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Virtual e-clinic could save £1m and slash waiting times

27 February 2017

230316_barts _day 2_0868A pioneering virtual e-clinic is helping to slash waiting times and hospital visits for patients with chronic kidney problems.

The east London e-clinic allows GPs to get specialist opinion quicker than ever, reducing waiting times from as much as 15 weeks to just five days.

By sharing the records of consenting patients, experts at The Royal London Hospital are able to view the patients’ test results and provide instant advice to their GP about the next steps for their care. This is preventing unnecessary trips to hospital and freeing up appointments for those who do need to see a specialist face-to-face. Automatic triggers are also put in place to alert GP practices to patients most at risk following routine blood test results.

The successful pilot scheme for Tower Hamlets, run by Barts Health NHS Trust, was recently extended to the Newham and City and Hackney commissioning areas, and will go-live in Waltham Forest this month. This means more than one million people living in the four boroughs will now have a live community kidney service.

It is one of the most dramatic examples so far of how the NHS can implement its national commitment to moving care closer to home, ensuring patients are treated in the community rather than in hospital.

Higher rates of hypertension and diabetes among the ethnic minorities of east London mean the population is more vulnerable to kidney disease than other parts of the country.

In addition, the community kidney service has invested in specialist renal nurses to help patients manage their condition at home.

As a result, only one in five kidney patients referred by their GP now need to be seen face-to-face in outpatients. Instead, consultant nephrologists (kidney clinicians) are reviewing most cases electronically once a week.

Dr Neil Ashman, consultant renal physician at Barts Health, said: “When reviewing patients, we have access to all of the investigations done in the community, enabling us to provide comprehensive management advice whilst avoiding unnecessary duplication of tests. And if people do need to be seen at the hospital, we have more availability in clinics to see them in a timely fashion.”

Before the Tower Hamlets pilot started in December last year, patients used to wait anything between 55 and 84 days for an outpatient appointment. By reducing this to five days or so, the e-clinic is not only making life easier for patients but also cutting the volume of outpatients’ appointments by up to a third. This could potentially generate savings of up to £1m across North-East London.

As well as reducing the number of people who need to make a trip to hospital, the e-clinic is also enabling GPs to ask for expert advice on patients they would not necessarily refer before.

Initial evaluation of the community kidney service received a positive response from patients as well as GPs and clinicians. In particular, patients reported that they were happy to share their medical records, and that their care was discussed with a specialist without needing to go to hospital.

Sir Sam Everington, chair of NHS Tower Hamlets Clinical Commissioning Group, said: “This collaborative approach by GPs and hospital consultants is enabling local patients to get fast expert opinion from specialists. Patients will be saved a trip to hospital, and waiting times for those most at need will be substantially reduced. Many congratulations to the team that have made this happen.”

Barts Health has one of the biggest renal services in London, and undertakes about 220,000 dialysis sessions a year. The number of people diagnosed with end-stage kidney disease (and therefore requiring dialysis or a transplant) has been steadily growing in recent years.      

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With a turnover of £1.4 billion and a workforce of around 16,000, Barts Health is the largest NHS trust in the country, and one of Britain’s leading healthcare providers. The Trust’s five hospitals – St Bartholomew’s Hospital in the City, including the Barts Heart Centre, The Royal London Hospital in Whitechapel, Newham University Hospital in Plaistow, Whipps Cross University Hospital in Leytonstone and Mile End – deliver high quality compassionate care to the 2.5 million people of East London and beyond.


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