the triple aim outcomes;
 The ten commitments in practice;
 Our global contribution.
Digital technology is an integral part of successful delivery and central
to the delivery of the Long Term Plan moving forwards.
Leading Change, Adding Value
#lead2add

For further information:
www.england.nhs.uk/leadingchange #lead2add
• Contact the LCAV team at england.leading-change@nhs.net
• Website: www.england.nhs.uk/leadingchange
• Twitter: @6CsLive #lead2add
• E-Learning - https://www.e-lfh.org.uk/programmes/leading-change-adding-value/

Thank you
Questions and Answers
#lead2add

Our Staffordshire story of digital upskilling of
practice nurses (action learning sets) –
How we did it and what we have achieved
Marc Schmid, Director, Redmoor Health, Social Enterprise
Ann Hughes, Practice Nurse, digital nurse champion,
Chris Chambers, Clinical telehealth facilitator
Paul Beaney, Year 3 medical student, Keele University

Staffordshire Action Learning Set Pilot
We received £150k in funding from the NHSE as part of their delivery of the GPN Ten Point Plan in
February 2018, hosted by Stoke-on-Trent CCG, to deliver a pilot project in Staffordshire to deliver
action learning sets to create digital practice nurses across the Staffordshire STP.
The successful completion of practice nurse participants in the ALS aimed to encourage the
adoption and embedding of Technology Enabled Care Services (TECS) in general practice nursing
and to deliver substantive cost, clinical and quality benefits.
The action learning set (ALS) pilot focused on practice nurses’ use of:
• Apps – Manage Your Health
• Flo Simple Telehealth
• Video consultation
• Social media
• Encouragement of patients to sign up to and use Patient Online

Recruitment and selection
Practice nurses, advanced nurse practitioners (ANPs) and health care assistants (HCAs) were asked
to complete an application form, co-signed by practice leads and then placed within the closest
group to where they were based.
We recruited 40 practice nurses across Staffordshire who were placed in one off the six cohorts of
ALS.
The Action Learning Sets
To be equitable to the local population of practice nurses, we held the ALS across four locations in
Staffordshire - two in Stafford; two in Trentham, Stoke-on-Trent; one in Hanley, Stoke-on-Trent; and
one in Lichfield.
Each ALS had three sessions focused on the adoption and embedding of TECS in practice nursing.

Participant Resources
Each participant received the necessary delivery kit, which included a tablet with the key apps
loaded (Facebook, WhatsApp, Manage Your Health, Skype), and a MiFi data dongle (data prepaid
for 12 months) to ensure internet connectivity wherever the site of care.
All ALS nurse participants were provided with a suite of educational resources for their learning
through the programme including:
• Digital Handbook
• Learning Document
• Action Plan template
• Medics Academy leaflet and access code for 52 ‘how to do TECS’ videos
• Leading Change Adding Value template (national template adapted for digital relevance)
• Digital literacy questionnaire
We also produced a summary document of practice performance in relation to delivery of LTC care
designed to highlight unwarranted clinical variation in the nurse’s practice in context of the
Staffordshire STP footprint.

Action Plans / LCAV questionnaire -
Leading Change Adding Value
All nurses were asked to complete an action plan between session 1 and 2 and submit
electronically to the project team for review and discussion.
Each nurse completed a digital literacy questionnaire at each session. This allowed us to track their
confidence and progress against the 7Cs.
The results were as expected with the vast majority of nurses gaining confidence between each
session.
As part of the evaluation process each nurse completed an adapted ‘Leading Change Adding Value’
questionnaire.

Personalised Support
In order for the successful completion of the course individualised support was provided outside of
the ALS sessions. This ranged from support to complete the action plan and LCAV and to discuss
the various ways to use TECS for specific conditions
Practice nurses were engaged with on an individual basis by the project team via face to face
meetings and via video consultation / phone calls / texts receiving support in writing and updating
their action plans, advising how to use TECS for specific cohorts of patients, following up on
concerns raised from the wider teams etc.
Technical and practical support was provided to the nurses by Redmoor Health, who visited
practices to assist the teams in creating public practice Facebook pages, Closed Facebook Groups,
and establishing video consultations etc.
The team were able to help encourage and promote the use of TECS to the wider practice and this
helped to embed the processes.

