1. Telehealth: benefits for primary care Shahid Ali GP & National Clinical Lead Commissioning intelligence Clinical Lead Primary Care NHS Yorkshire and Humber

2. TelecoachingTelemonitoringTelemedicineTelehealth Remote monitoring tools capture physiological measurements and relay them to a central location for review normally an suppliers intranet site. Telecoaching uses a one to one interaction with audio, visual and/or interactive communications, used to support the practice of health care/social care, enabling self care and improved condition management. Remote video consultations between healthcare professionals and patients which support care outside of hospital. Used to reduce LOS, support early discharge, and admission avoidance. Remote video consultations between healthcare professionals and patients which support care outside of hospital. Used to reduce LOS, support early discharge, and admission avoidance. The use of electronic information and telecommunications technologies to support long- distance clinical health care, professional health- related education, and public health.

3. Why use Telehealth? The Case for Change Increasing numbers of people have multiple long-term conditions 188% rise just in Diabetes by 2050 60% increase in multiple LTCs by 2013 252% rise in over 65 year olds by 2050 We currently spend £19 billion on people with 3+ long-term conditions. This is projected to rise to £26 billion by 2016 There is a need for a more integrated response to manage LTCs

4. Implications for NHS and General Practice Long term conditions represent: 70% of health and care spend, 77% of inpatient bed days, 60% of GP appointments and 68% of outpatient and A&E appointments. The average annual health cost of someone without a long-term condition is around £1,000; this rises to £3,000 for someone with one condition and to £8,000 for people with three or more conditions The biggest challenge to emerging Clinical Commissioning Groups includes the management of LTCs and urgent care

5. Self care – fully independent Signposted to information/advice services Advocacy & support Complex cases LTC Population

6. Drivers for further change Personalised health care- challenges current thinking of doctor-patient relationship Proactive rather than reactive care –challenges current models of care delivery Immediacy –challenges speed of care delivery © NHS Yorkshire and the Humber

7. More than redesign …….. Old PathwayNew Pathway Old Mindsets New Mindsets

16. A new approach to care delivery……

17. Patient level impact of care planning

18. Data extrapolation to practice list sizes Practice size Pre care planning (£000) Post care planning (£000) Difference (£000) 3,500 872.16 329.00 543.16 7,000 1,744.33 658.00 1,086.33 10,000 2,491.89 940.00 1,551.89

21. Patient Centred Care: Immediacy A clinical opinion in a different way.... Cohort of 16 GP practices / Nephrology (John Stoves, John Connolly et al, Bradford) E-consults for renal problems Channelled to single consultant Record reviewed / opinion written into e-notes Need for face to face consultation reduced by 80%

22. A world class solution……

24. Bradford care home telemedicine pilot Benefits Provides immediacy – patients can be assessed and treated sooner rather than waiting for a home visit. Electronic Patient Record (EPR) is available during the consultation so the GP can look at the record at the same time, and be better informed of the patient’s history, medication, hospital communications and any other important information that may be required during the consultation. Clinical triage- GP can assess the patient’s needs can give advice, prepare a prescription or indeed visit if needed. Increased efficiency- up to 80% of calls for home visits could be dealt with via telemedicine with only the minority still needing to be seen in person.

25. Benefits Releases capacity -Time saving, cost saving, safer, manages risk more effectively, and is a simple way of conducting consultations. Improved efficiency releases capacity in the Practice which is important as complexity and demand increases in primary care. Reduced admissions- the quicker you get to see a patient the easier it is to address their need. If you don’t get a clinical opinion early enough, the patient is more likely to end up in A&E or be admitted. Patients satisfaction high – patients and care home staff like it - they can see and speak to the doctor and get seen quickly. Simple to use and there is no training needed.

27. Regional T-health Programme - Role of the “Hub” Distributed specialist networks

28. Top Tip: “Don’t be afraid of new technology and don’t assume it’s difficult or complicated to use until you’ve tried it. It really is so simple, so do it!” Contact details: Shahid.ali@yorksandhumber.nhs.uk Shahid.ali@bradford.nhs.uk