Transforming outpatient clinics at The Walton Centre

Vicky Clarke,
Service Improvement Manager, The Walton Centre NHS Foundation Trust

I am responsible for The Walton Centre’s outpatients’ transformation programme. Pre COVID we were well underway with our outpatient transformation project, looking at how we could reduce the number of face to face follow up appointments. This was in line with national outpatient programme mandate, harnessing the use of technology to change the way in which we deliver services.

We had started our video consultation pilot with a number of consultants and specialist nurse teams. Everyone involved was very positive; but it was difficult to find new consultants to come on board due to their busy schedules.

The feedback has been extremely positive; consultants are surprised by how user-friendly the platform is for both clinician and patient. There is a lot of additional functionality they didn’t expect, such as inviting colleagues into consultations and instant messaging if they are overrunning, they can pop a patient on hold and send messages to patients in the waiting area to keep them updated.

Then everything changed because of COVID19. All outpatient face to face appointments were cancelled and clinical teams started exploring other ways to consult with their patients with video and phone consults. This accelerated our programme timeframes significantly.

We are now part of a regional programme managed by a Cheshire and Merseyside collaboration-at-scale group, using the Attend Anywhere video consultation platform, which is widely used across the NHS. Although we moved away from the system we were previously using for our pilot, it hasn’t caused any issues as Attend Anywhere is intuitive and user-friendly.  

In recent weeks we have been working with divisional and clinical leads to identify appropriate groups of staff to be set up on the platform, in waves. We’ve completed waves 1 and 2 and are just coming to the end of wave 3. In just two weeks we have over 90 users set up on the platform.

Training has been given via Microsoft Teams; we have been able to adapt existing user guides and training material; and we are part of a regional ‘self help’ group which has been great, as we can share experiences and issues with other colleagues. This has all really helped accelerate roll out, it means we are not starting from scratch.

Our IT department have been amazing; we have a great team who have technologically enabled our Trust for remote working in a matter of days, setting up the Attend Anywhere and MS Teams platforms, the hardware and devices. Most corporate and operational functions are working remotely and are keeping in touch via MS Teams. A significant number of users were set up in just over two weeks.  

The IT department are the ‘unsung heroes’ in this.

Attend Anywhere installed

Through a national NHS programme, we have been given 12 months free subscription to the Attend Anywhere platform, plus additional funding to secure hardware needed to set up video consultations in outpatient clinics and in staff homes.

As I write, cameras and speakers are being deployed in all rooms in our outpatient departments to enable virtual appointments. Patients can use any device that has a built in camera and speaker, such as a laptop, Apple or Android device. Patient user guides have been created and all material is available on our trust website.

While the previous platform we had been using worked well, from a patient’s point of view there was more for them to do, they had to download an app, create an account, put in a pin and a password to access the actual consultation. Here, we can control it from our end. The patient is asked to click on the appropriate waiting area on our website, input some patient identifiable information and we do the rest!

Great feedback from consultants

The feedback has been extremely positive; consultants are surprised by how user-friendly the platform is for both clinician and patient. There is a lot of additional functionality they didn’t expect, such as inviting colleagues into consultations and instant messaging if they are overrunning, they can pop a patient on hold and send messages to patients in the waiting area to keep them updated.

Before COVID19, we faced the barrier of pressure on staff time; there is a lot of admin involved in identifying patients suitable for video appointments. When the hospital is at full pelt it is very difficult for clinical and operational teams to take time out and consider different ways of working, which can often cause projects like this to fail.

However, video consultation became the only option for clinicians to see patients, so COVID brought an urgency which wasn’t there before. Now, clinical teams are proactively reviewing all waiting lists to identify patients suitable for this type of consultation.  

Delay in supply of hardware

The only glitches have been access to hardware like cameras and microphones coming from abroad; inevitably suppliers are extremely busy with a massive increase in demand. We have dealt with this by asking staff to use their own devices in the interim. We have equipped a number of rooms in our outpatient departments and expect that all rooms will be fully enabled in the next two weeks.

Unsurprisingly, as with any change there have been some staff who have struggled to adapt. For these individuals we have offered additional coaching and one-to-one sessions on Microsoft Teams to alleviate their concerns.

A few consultants were sceptical, they didn’t think that it would work for their patients and thought it would be difficult to connect, they expected it to be buffering. But they have been pleasantly surprised at how straightforward it has been.

There are always teething issues when introducing new ways of working but in light of COVID19, teams are more engaged with the change, they understand that this is the only way they can see their patients currently.

Patients are at the heart of everything we do, and all clinical teams want to be seeing and treating their patients by any means necessary.

Fantastic for a trainer

I am elated that people are getting on board with changes that we were hoping to make anyway; it was already in our long term strategic plan to enable video consultation.

It had been difficult for me as project manager and at times could be demotivating when you are trying to convince colleagues to get excited at new ways of working which you are extremely passionate about, but you are greeted with scepticism and busy schedules.

COVID19 has encouraged people to think differently and teams are proactively contacting me to get them up and running with virtual consultations. I am confident that a positive can come out of these difficult and challenging times, and we can embed virtual consultations into how we deliver outpatient services at The Walton Centre.

We provide services to a wide patient demographic; patients travel from as far as South Wales and the Isle of Man and it is time consuming for them to attend a face to face consultation that could have perhaps been carried out remotely. Similarly this can benefit consultants who travel to satellite sites if they can avoid unnecessary journeys.

Patient feedback has been extremely positive; in these difficult times they don’t want to be leaving their homes and they are really complimentary and appreciative of the new way of working.

Changes will continue

We are now reviewing outpatient pathways with clinical and operational teams to identify patients that would benefit from these new ways of working longer term, particularly long term condition patients.

My own learning is that I don’t have to be on site to deliver training at set times; I can work remotely using Microsoft Teams. We’ve also learned that we shouldn’t re-invent the wheel to deliver change at pace; we should tap into national and regional resources that may be available. With any change it’s likely that someone has already done it, so we can learn from their experiences.  

This is a project I am really passionate about and it’s fantastic to see it take off so successfully. I am thrilled that people are getting enthused and on board with the new ways of working and I want to work with teams to ensure we embed virtual consultations into how we deliver services long term.

It is a testament to the organisation that all teams have pulled together and are continuing to provide outstanding care through these difficult times.

Story told on 23 April 2020

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