NHS Bury Clinical Commissioning Group

NHS Bury CCG is responsible for a combination of 30 GP practices and medical centres. Many of these practices are owner occupied, with 4 practices being part of the LIFT procurement process, with the GPs as managed tenants.  

The practices are linked with other Greater Manchester (GM) healthcare sites through shared infrastructure, supported by the GM Shared Service.  They were already running elements of Wi-Fi, having a secure private (corporate only) channel, and are running a pilot implementation of Govroam, a service providing a local government network.  They intend to extend this into the remaining GM Network by the end of 2017. 

All GP practices in Bury use the In Practice (INPS) Vision medical record system, which has the integrated Vision Anywhere mobile device app, allowing 24/7 access to patient records on supported devices. Documents are stored in Docman, the GM integrated document management system. Bury has implemented a programme of  bring your own device (BYOD), allowing varied devices to be used. 

Procuring and deploying Wi-Fi

The Wi-Fi project started in January 2017.  An existing call-off' process allowed for rapid procurement and deployment across Bury.  A significant portion of the implementation time was involved in allowing the support services to interact with the practice staff, to cause minimal disruption to clinical services, as well as adding the facility for the public and guests (such as visiting clinicians) connectivity.

There was a soft launch on 1 May 2017, without advance notification to the public. Despite that, the service had over 100 unique users by the end of the month.

Accessing the service

To access the service users:

• go through a simple log-in process supplied by the CCG
• they directed to the NHS Wi-Fi landing page
• get a 5 day PIN when logged in, which will soon be used over 500 federated sites across Greater Manchester Healthcare

Supporting patients to get online

NHS Bury CCG practices use the 'Patient online' feature of the Vision software, with the CCG having the largest number of users within Greater Manchester. NHS Bury CCG wanted to develop this functionality further, so provided a tablet device to each practice, paid for centrally.  Each surgery had a nominated Digital Champion to educate patients in the use of 'Patient online', accessing the system and to answer any questions.

To ensure broadband capacity is not over-used, the Wi-Fi was restricted to between 7.00 a.m and 9:00 p.m, Monday to Friday, and 10.00 a.m to 6:00 p.m at weekends.
 
Unsuitable sites are filtered out and commercial streaming services blocked.  There's currently a high capacity internet feed for the whole of Greater Manchester dedicated to the Wi-Fi rollout, which may be increased if needed. All network hardware is provided by a single supplier, allowing Wi-Fi to fully integrate into current wired infrastructures.

Now that the infrastructure (devices, Wi-Fi) has been rolled out, the need is to inform and further educate their patients. The intention is to:

• increase the registration to use online services
• allow patients to book and reschedule appointments
• allow patients to request prescriptions while in the surgery

The CCG  rolled out the latest electronic prescription service (EPS2) in 2012, which allows greater integration of prescription services and prescribers, again benefiting patients.  The CCG is also a pilot site for Controlled Drugs (CD) ePrescribing, adding to the functionality for patients and clinicians by the reduction in paper flow, a founding precept for Paperless 2020.

INPS Vision has tools within the programme that will allow the practice to highlight under-using patients, flagging them on the system when they are waiting in the queue for appointments, allowing the digital champions to target and support them, facilitating greater usage of the system.

Additional benefits are continuing to be realised as both staff and the patients are becoming more aware of the functionality of WiFi, however there have already been many benefits.

Practice staff

Benefits for practice staff include:

• satisfaction of clinicians and practice staff in the reliability of WiFi, resulting in increased usage
• increased awareness of cybersecurity within the practice, resulting from protocols implemented during the roll out 
• a reduction in requirement for access to clinicians at the practice
• the ability of clinicians to be able to access medical records throughout the practice, rather than just in consulting rooms, giving both significant savings in time and reduction in delays in treating patients

"It's great to be able to sync our mobile devices to load patient records before going out on home visits. This allows us to have secure access to vastly more clinical information when assessing patients in their own homes." - Dr John Hampson, GP.

"The practice staff have found having the WiFi to enable laptops and tablets to be used for meetings has made a really positive impact and has changed our approach to the structure of practice meetings." -Jo Panter, Practice Manager.

"The implementation of WiFi across Bury has enabled to staff to work in an agile fashion, reducing the time spent travelling across the borough. It also allows CCG staff to work more closely with our colleagues in primary care, building relationships to help us to improve care for patients."  - Amy Lepiorz, Deputy Director of Primary Care.

Patients

Benefits for patients include:

• a greater awareness of services provided by the practice and the NHS to patients
• access to clinical information to enhance their consultation
• the ability to book further appointments instantly whilst within the practice

"We have noticed an increase in the number of hits the practice has had on our website and our Facebook page from patients reviewing our service while they wait to see the doctor.  As a result, we will be enhancing our use of online services to communicate with our patients." - Joanne Panter, Practice Manager

"It's great being able to access free WiFi whilst waiting for my GP practice appointment.   I'm already signed up to online services, but for someone who wanted to look into this service, which enables you to book appointments and order repeat prescriptions at a time convenient to you, they could see how it all works whilst waiting to be seen with the help of the Practice's Digital Champion.  If I see a leaflet in the practice, or an advert on the information screen that sign posts me to a health app, I can download it there and then before I forget.  I can look up health information and keep in contact with family more easily too.  It's a really positive move that improves my overall experience, and I'm glad Bury is one of the first to benefit." - Patient of NHS Bury CCG

After the initial success, the CCG wish to develop this further.

Phase 2 (April 2017 to March 2018)

In phase 2:

• secure messaging will be extended from internally within the practice staff, to work with patients, allowing targeted communications whilst the patients are within the surgery, as well as when they log-on at home - this will reduce wasted time within the actual consultation, freeing time for the clinician to better treat the patient's conditions
• as patients register their arrival in the surgery through their devices connected to Wi-Fi, this will create a visual notification for the GP, and reassurance to the patient that the clinician is aware of their arrival, building trust and co-operation, and improving the quality of the patient's experience
• 'Patient online' will be further developed, extending the service to Wi-Fi connections for all registered patients throughout the CCG (and eventually all of Greater Manchester) connected estate - this will ensure patients always have their records available to them whenever they are in contact with any health professionals, seriously reducing the errors and confusion that can occur due to misplaced records
• INPS are producing a digital centre called 'The Hive', this will originally be available to give controlled access to the digital champions, enabling them to share experiences and knowledge in how they have developed and promulgated Wi-Fi access within their practice
• increased co-operation between Digital Champions, allowing further development of the implementation process

Phase 3 (April 2018 to March 2019)

In phase 3:

• all GP practice software suppliers are developing their products to allow full clinician access to the patient record throughout the connected community - Wi-Fi will ensure that this is fully utilised throughout the CCG, also allowing controlled and delegated access to other health care professionals
• with the success of the pilot and secondary phase implementations, the intention is to provide Wi-Fi access to Community Services throughout the CCG - this will show how a relatively small implementation can rapidly affect the whole of the health and social care practitioners throughout a diverse health community

By taking advantage of the early adopter offer from NHS Digital, NHS Bury CCG with support from GM Shared Services have produced a novel solution that develops their original systems in many ways, implementing Wi-Fi to ensure that the public, practice staff and clinicians can all benefit from the investment in time and resources provided by the CCG.  

This has allowed more open access to health information, controlled by appropriate technology.  Along with other developments, this has resulted in an increase in satisfaction and health outcomes for patients, reduced frustration and wasted time for practice staff and increased health economies for the CCG.