A feature created by The Guardian in co-operation with the Royal United Hospitals Bath NHS Foundation and NHS Bath and North East Somerset CCG.
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When John Giles*, 77, started feeling very tired at a social function, he put it down to the emotion of the occasion. But when the extreme fatigue persisted, he decided to go and see his GP. “Giles was a patient who was generally in good health and a real pillar of the local community. But when he came to see me he was breathless and his heartbeat was very slow – around 40 beats per minute instead of a normal resting heart rate of 60,” explains Dr Dan Hubbard, a partner at St Chad’s & Chilcompton Surgery in Midsomer Norton, Somerset.
“Because Giles had a history of heart disease, we decided to give him an electrocardiogram (ECG) right away, which showed he had a condition called complete heart block. This occurs when there is no electrical conduction between pacemaker cells at the top and bottom of the heart and the heart is running on the ‘fall back’ ventricular heart rate alone.”
In the past, Hubbard would almost certainly have arranged for Giles to be taken to hospital by ambulance so he could be assessed as an emergency. However, thanks to the practice making use of Consultant Connect, an innovative telephone advice and guidance service that links GPs directly to local specialist consultants, Giles was able to bypass A&E.
“Using our surgery’s dial-in, I selected the specialism I wanted and was put through to Dr Anu Garg at the Royal United Hospitals Bath NHS Foundation Trust (RUH) in less than a minute. We were able to discuss the case and I was also able to share Giles’s ECG results after getting his consent,” says Hubbard.
Since Giles was tired but not critically unwell, the two medics decided to admit him as an urgent case the following day and put him on a normal surgical list to receive a pacemaker. This was better for Giles, as he was sent to the right place first time, without needing to endure a stressful ambulance trip or a long-wait in A&E.
Now covering more than a quarter of UK patients, Consultant Connect neatly overcomes a problem that has stymied GPs and consultants for years – how to communicate effectively in real time and streamline the referral process between primary and secondary care.
“Quite simply, it helps to get GPs and consultants talking again,” says Dr William Hubbard, a consultant physician and cardiologist, and associate medical director at RUH. “As time pressures have made [things] more difficult, this system gives them back the opportunity to have a conversation, which is extremely effective and immediate.”
“In a way we are using our new technology to make old-fashioned technology – the telephone – work better,” says Jonathan Patrick, CEO of Consultant Connect. “In Bath and North East Somerset, GPs have access to consultants from 23 specialties. I don’t think that there is a similarly extensive advice and guidance approach anywhere in the UK.” He points out that the service, which can be up and running in six weeks, is low-cost and easy to install, with no hardware or hidden technical spend.
Patrick calculates that the service has already saved the NHS more than £10m in the three years since it started, bearing in mind that each avoidable referral wastes around £200, and an unnecessary admission costs in the region of £1,500. Projections by the company see the system potentially saving hundreds of millions of pounds each year, if it were to be used by all NHS trusts in the UK across all specialisms. In Bath and North East Somerset alone, 10,000 calls have been answered since the launch of the project in December 2015. Over 68% of calls have resulted in a patient avoiding an unnecessary trip to hospital, saving the NHS money at the same time.
Consultant Connect is just one of many innovative projects at RUH that have helped it excel despite budgetary constraints and rising patient demand. As well as being named among the top 100 Acute Trusts in England in August 2018, according to data consultancy PublicView, the RUH also climbed the greatest number of places on the list – 29 in all.
“RUH is a Superimprover – a trust that improves faster than its peers – and this partly reflects its decision to embrace innovation,” says Jonathan Patrick. “The secret to its success seems to be the ability to follow through a lot of small improvements rather than trying to solve a massive problem in one go. The impact can be surprising.”
The trust’s Bath Tea Trolley training, for example, which was highly commended in the education category of the BMJ Awards this year, encourages staff to take tea and socialise while improving their professional skills with ad-hoc training.
“We are never going to have enough funding to do everything we need to do, so we have to strive to do the best with the resources we have got,” says Dr Richard Graham, deputy medical director at RUH.
Patrick concludes: “Smaller initiatives like ours are not the whole solution, but we have a part to play in ensuring that NHS trusts continue to improve their performance and patients get the care and support they need.”
* The name of the patient has been changed to protect his identity