Greater Manchester NHS Clinical Assessment is a unique concept designed to deliver mobile outpatient healthcare to local communities. Pat Phillips, operations manager, describes how the service is bridging the gap between acute and out-of-hospital care, with electronic patient information at the heart of its success.
When the Greater Manchester NHS Clinical Assessment and Treatment Service (GM CATS) was launched back in 2009, our ambition was to decrease hospital admissions by providing a flexible and convenient treatment and assessment service that delivered faster care pathways and expert support to GPs. Five years later, the service, which is operated by Care UK, has grown from strength-to-strength, accepting nearly 300,000 referrals and handling over 730,000 appointments across that timeframe.
We have been able to reduce pressure on local acute care by accepting referrals from GPs and assigning patients to a member of our specialist teams away from the hospital delivering urology, ENT, gynaecology, musculoskeletal and gastroenterology services as well as a range of diagnostics including MRI, X-ray, ultrasound, CT and endoscopy.
A mobile approach
A major part of the service’s success has been the roll out of large mobile units delivering outpatient healthcare in seven different convenient locations around Greater Manchester routinely treating 1,500 patients each week. The lorry, trailer-like units travel to seven different sites, such as shopping centre car parks, offering appointments across 12-hour days, seven days per week, typically spending four days at each, before moving on overnight. There are also eight fixed sites, including a patient management call centre.
Our reliance on mobile units means every centimetre of space is valuable, therefore storing and filing patient records on paper for a catchment area of three million people inside the vehicle is simply not viable. We therefore place a strong emphasis on utlising our electronic patient records (EPR), and patient administration system (PAS), using as little paper as possible.
Our ‘paperlite’ approach is based on our innovative use the EPR and PAS. Working in partnership with software supplier IMS MAXIMS, our clinical, managerial, and support staff based across Greater Manchester are able to access and constantly update patient information wirelessly and securely at any time, in any location. And on rare occasions where paper has to be used, working practices have been developed to manually input data back into the EPR and PAS within 12 to 24 hours.
Coordinating care pathways
The EPR and PAS have enabled our service to adopt a new way of delivering traditional hospital services in a mobile environment that not only helps to improve organisational efficiency but also offers the ability to make better, faster, and safer clinical decisions and improve patient outcomes.
Clinicians are able to order and receive test results within the same appointment, clinical decisions can be made faster, patients’ needs can be addressed much sooner and treatment plans can be agreed more quickly including, for example, counseling for patients receiving distressful diagnoses.
We pride ourselves on delivering a very coordinated service. Our staff can use the EPR and PAS to access patient information and communicate very efficiently to patients. For example, dictated discharge letters are instantly passed to administration and medical secretaries electronically, which is a much faster process than via paper and post. The result is more efficient care pathways compared to a traditional hospital service. For 98% of our patients our assessment, treatment, diagnosis and pre-operation assessment process is reduced to eight weeks, down from a typical 18-week process, across just one or two appointments. Furthermore, 95% of procedures are carried out within 28 days – giving patients the best chance of getting back to full health as soon as possible.
The convenience of our service means that we are seeing a continuing decrease in the amount of patients that do not attend (DNA) their appointments. Over a three-month period (November to January) in 2011 DNA-rates were at an average of 8.7%. For the same time period in 2014, DNA rates for all our service are currently at 6.5% average for the year. If you remove physiotherapy appointments (which has the highest rate of DNA) then the result is 5.6% – much lower than typical NHS hospital services.
A productive workforce
A totally integrated EPR and PAS approach means that no matter where our staff are based, each authorised employee can order and access results for every imaging, pathology, and other diagnostic test that the service undertakes. Furthermore, staff in the patient management centre are much better placed to answer patient questions or refer to the clinical team without delay.
Clinical staff also regularly cite the benefits they experience on a day-to-day basis and many say they could not imagine going back to paper-based processes. My colleague Ray Ross, a consultant spinal clinical lead and orthopaedic spinal surgeon, says, he is able to order investigations from wherever he is based and can decide how best to manage not just his own patients, but also those of his colleagues, if required. He is able to look at, for example, an MRI scan and make decision on whether to see a patient again or refer them to secondary care or back to the GP without having to physically be present with the patient at that time.
Our lead cancer nurse, Janet Charters, says the EPR and PAS improves our data quality and information, and saves time. She cites previous organisations she has worked at using paper-based systems and having to physically look for records when she needed them. Now she is able to access records at any time, checking results, updating clinical entries, and performing a range of permitted transactions, meaning electronic records are always updated and patient pathways are well coordinated. It also allows us as an organisation to respond to patient requests for copies of their record almost instantly.
Clinical engagement has been key to the success of our EPR and PAS systems. By holding regular clinical assurance meetings, we ensure that any changes to the systems have a complete buy-in from clinicians. It is such an important part of the way we work – both clinical and management staff use daily system reports to check on progress of all patients in care, helping to make better informed decisions through their pathways.
Is mobile the future?
Our mobile approach was born out of the need to manage large volumes, around 20% of patients outside hospital. This figure increases to 30% for muscular skeletal patients in Greater Manchester area that we attend to on non-admitted 18-week pathways. At a time when there are major challenges for traditional hospital care and increasing pressure on community services, as well as a drive to provide care closer to home, the accessibility and flexibility of our service is delivering improvements in patient experience (96% excellent or very good in patient surveys) and means that patients only go to hospital when absolutely essential.
The delivery model is underpinned by the bespoke IMS MAXIMS EPR and PAS systems, which helps us to support the NHS’ paperless agenda, and empower our clinical, management, and support staff to work effectively at all times of day across Greater Manchester. We believe we have created a service which can both improve patient care and deliver efficiency targets whilst supporting the needs of today’s patients.