The 7Cs
1. Competence: practitioner, manager and patient/carer/citizen – ability in relation to personal use of range of modes of
delivery of TECS for agreed purpose and feeding in information/acting on advice and information
2. Capability: practitioner, manager and patient/carer/citizen – actual best practice in use of range of modes of delivery of TECS
for agreed purpose and feeding in information/acting on advice and information in daily professional/everyday life
3. Capacity: possess protected and prioritised time for initiating and participating in remote delivery of care, that is regarded as
key element of work role (practitioner/manager) or personal life (patient/carer/citizen) + the IT infrastructure and equipment
is available and easily accessed by all service providers and users
4. Confidence: practitioner, manager confident that organisational infrastructure is in place in line with code of practice
including reliability and validity of equipment and its outputs. Patient/carer/citizen confident that usage of TECS is integral
part of clinical best practice as agreed with clinician, and that their responsible practitioner will access/act on relay of TECS
messages or interchanges.
5. Creativity: practitioner/manager able to adopt and adapt agreed TECS for different purpose or patient/carer group in line
with code of practice.
6. Communication: the sharing and dissemination of digital modes of delivery and associated clinical protocols and evaluation of
applications/outcomes/challenges etc. with a team or organisation working together and sharing what has worked well and
what has not worked so well.
7. Continuity: at least one practitioner/patient able to interact via mode of TECS along one pathway for LTC/lifestyle habit; if
practitioner not at work cover arranged as appropriate and pre-agreed with patient in line with agreed shared care
management plan.
Key elements of a digital exemplar general practice – practice nurse attainment of the 7Cs
(Chambers R, Schmid M, Al Jabbouri A, Beaney P. Making Digital healthcare Happen in Practice. Oxford: Otmoor Publishing, 2018)

Action Learning Sets – some
challenges
Chris Chambers
Telehealth facilitator
Northern Staffordshire CCGs
North Staffordshire Clinical Commissioning Group
Stoke-on-Trent Clinical Commissioning Group

The seven ‘C’s
1. Competence
2. Capability
3. Capacity
4. Confidence
5. Creativity
6. Communication
7. Continuity

Many use technology in daily life- but not
for health

Creativity
 Action plans
 Facebook
 Apps
 Video Consultation

Not always easy to persuade the team of
the benefits
 Some couldn’t cope with new ideas
 Some felt the practice hadn’t got the
capacity
 Some were ardent traditionalists
 Some sceptics

The communication skills of the digital
champions were often put to the test

So they started in small ways with TECS which
helped patients, such as free apps

So they developed their own confidence, which
helped when ‘selling’ their ideas to other
members of the practice team

Support of other nurses in the Action Learning
Set, through face to face meetings and
Facebook or What’s App groups was essential to
building confidence

Eventually most people were persuaded that
TECS brought benefits to patients and the
practice

Almost every practice now has its own Facebook
page, and most are using video consultation
with nursing and care homes. A wider range of
apps is being used, and Flo Simple Telehealth
has become very popular for a wide range of
situations.

There seems to be an app for everything
these days…

ALS - Evaluation
What did we learn?
Project evaluator – Paul Beaney 3rd year medical student - Keele
University

Purpose of presentation
Important findings of the
evaluation
Benefits of the project
What could be improved

Important findings
1. No-one needs to be tech-savvy to take
part
2. Factors that influenced the modes of
TECS chosen by nurses
3. Benefits for patients, practitioners
and practices

1. No-one
needs to be
tech-savvy to
take part

1. No-one needs to be tech savvy to
take part
 ‘Baseline survey’ data
 Almost half of the cohort self-reported as ‘digitally worried’ at start
 Reduced to 5/27 at end – of which 4 reported feeling more confident
later in ‘phone survey’
 All but one increased their confidence with technology enabled care
services (TECS)
 There are TECS available to suit all levels of ability
 The ALS sessions were a supportive environment - facilitators and peers

2. Factors that influenced the modes
of TECS chosen by nurses
 Most chose based on two factors:
 Clinical need
 Familiarity/ease of use
 Digital-ready workforce

3. Benefits for patients, practitioners and practices
Patients
• Over 75% reported
that the majority
of their patients
received the use
of TECS positively
• Increased
ownership/control
of health
• Newly-diagnosed
given access to
reliable sources of
information
• Fewer unnecessary
appointments and
phone calls
Practitioners
• Skype
consultations
saved travel time
• AliveCor improved
confidence in
consultations
• Flo Telehealth
reduced
unnecessary
appointments
• Facebook useful
for awareness
campaigns e.g. Flu
jab
Practices
• Improved attitudes
towards TECS
• Reduced
unnecessary
appointments and
phone calls
• Upskilled and
enthusiastic
workforce

