Prof-to-Prof advice in NHS Lanarkshire

NHS Lanarkshire share how their use of prof-to-prof clinical decisions is playing a key part in their response to the national goal of redesigning unscheduled care.
GP case study: ENT - Consultant Connect

Consultant Connect changes the way clinicians interact with colleagues in hospitals and other secondary care services, improves patient care, and reduces unnecessary referrals. In Scotland, three Health Boards are using Consultant Connect for rapid prof-to-prof clinical decisions to support clinical decision-making, reduce unnecessary attendances, and navigate patients to the most appropriate place, the first time.

The conversations between clinicians and specialists, result in between 30% – 60% of patients avoiding an unnecessary hospital appointment.

If you missed our webinar on the topic, the article below summarises the case study shared by the speaker panel from NHS Lanarkshire

  • Ramping up prof to prof clinical decisions in 2020, in the context of national redesign work

 Dr Gordon McNeish Consultant, Emergency Medicine, University Hospital Hairmyres, NHS Lanarkshire

‘Every Health Board has complexities, ours is fairly unique with three similar-sized hospitals with three Emergency Departments (EDs), each seeing around about 1,200 to 1,300 patients a week (pre-COVID).

We first started to look at prof-to-prof clinical decisions based on a couple of things:

  • First of all, we’d had a GP out-of-hours pilot where ED consultants were working in GP out-of-hours and working alongside GPs. They started to tell us about how they didn’t really have alternatives to referrals other than through our existing Emergency Response Centre (ERC) which has been in place in Lanarkshire for about 15 years. The ERC is the in-hours call handling of GP unscheduled care referrals.
  • The emergency medical consultants within Monklands, (one of the hospitals in Lanarkshire), told us about the variability in the type of patients being sent in. Sometimes we would have frustration about whether there was an active alternative.

So, in August 2019 we set up a short-life working group where we tried to gather representatives from primary care, and secondary care, across all three sites, to try and put something together in terms of what we could do to look at unscheduled care referrals and Consultant Connect was mentioned as an option. Hearing from experience in Tayside and Greater Glasgow & Clyde certainly set the ball rolling to look at that in a bit more detail.’

  • Front door and back door approach

 Dr Gordon McNeish

‘Through contact with Consultant Connect and a conversation with Dr Ron Cook and a representative from Greater Glasgow & Clyde, we got the notion of Tayside’s front door approach with their paramedics being at the forefront of calls, and Greater Glasgow & Clyde’s, at the time, back door approach, where the specialty consultants were taking calls similar to what Susan was describing earlier. We were keen to push ahead with both of these approaches.

We were about five months into planning when COVID arrived. The redesign of urgent care and unscheduled care approach which came from the Scottish Government included press for prof-to-prof clinical decisions, and scheduling of unscheduled care. That gave the spur to finish off the business case that we were developing and present it to the board for funding of Consultant Connect.

While we were waiting for an answer on the business case for Consultant Connect, we started trying out a prof to prof clinical decisions link with the Scottish Ambulance Service at Monklands with an initial focus on for patients with potential COVID. As Tayside found, it was a challenge trying to keep track of these conversations. We went through different recording solutions with paper, we put a database together, but each of them failed to really have a reliable capture of the amount of calls we were taking and the outcomes, and similarly any governance towards any non-favourable outcomes about patients ending up with us anyway.

So, when we got an agreement for funding for Consultant Connect, we went two-pronged. We looked at eight specialties in the first instance, to be able to take calls directly from primary care, initially to gauge this advice for patients that you would otherwise have sent via the ERC, to the acute hospitals before, for unscheduled care referrals. This was to see if there were any patients that were on the borderline of requiring acute referral and if a discussion with a specialist would maybe offset that. Then, having ED as one of those options for GPs, but also giving that ED option, and other options, such as medicine for the elderly, to paramedics across Lanarkshire, and then scaling it up right across Lanarkshire, so that all three EDs and the specialists across Lanarkshire.

 At the same time, our ERC developed into our Flow Navigation Centre, which was another one of the asks of the redesign of the urgent care programme. We had an existing structure of an ERC, but we needed to scale it up, so we could operate 24/7, as well as taking GP calls, as we did previously, and also have Consultant Connect as an option.’

