Impact case study database

Warwick research is influencing NHS policy, commissioning and service delivery, and informs rigorous development of digital interventions.

Development and adoption of the Odyssey triage system

As Dale is part-time Director of the Clinical Knowledge Unit with Advanced Health and Care Ltd, Warwick research on initial triage, secondary triage and patients’ self-assessment of acute health problems directly influenced the development and marketing of Odyssey triage system. The Managing Director of Advanced highlights evidence from Poote’s PhD thesis on clinician time savings following patient’s self-assessment of symptoms using Odyssey, together with a 25% reduction in numbers seeking an urgent same day appointment [5.1].The ESTEEM trial findings (co-investigator Dr Tim Holt based at Warwick at the time of the trial) leading to a Lancet (2014) publication that was used to inform development of Odyssey for managing same day GP appointment requests; and the SAFER1 trial findings [3.3] showing the benefits of using Odyssey to support paramedics undertake at scene assessment of patients who have fallen, “research has strategic value to Advanced that supports our sales and marketing of Odyssey to ambulance services” [5.1]. Warwick research [3.1] has been used to inform deployment of Odyssey by national helplines, and ambulance and urgent care (e.g. out of hours) services in the UK, Eire, Australia and New Zealand, and has been used by Advanced to inform its product development and sales strategies [5.1]. The research has also informed guidance more widely; for example, referenced by NICE (Emergency and acute medical care in over 16s: service delivery and organisation guideline; NG94, 2018).

Drawing on Dale’s research of the effectiveness of Odyssey to support secondary triage in emergency ambulance services, Advanced has seen its market share grow substantially; “we now have 100% [of ambulance services] in New Zealand, about 40% for Australia, and about 30% for England, with more services taking Odyssey each year” [5.1]. East Midlands ambulance service (EMAS), for example, report savings of over GBP10,000,000 annually through using Odyssey to support secondary triage of 999 ambulance calls [5.1]. Re-directing 999 callers to non-emergency ambulance responses resulted in EMAS consistently achieving the highest Hear and Treat rate in the UK in England [5.2]. EMAS’s service improvement manager states: “ Advanced's software has made a huge impact, enabling us to boost performance dramatically by increasing efficiency. Without it we would not be able to save the amount of lives we do because we would have vehicles tied up on nonemergency calls…. Systems like Odyssey provide us with all the support and information we need to be able to make decisions safely for our patients. Without them more patients would be unnecessarily taken to hospital, which is inconvenient for them and the wider NHS” [5.2]. Ambulance services worldwide are achieving similar benefits with Odyssey [5.1]; for example, Ambulance Victoria (Australia) have deployed Odyssey and is using it to assess 200,000 emergency calls per annum, and New Zealand’s helpline for over 350,000 calls per annum [5.3].

Advanced and Sensely, a Californian app designer, drew on Warwick research to develop the AskNHS symptom checker, incorporating Odyssey clinical content [5.1]. This is being deployed to support patient self-care, with Sensely winning the West Midlands Academic Health Science Network Industry Collaboration Award in July 2017 for its successful introduction [5.4]. It is enabling improved access to general practice in the NHS; the virtual health assistant, used in a federation of 38 GP Surgeries serving over 300,000 people in Lewisham, was praised by One Health Lewisham CEO, commenting "We see incredible value in technology to empower patients to self-assess…I’m confident the app’s obvious benefits will eventually be accepted and adopted by everyone” [5.5].

The rigour of Odyssey and the evidence base that supports its use has been recognised by NICE. The Medical Director at Advanced states that: “There are no equivalent symptom triage solutions that have been through and achieved the [NICE] accreditation…… Gaining this accreditation is testament to the expertise and experience of an in-house clinical team at Advanced, led by Professor Jeremy Dale” [5.6].

Online platform intervention to support carers – Care Companion

Nanton and Dale co-developed, with industry (Global Initiative, a software design company) and wider stakeholders from the statutory and voluntary sectors [3.4]. It has now been commissioned across Coventry and Warwickshire by the local authorities and NHS as part of the area’s Carers Strategy [5.7]. Promoted across the range of health and social care and third sector organisations, it has over 500 registrations (April 2020). There has been interest in deploying Care Companion more widely, and in January 2020 Professor Dale presented Care Companion to the Minister of State for Care.

Adoption of digital GP consultations and best practice guidance to GPs

Warwick research has influenced the guidance provided to healthcare professionals planning delivery of digital consultations. Atherton directly influenced the content of national guidance produced by NHS England on the implementation of online consultation in general practice. In line with their objectives to move towards ‘digital first’ primary care, NHSE has produced evidence based guidance for general practice, drawing on Atherton’s research and associated toolkits [3,5, 3.6]. Atherton is a member of the NHSE Primary Care Digital Transformation advisory group and the Using Online Consultations In Primary Care Implementation Toolkit guidance was launched nationally in January 2020 to support adoption of online consultations [5.8]. In March 2020, the Medical Director for Primary Care (NHS England) instructed GPs to reduce face-to-face appointments for patients displaying symptoms of Covid-19, directing them to the aforementioned toolkit.

Atherton authored guidance for primary care on how to use text-based consultation, written in conjunction with the Deputy Director and Clinical Lead for Digital First Primary Care at NHS England, which has formed part of the NHS ‘Advice on how to establish a remote

‘total triage’ model in general practice using online consultations’ published in September 2020 [5.9].

Atherton has worked with professional bodies ensuring research is embedded to impact their guidance and practice, and facilitate uptake. In 2018 The Royal College of General Practitioners devised a guide for patients and clinicians, [5.10] which drew on research conducted by the Warwick team [3.5]. The guide has been downloaded 1601 times. Warwick research informed the General Medical Council (GMC) guidance for doctors on remote consultations (2018) [5.11] which forms the gold standard for practice in relation to remote consultations in order for doctors to fulfil their GMC registration requirements. Warwick also informed the development of a regulatory framework for assessing online providers of primary care (2017) to ensure that patients receive a minimum standard of care from online providers operating outside of the NHS; this is now applied to providers yearly [5.12].

Implementation of cancer specific holistic needs assessment intervention

Nanton’s research underpinned the development of the first online cancer specific holistic needs assessment (csHNA), CHAT-P [3.4], in the UK. CHAT-P offered patients remote follow up with their healthcare team to discuss any concerns, enabled through online monitoring and assessment enables the safe implementation of the stratified care pathways for cancer currently taking place across NHS Trusts. The prostate specific HNA has been endorsed by the Urology Expert Advisory Group of The West Midlands Cancer Alliance who are actively promoting rollout across the region as Urology Services move to this model of care.

Nanton’s CHAT-P [3.4] has been commissioned by University Hospital Birmingham NHS Foundation Trust (UHB), with further NHS trusts considering adoption and is receiving positive feedback from both patients and hospital staff [5.13]. Developed in collaboration with Infoflex, a major NHS IT supplier, the platform is promoted to its customer base of 200 NHS Trusts and CCGs. Since Infoflex merged with global IT service provider CIVICA, the csHNA now forms part of an offer with global reach. The platform is in further development, funded by Action on Bladder Cancer, to expand to cover bladder and colorectal cancers. Implementation and deployment of the prostate csHNA at UHB planned to take place during the spring of 2020 has been delayed by the diversion of Trust resources due COVID-19.