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In Conversation with Andrew Noble – City Healthcare Partnership Frailty Team

In this guest blog Andrew Noble, GP with Extended Role at City Health Care Partnership in Hull, discusses their remote monitoring programme and transition into a virtual ward in December 2022.

Our evolving service started as a frailty advice and guidance line, we then added the urgent community two-hour response service (UCR) and now we have a virtual ward that started in December 2022. Clinicians are on the end of a phone with clinical support workers and advance care practitioners who are physically delivering any care needed out in the community. This service is community-based and encompasses all the care homes within Hull and East Riding with nearly 200 care homes. Paramedics may call the UCR for advice and guidance to enable patients to be treated in the community. This service isn’t just for frail patients, it’s for anybody who could be managed in the community with a two-hour response service to be able to prevent them from going to hospital, however most of our patients are frail.

To engage the right people, we initially approached our frailty service within City Health Care Partnership (CHCP) as we already had a good mix of skills available for this. Outside of that, it’s been important to get the buy-in from the Yorkshire Ambulance service, because they need to seek advice from our service quickly. They can speak to someone for advice while still with a patient in their own home without actually having to transport them to hospital.

Then we needed primary care to be aware of the UCR service, for example GPs, community nurses, palliative care teams, mental health teams, frailty and dementia teams. GPs receive a lot of information and sometimes struggle to filter what’s new and relevant. We have a lot of GPs with extended roles working with us who can then share information about our service in their own areas and across Primary Care Networks (PCNs).

When designing the service, we gained feedback from our frailty service, the wider community of healthcare practitioners and our PCN leads who sit on groups with other PCNs. It’s important to make sure that healthcare professionals and multidisciplinary teams are informed and can help shape the service, because they’re the ones working with patients and using the service. To help professionals have a better understanding of the benefits of our offer, we held a series of twelve remote talks providing education and learning as well as some tailored information around frailty care.

Benefits of using remote monitoring solutions

There are great benefits for us in using remote technology as we can take more timely decisions about a patient’s care needs. For example, using remote monitoring technology such as TytoCare with its stethoscope function, we were able to listen to a patient’s heart and diagnose things like possible aortic stenosis and worsening heart failure.

It has enabled a clinical support worker to complete examinations reducing the need for an advanced care practitioner or a GP to be involved. The technology provides good quality video consultations which means excellent remote patient conversations. The patient can see us, talk to us and we can read their facial expressions to understand how they’re feeling.

There are a number of other benefits in using remote monitoring solutions including electronic prescribing so that prescriptions can be picked up directly from a pharmacy; avoiding unnecessary admissions to hospitals or to emergency services as we can initially monitor patients remotely and follow up with a face-to-face visit if necessary.

Within primary care, I think GPs find being able to share decision making quite difficult. In hospital if we’re struggling over a clinical decision and we need that shared decision making, we can just talk to the person at the desk next to us. With our service, GPs know they can phone us for a quick response to share their thoughts about what’s going on with a patient and agree the best course of action.

Overcoming challenges

One of the challenges we encountered was how to work with other teams. We started off with just our own team, but then we soon realised that we needed to involve teams such as urgent care, community nursing, the ambulance service. For instance, now we’ve a two-way conversation going on with mental health services and we regularly join their multidisciplinary team video calls.

Because of the pressures on health services in the last few years, at times it has been difficult to work collaboratively, but it’s important to break those barriers down as by working together we can provide a more efficient and effective service.

We haven’t conquered this yet as we would like to work with more teams, but we are working really well with the ones we are involved with. For instance, the emergency department has a Frailty Intervention Team. If we’re sending someone into hospital because it is not possible to keep them at home, we can call them directly to explain the situation, and this means that patient doesn’t need to queue once they arrive at the emergency department.