LDRs: a critical part of STPs and sharing cross-border learning

Source: NHE Mar/Apr 17

Dr Masood Nazir, national clinical lead – digital transformation of general practice at NHS England and information lead & senior information risk owner at NHS Birmingham CrossCity CCG, discusses the opportunities for sustainability and transformation plans (STPs) to adopt shared approaches across regions.

Following the Five Year Forward View, local health and care systems were asked to set out, through Local Digital Roadmaps (LDRs), how they would achieve the ambition of ‘paper-free at the point of care’ by 2020. 

In total, 73 LDR footprints were submitted in June 2016, but in the autumn this was reduced to 65 as some combined in order to align more closely with the 44 STPs. 

Discussing the work, which saw all LDRs published in January, Dr Masood Nazir, national clinical lead – digital transformation of general practice at NHS England, said: “LDRs preceded STPs. The challenge has been trying to align them. The key reason for them is that you weren’t going to achieve the paperless agenda unless you collaborated in a group. One of the key things STPs have to do is deliver efficiencies and a key thing to efficiency is making some of the processes paperless.” 

Not all LDRs were CCG-led, but a key requirement was having someone who had the credibility in the patch to lead the digital agenda. 

While noting that primary care is ahead slightly in terms of digitalisation, as recognised in the recent Wachter review, Dr Nazir said: “But they have only digitised their records, there are still lots of processes in practices which aren’t digital and are very reliant on other people in the health economy. 

“It is all good and well me saying I want a paperless practice, when everyone around me is still using paper. There is a lot more investment needed to make hospitals paperless and paperlight, at least, but we need to bring everybody on the journey together. 

“If we don’t recognise what the challenges in primary care are, then what will happen is we will make paperlight hospitals with primary care still sending paper into hospitals. That is why we need to have them working together.” 

Discussing investment, Dr Nazir, who is also the clinical information lead and senior information risk owner at NHS Birmingham CrossCity CCG, added that, as is often the way, projects take off at speed and digital can often be a bit of an add-on. 

“It really needs to be considered early on,” he said. “It needs to be brought in at the beginning of the agenda. It’s because of this initial investment that LDRs really need to be a critical part of the STPs. With digital agendas, an organisation spending money on its own won’t go very far. 

“Investment, although challenged, will come into STPs. So, it’s really important that organisations work together and really look at what the local health economy needs and make the best use of that investment. 

“If you collate the amount of money you have for this, at scale, across a health economy, it will go much further. The money will buy you what you need in order to build the foundation to really make it work, and you’ll also get the efficiencies with it. Otherwise you will get silo processes and working.” 

While accepting there is a challenge to meeting the ‘paper-free at the point of care’ by 2020 deadline, he said that the dates “are achievable, if we share”. 

“Having worked on a programme to share electronic documents out of hospitals to GP surgeries, the initial bit took quite a long time because there were so many lessons to learn with regards to going paperless,” said Dr Nazir, adding that once the process has been mastered and the confidence is gained then the challenge of behavioural change is made much easier. 

He also reflected that, locally, his LDR has been described as fairly mature, and that the Birmingham and Solihull STP is looking to work with other footprints on issues like documents standardisation. 

“We are starting to have conversations with surrounding STPs to say there are some things we should do on an even bigger footprint than our STP,” said Dr Nazir. “Because we are in a good place, we have been able to have those conversations and influence colleagues around us. For instance, we are already talking about standards for document sharing across the borders –  not just Birmingham and Solihull. 

“We are in regular conversation with NHS Digital, because we have been described as a fairly mature LDR in terms of our thinking and what we want to try and do. But it isn’t just Birmingham and Solihull; if there is an opportunity to work with the Black Country STP and the guys in Midlands and East and Coventry and Warwickshire those conversations are happening. 

“That will mean, in the longer term, that any flow of information that comes back to Birmingham or we send out to other areas will be in a standard format.” 

Discussing the future of STPs, he concluded: “There may be an opportunity, and depending on the lessons learned from the STPs, for them to become organisations that have a longer life. There is always change happening in the NHS, but the good things tend to stay.”



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