In 2016, a small, four-specialty project in Greenwich feeding into Lewisham Hospital was the acorn from which the mighty South East London project grew. As the geographic footprint of the project expanded into the neighbouring boroughs of Bexley, Bromley, Lambeth, Southwark and Lewisham, so did the ambition of management to use the technology to ensure patients get the response they need the first time.
Today, primary care clinicians can access rapid advice and guidance from over 50 NHS specialties across Elective and Urgent Care using telephone or photo messaging.
For example, South East London ICB have set up links to efficiently route GPs to their Same Day Emergency Care (SDEC) services, allowing for a more specialised approach when it comes to treating patients requiring urgent medical care. As well as primary care clinicians, in 2021 the service was extended further to provide clinicians working in 111 Integrated Urgent Care (IUC) service with access to the SDEC lines GSTT, King’s College Hospital (KCH) and Lewisham and Greenwich NHS Trust (LGT) and 999 paramedics from April 2022.
We recently caught up with Dr Roshan Navin, GSTT Clinical Lead for Acute Medicine & SDEC, to find out his experience of the SDEC service via Consultant Connect.
1. What was your initial aim with setting up your SDEC services in SEL?
‘We set up SDEC services to streamline care and make it as efficient as possible for patients, clinicians, for the operational system and the community.
SDEC aims to remove any unnecessary delays for patients who require specialist input, further investigation or urgent treatment for their conditions. It helps manage acutely unwell patients and creates improved patient flow from the point of referral to their arrival in secondary care, whilst enabling earlier access to senior clinical decision making and maximising the opportunity to complete patient care within the same day, whenever possible.
SDEC is about giving patients access to the right care in the right place, first time. Rapid assessment, diagnosis and treatment for their acute medical conditions significantly reduces the likelihood of inpatient admission to a hospital ward. It also enables us to allow the patient to return to hospital in a planned manner for additional treatment or monitoring that would otherwise have required inpatient admission and overnight hospital stay.’
2. Was this influenced/altered by Covid?
‘SDEC was crucial in freeing up the inpatient bed base capacity, not only for Covid patients, but also non-Covid patients. A lot of the non-Covid patients were able to be treated through SDEC without impacting the use of beds for Covid during the peak pandemic.’
3. Why did you implement access to SDEC via Consultant Connect?
‘Moving SDEC access to Consultant Connect enabled us to offer a standardised process for all, a single referral route, a single point of access, and audit and monitoring of referral activity demand and outcomes. It also provided an understanding and oversight of options offered by other specialties and services, which helps offer more joined up care plan for patients and provide the most appropriate options available to them.’
4. What was the SDEC pathway for a GP before being able to access it via Consultant Connect?
‘GPs would have to go through different processes for different hospitals. For the admission of a medical patient, the patient would often just be sent to A&E with a GP letter. The patient could also be referred to the medical registrar on call through the hospital switchboard. The GP would have to phone and wait for the hospital switchboard, be put through to a bleep holder, go through the hospital bleep system, and wait for an answer, which had variable reliability. This would often mean that the GP would have to wait a considerable amount of time to get through, which would have obviously been frustrating and inefficient.’
5. Has the SDEC Consultant Connect service improved operations and the patient experience?
‘It has been excellent for the patient experience. It has reduced unnecessary delays due to the rapid access to expert senior specialists. The specialist advice also results in patients being treated out of hospital where appropriate.’
6. Why is it useful to receive calls from other clinicians either in primary care or from paramedics, or from across different health disciplines?
‘Clinician-to-clinician discussion is vital. It provides accurate patient information, minimises the need for patients to repeat the same information and is better for patient safety. The conversation offers a direct referral pathway to specialists and can bypass the ED. The referrer can discuss patient attendance at a time suitable for the patient and, dependent on their clinical urgency, we can either expedite a patient being seen, or we can offer a more appropriate time for the patient to be seen, if that is more suitable for them.’
SDEC lines performance to date
- >20,000 calls placed to date
- 15 second average connection time
- 94% of calls answered first time
For calls to SDEC lines where outcomes were reported
- 83% of calls resulted in the patients being navigated to A&E alternatives:
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- 13% of calls resulted in the patient being treated out of hospital
- 12% of patients navigated to clinic or outpatients
- 58% of calls resulted in an SDEC referral being made
- 17% of calls resulted in patients being admitted
In addition to their SDEC access, clinicians in SEL have access to 19 urgent care lines. More than 1000 calls are placed a month to these lines, resulting in 84% of patients being navigated to A&E alternatives.
*Data correct as of October 2024
If you would like to discuss how we can help your NHS area, please contact us: hello@consultantconnect.org.uk or 01865 261 467.
Related links:
- SDEC: Growth and Impact
- Impact: Ambulance Trusts using Consultant Connect
- Consultant Connect Performance Benchmarks: Urgent Care
- Watch now: NHS vs Winter: Proven UEC pathways from across England, Scotland, and Wales Webinar