Wider benefits of the project
Regional -> National?
Digital-ready workforce -> identify
clinical needs and target them
Widespread improvements for patients,
practitioners and practices
Local
Increased practice engagement with
TECS
Increased ‘toolkit’ to help manage a
broad range of patients
Individual
Patient empowerment
Practitioner empowerment

What could be improved
Encourage peer-to-peer support groups (i.e.
WhatsApp/Skype) from the start -> lone nurses felt
isolated whereas groups tended to share learning and
progress

Summary
 All levels of experience with technology
can be successful on this programme
 TECS can be selected based on clinical
need by a digital-ready workforce
 Patients, practitioners and practices all
stand to gain
 When scaled-up regionally there is the
potential for huge benefits
 Build on what has been learnt in this
project to make this an even bigger
success

General Practice Nursing
10Point Plan –
Digital Objectives
Jason Westwood - General Practice Nursing
Programme Manager, NHS England
Cath Johnson, Clinical Specialist, and Clinical
Lead for GP Connect Digital Transformation of
General Practice, NHS Digital

GPN 10PP Digital Objectives
Formation of digital ambassadors in General Practice Nursing
Facilitate supervision through a digital platform
‘Single Point of Access’ to GPN digital resources

Digital Supervision – Background
• Clinical & other types of supervision varies across
England
• Some CCGs/STPs support local clinical supervision
• No consistent model of supervision used across
England
• Revalidation support will increase over coming years

Digital Supervision – The ask…
• Simple access from same portal
supporting all transformation
• Group and 1:1 capability
• Flexible access over multiple
platforms
• Scheduling
• Platform encompasses
consistent model

Work streams
Platform Model
Digital
Supervision
Supervision role ?
Clinical & Restorative
Employer led elements
Cost
effective
Scalable &
Modular

Pilots – Proof of concept
Bexley
Wolverhampton
Blackburn
Social Care
Provider
• Own model applied to
platform
• Existing supporting
documents applied to
platform
• Use of concept evaluated
and spec adjusted

What do we want to learn?
• Do nurses like to use this remote technology? Why?
• Are they enabled to have clinical supervision within work time?
• Can they find a quite place where they wont be disturbed?
• Where there any sound or visual problems?
• Where there any connectivity issues?
• Which device was preferred when accessing the supervision?
i.e. laptop, tablet, work PC, phone

What do we want to learn?
• How did they find having supervision with nurses they didn’t
necessarily know?
• Did they feel they could open up and have confidential
conversations? Does the remoteness of the supervision affect
this?

Phase Two - Aim
• Integrate into the NHS Futures
platform
• Gain the capability to record group
and 1:1 session headlines/actions
on participants records for audit
retrieval or use in nurse
revalidation.
• Embed and support the formulated
national model of supervision for
GPN

Digital Supervision Platform – Concept View

www.england.nhs.uk
Jason Westwood
General Practice Nursing Programme Manager
Nursing Directorate, Nursing and Midwifery Team
07714 773334 - jason.westwood@nhs.net
or follow me on Twitter @NHSjwestwood
Cath Johnson, Clinical Specialist, and Clinical
Lead for GP Connect Digital Transformation of
General Practice, NHS Digital
07714839349 - cathjohnson@nhs.net

Action learning examples: digital GPN
case studies –
15 minute slots with critique by the
‘experts’.
Dena Corden Le Petit, Practice Advanced
Nurse Practitioner
Rachel Viggars, Practice Advanced Nurse
Practitioner

Video consultation
DENA CORDEN-LEPETIT
ADVANCED NURSE PRACTITIONER.
BRINSLEY AVENUE MEDICAL PRACTICE, TRENTHAM, STAFFORDSHIRE.

Video Consultation
 Before video consultation.
 Introduction to video consultation – Digital Nurse
Champion.
 The benefits that can be gained from video
consultation.

Leading change adding value
 Digital Nurse Champion
 What can we do differently?
 Introducing Skype to the residential home - the challenges
 Using mobile technology – emis mobile.
 Overcoming fear of technology.
Ref: England, N.H.S., 2016. Leading change, adding value:
a framework for nursing, midwifery and care staff. NHS England.

Examples of how Video Consultations work for us
at Brinsley Avenue Medical Practice.
 Residential Nursing Home Skype sessions
 Pre skype training for the homes – an opportunity to upskill.
 Patients interaction with Skype – rashes, insect bites, cellulitis, general long term condition
reviews etc.
 Nurse to care staff sessions

Video Consultation
Consider the benefits of video consultation for
your practice.
Where are the gaps in your service provision,
what could be improved?
Who could become your Digital Champion?
Keep it simple.
Don’t Panic – its easy when you know how!

