Innovations in community care delivery

A mini-revolution in community care

Virgin Care, part of the Virgin Group, has over a decade’s worth of experience providing independent community services for the NHS. Tasked with integrating and improving NHS services and ensuring a better patient experience of such services by commissioners, the organisation has a gained track record for investing in technology and colleagues to achieve these aims.

The Surrey Story

In 2012, Virgin Care was awarded a contract to deliver adult community health services of five Clinical Commissioning Groups (CCGs) in Surrey. As with many of our services, the major challenges within community nursing services such as historic ways of working, reliance on paper records and old IT systems, meant that nurses were having to care for increasingly complex cases and having to record care and data multiple times into different systems. General Practitioners could only access the paper notes kept in the patient’s home.  

We therefore undertook a detailed review of these services. We analysed performance information and observed nurses at work in the community; results showed that;

• Nurses spent only a third of their time with patients – the rest was spent on travelling, administration and other tasks such as stocking up bags, returning GPs’ calls and manually planning routes for each day’s visits
• The information technology (IT) system was somewhat old, which mean that data input was slowed
• Referral forms from GPs were incomplete or illegible because they had been faxed
• Appointments were being missed and there was no effective way of communicating information between nurses

Not only was this affecting our patients’ experience, but it also meant staff morale was at low.

The CNIP solution

In order to address these issues and to provide a sustainable community nursing service which met the needs of patients, nurses and GPs, and was fit for the 21st century, the Community Nursing Improvement Programme (CNIP) was implemented. The programme was led by clinicians, subject matter experts and experts in service transformation employed by the Virgin Care team. Changes largely fell into two themes – communication and record keeping.

A communication charter between the service and local GPs outlined the expectations of both groups so that teams could improve the experience of people who the services. In addition, a new clinical management system (CMS) was developed to help address many of the issues found in the initial review; this has facilitated easier access to records while the nurse is away from base and the centralisation of communication with GPs at 5 bases across the county.

TotalMobile, a technology platform which eliminates paperwork, is key to the system which supports clinicians to work in the most efficient way for them while also providing real-time information about patients at the point of care (often in their own home).

Electronic tablets are supplied to all of our nurses allowing them to manage their entire role including appointments, emails and patient notes. All referrals from GPs are triaged, tracked and monitored through the system, and appointments are booked and changed by our ‘hub’ teams in each locality, where a senior clinician monitors the service throughout the day and is on hand for GPs and nurses by phone. The TotalMobile system can be used in the patient’s home to make notes which are automatically uploaded to the relevant clinical systems, and – where patients have consented – added in to the GP’s patient notes. 

The system even works where there’s no mobile signal – an issue in a surprisingly large number of homes – and is approved by NHS Digital for access to the NHS spine, meaning that records can be updated automatically as soon as the device is back in an area with signal without intervention from the nurse.

At the same time as introducing new technology, the CNIP also led to protected lunch break, handover and protected learning time for every nurse in the service, every single day – and a new design for our ‘hubs’, based on the changing needs.

Conclusion

With the introduction of tablet computers and protected handover time for nurses to discuss complex patients, teams found they needed space to collaborate rather than to work alone. So we replaced individual desks facing the wall in our handover rooms for a single, central table.

As a result of the project, there’s been a 30% increase in the face-to-face time our nurses spend with patients, adding around two additional visits per nurse per day. Thanks to the use of central locality hubs, when things change and our patients need to cancel an appointment they have with us they can, thereby cutting down on the number of wasted appointments, and allowing us to make use of the appointment for another, perhaps newly referred, patient.

Virgin Care’s in-house band 5 development programme has allowed our colleagues to have confidence in managing the modern community nursing service we deliver, and successfully deliver the technology which has underpinned our remodelling.

The system has since been rolled out across the whole of the Surrey service, and we’re now rolling out similar technology in our services in Devon where we visit children, parent(s)/carers and families in their own homes to deliver interventions.

As a result of the project, there’s been a 30% increase in the face-to-face time our nurses spend with patients, adding around two additional visits per nurse per day.