OneLondon: Shared care records in London
To many outside observers, the UK healthcare system and the NHS seem centralized and consolidated. It’s far from it.
Up until recently, 221 commissioning groups have been in charge of procurement projects for over 200 NHS Hospital Trusts. The British system is restructuring and consolidating. In July, 42 Integrated Care Systems were established to enable the creation of less fragmented regional systems.
NHS has a long-term plan to fully digitize health and care organizations by 2024. Several Local Health Care Records Exemplars projects have been running in NHS England since 2018, aiming at creating single shared care records in London, Manchester, Yorkshire and Humber, Wessex, Thames Valley, and Surrey.
In London, the consolidation project is called OneLondon. It covers a population of 10 million people and connects 35 NHS trusts and almost 1,400 GP practices.
“The regional approach in London is about collaboration. We like to work in that way to help the ICSs achieve their goals and their objectives. We're still working out how collaboration should look on a regional level and a local level, what an ICS is, and how from a digital perspective, an ICS functions. There are obvious benefits to having an economy of scale, which ICSs should begin to conform with. But there are collaboration challenges there. I think most people who have worked in technology for some time have come to the realization that the real challenge of these projects is people. It's getting people to do the right thing, collaborate in the right way understand the benefits and the justification for doing things predominantly around improving patient and improving workforce efficiency and experience. Sometimes the political element overtakes the conversation. That's where the challenges come from. We're still learning to collaborate in some cases,” says Gary McAllister, CTO of One London.
The notable thing about OneLondon, among other things, is the citizen inclusion in the planning of the project. In 2020, 100 people took part in the OneLondon Citizens’ Summit held over two weekends. These 100 Londoners - reflective of our diverse population - came together from across all 32 boroughs, from different debated and shared perspectives with their view about what joining up and using people’s data to support individual care should look like.
Tune in to the full discussion with Gary McAllister in Spotify or iTunes.
Urgent care planning
As part of the One London portfolio, the urgent care plan program led to the design and implementation of a new digital care planning solution in 2021.
First: what are urgent care plans, and why does digitizing them across organizations matter? An urgent care plan is a testament to patients’ preferences regarding their treatment that is made in conjunction between healthcare professionals, patients, and families. It is usually prepared for patients with an increased likelihood of needing urgent care services.
»Very often, those patients are in the end-of-life phase because they often present more frequently to urgent care services. This is equally applicable to a child with complex, difficult epilepsy, for instance, where we might share information about their medical management just to ensure that whoever's on receiving them and delivering their care is fully up to date with the care that's happened before,« explains Dr. Katherine Buxton, Consultant in Palliative Care Medicine for Imperial College Healthcare NHS Trust and Clinical Director, Palliative and End of Life Care Strategic Clinical Network for London.
While many institutions already had digital urgent care plans, these weren't connected among institutions. By connecting all care levels, clinicians can now easily access urgent care plans to guide them in the care they provide to patients based on patient'’ individual preferences. »The urgent care plan allows us to share plans across the entire geography of London, which is a unique system. We now have access directly to the urgent care plan system, whereas before, there were often barriers with passwords and various things. And so, it wasn't always easily accessible to be able to view a care plan. Whereas now, absolutely a lot of those barriers are starting to be broken down. And those wishes and care plans are much more visible to the providers across London,” Dr. Katherine Buxton said.