All Our Health: supporting a radical
upgrade in prevention
Professor Jamie Waterall, National Lead for
Cardiovascular Disease Prevention &
Associate Deputy Chief Nurse, PHE

GP IT Futures
GP IT Operating
Framework
GP Online
Services
CQRS
A Primary Care Digital Transformation programme @ NHSEngland
Online Services in Primary Care
Primary Care Digital Transformation
Nursing update
Helen Crowther
Clinical Nurse Advisor for Primary Care DigitalTransformation
NHS England
Kathryn Yates
London wide LMC
Primary Care Digital Transformation

From the beginning
Partnership work between NHS England and the Royal College of Nursing
A project which would align with and support the
‘Every Nurse an E-Nurse’ Campaign
Establish a new role of for a Digital Nurse Champion
Create a nursing engagement strategy and implement
Attend and exhibit at nursing events to promote new
role and strategy

Where we are now
We have recruited two
amazing nurses with a
wealth of experience working
in general practice.
Helen Crowther Ann Gregory
Ann and Helen are already involved in a
number of new projects looking at how
digital services can help improve work areas
such as:
• Sepsis identification
• Cervical Screening uptake
• Transfer of data between GPs and the
Department of Work and Pensions
• Prescription pathways
Going forward we will be identifying other
areas that can benefit from digitisation, if
you have any idea please let us know.

What’s next
1. Further recruitment – we want more nurses
2. Development of the Digital Nurse Network
3. A workforce promoting ‘Digital First, Primary Care’ to patients

Helen Crowther
and
Ann Gregory
Welcome from our nurses

What are we doing?
Clinical Nurse Advisor - Scope of the project
Projects
Identify areas that could
benefits from digitisation
Events
Showcasing best
practice and sharing
info on digital
Networking
Promoting the network
and the nurse advisor
role
Advising
Working with teams to
incorporate the digital
nursing agenda
Clinical input
Representing the
clinical nurse voice
Empowerment
Empowering nurses and
other staff to become a
digital first workforce

Digital Nurse Network
An online forum to learn, share and grow your knowledge of digital services
The Digital Nurse Network
aims to bring together nurses from around the
country who want to learn more about
digital programmes and online services.
The network will offer training, briefings,
webinars and more with a focus on digital and
technology.
No prior skills or knowledge necessary.

Showcase your work and best practice
Be a presenter to the network
Have you delivered a programme or completed a
project that you would like to showcase to the
network?
• Tell us about your digital project
england.digitalnursenetwork@nhs.net
• Create a slide set
• Deliver a webinar
(or ask one of our Digital nurse Champions to present foryou)

Digital Engagement
Join the conversation online
Twitter
Join the conversation online today
Our Clinical Nurse Advisors:
@nursehelenc
@AnnGregoryRN
Programme:
@PatientOnline
@NHSEngland
Website
www.nhs.uk/GPonlineservices
New page on Digital Nursing which
links through to:
• Royal College of Nursing
• Queens Nursing Institute
• NHS Digital

Tell a friend
We know word of mouth is still one of the
best forms of communication.
News spreads fast from person to person.
We would love for you to tell one friend.
To help us get these messages and platforms for
engagement out to as many nurses and health care
professionals as possible.

Further recruitment
Do you think you could be a
Clinical Nurse Advisor
for the Primary Car
Transformation Team?
MIDLANDS & EAST
SOUTH
LONDON

Questions

Nurses and Patients perspective
of the future of digital nursing
care
Kellie Johnson – Clinical Quality Improvement Manager
Teresa McGougan – Strategic Improvement Lead for Nursing
& Patient Care
04/12/2018 129

Patient perspective
What nurses have observed:
 Patients and family more engaged and reassured
 Manage your health app supporting long term condition
management
 Patients enabled to manage their symptoms at home
 Improved access to monitoring and treatment
 Avoidance of unnecessary treatment
 Patients cascading information
 Empowering patients to take charge of their health
130

Nurses Perspective
 Technology is a major factor impacting nursing practice
 Nurses are at the forefront as leaders of technology enabled care initiatives
 Being technologically adept can improve healthcare career opportunities
 Do you have opportunities to lead and champion technology enabled care?
 As a patient do you have access to technology enabled care? If so what types
and how useful? What do you want and have you asked?
131

Leadership & Technology Enabled Care
132
What opportunities are there for digital champion and digital lead roles?
 Working with PPGs
 Practice champion
 GP Federation
 CCG – digital roadmap
 LCAV Nursing Framework
 Author/Presenter
 App Designer
Health needs will go
unmet unless we
reshape care,
harness technology
and address
variations in quality
and safety.