  • Flow centre and Patient Connect approach

 Dr Gordon McNeish

‘Patient Connect is part of our flow navigation centre strategy. We were looking to provide some senior decision-maker support to the nursing staff who operated within the flow navigation centre, so we created a rota which covered peak times between 12pm and 8pm, seven days a week. We have around ten ED consultants across the three sites in Lanarkshire who cover these shifts.  We have some variability in it but a reasonable pickup rate for these shifts as additional shifts to ED shifts.

They were initially done within the flow centre at Hairmyres, so we were sitting in amongst the staff to be able to see the setup of it all, but more latterly we’ve been able to do that remotely from a laptop, either at home or within the office, so that makes it a bit easier for consultants to sign up to these shifts and provide that support.’

  • So, what is the support we’re providing? 

Dr Gordon McNeish

‘Different Health Boards are all doing things a bit differently, but with our flow navigation centre, the calls from NHS 24 to ED are getting booked onto the Adastra system and displaying on the Trakcare systems of the individual acute sites across Lanarkshire.

We’re able to see these calls coming through and pretty much phone back the patient immediately using Consultant Connect’s Patient Connect to do that.

With Patient Connect, we use the Consultant Connect App, and are able to dial out to patients. Via Consultant Connect all calls are recorded in the same way that they are when it is a clinician-to-clinician call via the system, outcomes can be recorded by the consultants, enabling us to capture accurate data on what the call outcomes are. Data* shows that with about 30-35% of calls we make we’re able to divert patients away from ED. I think we’re approaching about 4,000 consultant-to-patient calls since we started doing this at the end of December 2020/beginning of January 2021 and we’re hoping that the national messaging campaign from the Scottish Government about calls going via NHS 24 we can hopefully redirect even more patients away from ED.’

*Data correct as of May 2022

Related case studies

5 minutes with… the Flow Navigation Centre clinicians in NHS Lanarkshire

5 minutes with… the Flow Navigation Centre clinicians in NHS Lanarkshire

We spoke with three clinicians in NHS Lanarkshire to find out how the Flow Navigation Centre uses Consultant Connect to reduce unnecessary hospital visits and enhance patient care.

GP case study: Mental Health advice in Greater Glasgow and Clyde

GP case study: Mental Health advice in Greater Glasgow and Clyde

Since June 2021, clinicians in Greater Glasgow and Clyde Health Board have had access to the Mental Health Assessment Unit (MHAU) line for emergency mental health advice. We spoke with Dr Ejike Peterside, a GP at Lennox Practice, to find out the benefits of this service for him and his patients.

NHS Area Case Study: Enfield – Advice & Guidance project update & expansion plans

NHS Area Case Study: Enfield – Advice & Guidance project update & expansion plans

Six months since Enfield, NHS North Central London ICB launched Consultant Connect, we discuss with the senior programme manager from Enfield Borough Directorate how the project is performing.

GP case study: Enhanced Advice & Guidance in Oldham

GP case study: Enhanced Advice & Guidance in Oldham

In November 2022, Enhanced Advice & Guidance provided by Consultant Connect was launched in Greater Manchester ICB. We spoke with Dr Fathema Johura, a GP in Oldham, to find out how the service benefits her and her patients.

- Consultant Connect

Contact us

For more information about how we work with commissioners, hospitals and mental health trusts to improve patient care, please get in touch.

- Consultant Connect

Join a webinar

Listen to health experts from the comfort of your desk as we bring the experts to you in our series of online webinars.

- Consultant Connect

Join our mailing list

Join our mailing list and we'll keep you informed of our latest blogs, project news, and upcoming webinar dates and topics.

Contact us

Permissions

You can view our Terms & Conditions here.

Most Read Articles

Suspected Head & Neck Cancer Messaging service

The Suspected Head & Neck Cancer messaging service was launched in May 2023 to all clinicians in North Central London ICB. We caught up with the Lead Head & Neck and Thyroid Clinical Nurse Specialist who manages the line, and a GP who used the line to find out more.

read more
Transforming the care of older people

Advances in healthcare mean more of us are living longer, and, in recognition of the International Day of Older People, we’re showcasing how we support clinicians in providing the best care for these patients.

read more