London Programme for IT

Barnet first for community

The podiatry and dietetics teams at Barnet PCT became the first in London to use the new community health computer system, part of the NHS Care Records Service (NHS CRS). The community system is an integral part of much larger change for the podiatry team, supporting the team to reduce waiting lists and improve processes. Find out more about the community system and how the team at Barnet decided to use it...

The podiatry team at Barnet PCT had to take action. Waiting lists were long and the team were stressed. To improve patient service, the team undertook to modernise their service; looking at how things work, and how they should work. Their community health computer system, part of the NHS Care Records Service (NHS CRS), supports the changes they proposed.

Mapping the service

First of all they mapped the service; looking at who does what, when and how. Every process in the podiatry service was put under the microscope and recorded.

Once they had this overall picture, the podiatry team could think about how they wanted to do things in the future. They considered the needs of their patients; where and when they could attend appointments, and the most common conditions being presented. They also considered how the community health computer system could best support the new processes they proposed and the system was tailored to their requirements.

Fiona Jackson, head of allied health professionals at Barnet PCT says "I'd recommend that other trusts see the new systems as an opportunity to redesign the way they work for the better. Get as many people involved in your process mapping workshops. The staff working in the service know most about how things are done and how they need to change to best support patients in the future; so they're the people who should lead the decisions on how the systems operate."

A big change

Fran Gertler, head of podiatry says: "The new computer system was introduced at the same time as this modernisation, which was a massive amount of change all at once. Even with hindsight I think we did it right. To introduce changes bit by bit would have prolonged the upheaval and inconvenience to staff and patients. It was tough, but the team just threw themselves in and got on with it."

Tips for other trusts

Fiona Jackson, head of services says: "For me, the main lesson is that this is about a new way of working and not about IT. It's not just about doing the same things we used to but with a computer – it's much more fundamental than that. We're working in a completely different way from before and it is better, but I wish that had been clearer to me at the beginning."

In the first eight weeks of operating the new system, consultation times were extended by 10 minutes to give staff plenty of time to do all they needed to do, and get used to the new way of working.

The trust were able to employ temporary data entry staff for a short time to ensure that all the patient notes available were entered into the system.

Fran suggests that clinicians in other trusts spend some time before go-live ensuring that all their notes are complete, clear and up to date: "While it seems like a lot of hard work, it seriously pays off. Having all the relevant information on the system from the start is so useful."

Fran also recommends reducing the demands placed on staff in the first few weeks after go-live by reducing the number of non-urgent appointments.

Early results

While the waiting list grew initially, due to the extended consultation times, they have now fallen. The project to improve patient service was the chief reason for this reduction, however, says Fiona: "The new community system has definitely supported this, and helped it happen much faster."

Members of Fran's team work all across Barnet and the new system has given her a good overall view of progress. With a paper based system this was impossible. Fran says: "In the new world of commissioning, being able to demonstrate what we're doing will be invaluable. The team deliver real value for money but before we had no evidence of that, so the new system puts us in a much stronger position."

Notes are now much clearer, since they are in the system rather than written on paper. It's an old cliché that clinicians have bad handwriting, but difficult-to-read notes can pose a clinical risk. Now that notes are entered into the system that is no longer a problem.

"We know that some of the other benefits of the system are a long way away, like being able to access information from other trusts, and share our patient records with social services, but we feel like we're on the way and we can see how good it will be"