Behaviour /Cultural Change Towards TEC
133
• Reduce barriers ask people
what is stopping them?
• Ask people what would
motivate them
• Make it easy and accessible
to increase the chances of
it being adopted
• If a person can monitor
their performance they’re
more likely to succeed
https://youtu.be/2lXh2n0aPyw

The Change Model ‘Energy for Change’
https://youtu.be/XBwcYYy3u74
 Improvement tools - PDSA
 Leadership by all:
 Sharing the vision
 Engaging with the team
 Motivate and mobilise:
 What motivates and matters to people
 Connect with their values
https://www.england.nhs.uk/sustainableimprovement/change-model/
134

Annual asthma consultations via
Skype
Charlotte Harper, General Practice Primary
Care Development Nurse
Rachel Viggars, Practice Advanced Nurse
Practitioner

Setting the scene
 Who are we?
 Where do we work?
 Why choose video consultation?

Where to start?
Before any patients could be recruited to a pilot study a Privacy Impact
Assessment (PIA) had to be completed. This is a process that helps assess the
risks to individuals in the collection, use and disclosure of personal information.
This is due to the fact we are proposing “to collect personal data from a new
source or for a new activity”.

Support?
 Regionally we have been supported by Redmoor Health, Social
Enterprise who were commissioned to deliver the digital training for
the NHS England nurse upskilling programme.
 Equipment.
 Technical support.
 Protocol support.

https://www.video-consultation.co.uk/documents

Toolkit
The value of the toolkit is the provision of a structured approach. It is
effectively a template that enables you to structure your own protocol.
Through this step by step approach we were able to create:
 own practice protocol on how to deliver an annual asthma review using skype,
 a combined patient information leaflet and consent form,
 a poster informing patients about the service.

Step 1
Ensure that your local organisational Privacy Impact Assessment, Standard
Operating Procedure and Information Governance documents have been
signed and endorsed by your CCG’s Caldicott guardian and by the GP in your
practice.
Step 2
Practice organisation & set up:
Establish with your Practice Manager that the medical defence organisation
covers this mode of delivery of clinical consultation activity.
Step 3
Be clear what you are choosing to use the technology for:
Video technology using skype is the chosen technology for patients
requiring an annual asthma review who meet the later outlined criteria,
but who struggle to access convenient face to face appointments. It is
intended for patients who consent to access a skype consultation from a
more flexible, convenient, confidential environment.

Step 4
Patient:
The patient agrees that they will only call from a confidential setting where they will be able to speak
freely.
Step 5
The practice:
The practice will only accept video calls from an existing contact list. This list will be added to as patients
initially consent to participate in this consultation mode at which point they will share their skype account
details which will be added to their records as an appointment is made.
Step 6
Training:
The Practice Nursing team must receive training in the use of skype/video consultation technology.
Training includes set up, selection criteria as defined in the practice protocol, obtaining informed consent
etc.
Step 7
Evaluation:
For the first 40 patients the clinician will undertake a simple evaluation to capture what went well, any
obstacles/challenges and how these can be overcome in future.

Step 8
Prior to video consultation:
Patients will have provided consent to receive their next annual asthma
review via video consultation; will have downloaded ‘Manage my Health’
app; will have been provided with a free Peak Flow meter and so will have
obtained a current Peak Flow reading; completed the ACT score and
watched/read the relevant inhaler technique clip.
Step 9
Agree inclusion and exclusion criteria for patients who might consult
remotely via video link for their annual asthma review:
Inclusion criteria:
Patients requiring annual asthma review
Patients that have not had more than two exacerbations in last 12 months
18 years of age or above
Exclusion criteria:
Under 18s
Patient experiencing an acute exacerbation of asthma
Intermediate to high risk patients i.e. those with three or more
comorbidities

Pilot:
 What happened?
 What were the challenges?
 What did we learn?
 What will we do differently?

What next?
 Share the learning
 Patient engagement
 Promote the service

Use of telemeds in New Zealand rural
areas 2012/2013
KIA ORA
Hazel Nelson EN,RGN, QN

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