How this PCN uses digital innovation

Central Camden PCN is one of the seven networks shortlisted for PCN of the year. It has used digital innovation to improve early diagnosis and treatment in two pathways – the microsuction removal of ear wax and non-urgent colorectal cancer. Beth Nelson, PCN chief operating officer, explains more.

All nine member practices of Central Camden PCN share a common desire to work together at scale to improve the quality of care and patient outcomes. All PCN services fit with the strategic priorities of our North Central London integrated care board (ICB) and NHS England’s Core20plus5 approach to improve early diagnosis and treatment and reduce healthcare inequalities and wait lists. We see digital innovations as a key enabler in achieving these goals.

To help us maximise the potential of digital solutions to design and deliver at-scale services within a primary care and community setting, we collaborate with a range of external stakeholders. These include University College London Hospitals (UCLH), medical technology companies TympaHealth and SurgEase, academic health science centre UCLPartners, North Central London boroughs, and local community providers.

This collaborative approach has led to the creation of two new treatment pathways.

Digital innovation has enabled us to redesign the pathways for the microsuction removal of ear wax and non-urgent colorectal cancer pathways. The benefits have been felt by the PCN’s 85,000 registered patients, its healthcare workforce and across the wider North Central London footprint. Both pathways have strengthened system resilience by reducing the need for appointments in primary and secondary care. 

New pathways

The aim was to identify ‘high volume, low complexity’ elective procedures with long wait times which could be undertaken in a primary care or community setting using innovative digital devices. 

Our goal was to increase patient access and address the long waiting times for assessment. Additionally, we aimed for earlier definitive diagnoses in a primary care setting to reduce the need for unnecessary and invasive procedures. This approach had the potential to improve the patient care experience and reduce morbidity risk.

To achieve this, we worked with external stakeholders such as UCLH and technology providers to identify the best pathways to explore. This led us to focus on the ENT procedure and non-urgent colorectal care.

For the ENT procedure, we decided the best digital solution for microsuction wax removal – and remote review capability – was provided by the TympaHealth platform. A collaborative working group comprising the PCN, UCLH, TympaHealth and UCLPartners was set up to mobilise a 12-month PCN microsuction pathway pilot.

We trained and upskilled the ARRS workforce on the digital devices to deliver a microsuction service. This was done in a primary care setting with advice and guidance provided remotely by UCLH ENT consultants.

Digital innovation

For the non-urgent colorectal pathway, we partnered with SurgEase, which had developed a digital rectoscope called LumenEye X1. This device provides a clear view of the inside of the anorectal tract and can be mobilised in a primary care setting. High-quality imaging of the anorectum at the point of care facilitates rapid diagnosis; it reduces the need for formal endoscopy and identifies cases requiring a colonoscopy due to polyps or other serious pathology.

To implement this solution, we collaborated with SurgEase and UCLH to mobilise a rectal pathology clinic in primary care for GP referrals. The aim was to improve patient access and reduce the 18-month wait times for low-risk patients presenting at their GP with rectal bleeding.

The rectal pathology clinic rotates between two PCN member practices, The Bloomsbury Surgery in the south, and Swiss Cottage Surgery in the north, to ensure it is easily accessible for all patients registered within the PCN. As with the microsuction service, we trained the ARRS workforce to use the LumenEye X1 digital endoscope under the supervision of a UCLH colorectal consultant. In both pathways, workforce satisfaction increased as a result of the upskilling and training provided.

Care coordinators play a crucial role in supporting patients through these new pathways. With some PCN services located in the local community centre, they also signpost patients to activities and support that promote broader health and wellbeing. In addition, the ARRS workforce supports the local community centre with health promotion activities and educational sessions on topics such as the importance of cancer screening. 

To assess the impact of these initiatives, we worked with UCLPartners, which supports the PCN with service evaluations. Using a standardised framework, we were able to demonstrate improvements in patient care and outcomes, reductions in health inequalities and the impact on the wider healthcare system.

Outcomes

The PCN-led microsuction pathway has been shown to be two-thirds cheaper than the acute-led version, with the referral-to-treatment time reduced to three weeks compared to 52 weeks in a secondary care setting. Since the service launched in September 2022, 855 patients have been referred, while referrals to secondary care for microsuction have fallen by almost 40%. Patient feedback has been overwhelmingly positive, with more than 90% of patients recommending the service.

The PCN rectal pathology service has also been highly successful. It has reduced secondary care referrals by 90% and reduced wait times by 70 weeks. In addition, the service has increased secondary care capacity for cancer patients who often require more specialist care and treatment.

To date, 107 patients have been referred to the PCN rectal pathology service with data analysis revealing that more than 60% of these patients reside in areas considered as the most deprived (Index of Multiple Deprivation 1 and 2) in North Central London. Of the 88 patients who attended a PCN-led rectal pathology clinic appointment, 69% of patients were discharged without needing an onward referral to secondary care. Patient feedback has been excellent, with 94% of patients recommending the service.

Delivering care sooner and closer to home helps reduce local health inequalities, particularly for the PCN’s large population of patients who experience cultural stigma associated with anorectal examinations.

Following the positive pilot outcomes, the PCN was approached to deliver the microsuction service using the TympaHealth platform in Islington and Haringey boroughs to improve patient access and reduce waiting times. The PCN is now in conversations with the ICB about expanding these services into other boroughs.

This is the last of seven Profiles of the shortlisted PCNs featured on Pulse PCN in the run up to the awards night on Friday, December 6.