Clinical Engagement and Telemedicine

Church View Surgery

Andrew Innes

Why clinical engagement?

• Makes sense

• Viewed as self-evident in current UK health policy (1)

• “ Improvement of the performance of healthcare depends first and foremost on making a difference to the experience of patients and service users, which in turn hinges on changing the day to day decisions of doctors, nurses and other staff”.(2)

(1) High Quality Care for All: NHS Next Stage Review final report. London: Stationery Office, 2008.

(2) Ham C. Improving the performance of health services: the role of clinical leadership. The Lancet 2003;361:1978–80.

General barriers to clinical engagement

• Lack of time

• Pressure of competing demands

• Lack of understanding

• Lack of expertise

• Disinterest

• Frank prejudice

A question of culture

Clinical culture and the role of clinical trials

Cum Scientia Caritas

• First the science

• Then the caring

• Medical training

Science

• Epistemological schism

• Mixed quality (better in heart failure than COPD)

• Problems of considering cost effectiveness

Caritas

• Antithesis of personalized healthcare?

• Remote

• Cost-cutting?

• Concerns about clinical governance and safety

Overcoming barriers to telehealth – What excites clinicians?• Improved quality of care – an additional window on

a patient’s problems

• Improved clinical relationship with patients

• Improved efficiency

• Improved cost effectiveness

• A different way of working

• Application of technology

Overcoming barriers to telehealth – What excites patients?• Empowerment – the expert patient

• Effective, timely and safer care

• Improved access

Why must clinicians change?

• Tsunami of long term conditions

• LTC affect 31% of the population and account for 52% of all GP appointments and 65% of all OPD

• Around a 25% in the numbers of patients with LTCs over next 25 years

• Changing practice with risk tools and community MDT

Key components of resolving clinical engagement• Adopt a communication strategy that addresses the

problems and the benefits in terms that clinicians understand

• Good clinical evidence of benefit

• Prioritise clinical domains rather than management targets

• Local “Champions”

• Funding – pump prime through enhanced service or QOF mechanisms. NB. Little evidence to support much of what QOF does and yet GP’s perform well in this framework

Thank you

• Any questions?

• andrewinnes@nhs.net