Personalising service for people with an urgent care need, at scale.

The background to the challenges regarding the delivery of effective urgent care services in the NHS are well rehearsed and include:

- Growing demand as a result of an ageing population and changes in public expectations

- Disjointed service delivery involving many different providers

- Inequitable investment in technology enabled services and a lack of community//#

system wide connectivity

- Barriers to adopting new technology enabled pathways of care

- Poor Patient experience in navigating to the right advice and definitive care

- Avoidable administrative burdens placed on clinicians

- Avoidable levels of inappropriate referrals for hospital based care etc

In response, NHS London through the Healthy London Partnership selected the Redwood Technologies Group to develop a new Patient Relationship Management Service, to deliver more personalised services for callers to their urgent care communities. Available across the whole of the capital, Redwood overlayed their cloud based, integrated communications service called ‘ Storm’ between the national telephony provider for NHS 111 and across all of the different providers of NHS 111. This enabled London to avoid the need for a ‘rip and replace strategy’ and instead, connect legacy technologies used by local providers into a more coherent London wide solution.

Launched over four years ago through a combination of integrated communication technologies and agile programme management involving over 100 service development sprints, London has developed their Patient Relationship Manager Service to:

- Provide a London wide, real time view of provider performance across multiple urgent care systems. Including real time alerts to key members of staff in the event of an emerging problem....e.g call waiting times exceeding agreed thresholds or increases in calls related to Covid-19.

- Support development of new ways of managing demand into NHS 111. For example by using an IVR message at the front end of NHS 111 to provide an option for the caller to transfer to the local dental pain service or London wide pharmacy advice service in the event the caller has flu type symptoms.

- Support development of wholly new and personalised pathways of care using a combination of inbound call number, type of care/ crises plan and self service, as an alternative to an NHS 111 consultation. This reduces demand for 111 agents/clinicians and includes personalised pathways for people who are frail/ elderly, mentally ill/ high service user and multiple sclerosis care for example.

- Reduce the numbers of inappropriate admissions by providing NHS 111, GP Out of Hours services, Ambulance and other providers with access to multiple/ legacy/local care/ crises plans at the point of contact with 111. This included an ambulance service ‘tweet’ message sent direct to the paramedics device announcing the availability of a care plan to help support community care in the home.

- Report on syndromic demand involving d&v, flu sending real time messages to the local public health team to place a message at the front end of 111 offering local alternatives to a 111 consultation.

- Support the use of AI enabled self assessment and patient self care at the front end of the NHS 111 call, to reduce demand and support self care. This includes transfer of the data to an NHS 111 operator or clinician in the event the patient requires further support from 111. Meaning the caller does not have to repeat their history. .

- Prioritise repeat callers automatically and by transfer to the first available clinician.

More recently, the latest agile sprints within and beyond London, have focussed on testing the potential of natural language processing re:

- Taking demographic information prior to answering the call, helping to reduce call handling time/ resources.

- Supporting delivery of a greater range of self service options for callers.

- Alexa enabled self triage and onward referral to 111.

- Embedded video services using sms/web links rather than app based technologies.

- Improving compliance/assurance by using NLP based voice, data and screen recording technologies. This involves the use of technologies already deployed in mission critical command centres, airline control rooms etc and embedding it within a clinical pathway.

By way of conclusion, there are substantial benefits of using modern contact centre technologies to deliver more personalised care, especially for callers who are vulnerable or at risk of admission. One of the unique features of this NHS ‘ first of its kind’ project involved the development of a London wide communications cloud service as a separate service from technologies deployed by urgent care providers. By overlaying this commissioner led cloud over provider based legacy technologies, commissioners where able to more quickly develop and deliver changes to clinical pathways. This coupled with the use of agile change techniques effectively de risked development of these pathways.

One of the lessons learnt during this initiative is that relying on multiple provider technologies to deliver consistent and personalised care at scale, hasn’t worked. Commissioners in London, have moved beyond this and have benefitted substantially from this initiative.