The challenge
As the elective waiting list continues to increase and with patients waiting longer for their operations or procedures, York Health and Care Partnership, working alongside Nimbuscare, wanted to reassure patients that they had not been forgotten.
They sought to identify people who may require additional support in terms of managing their long-term conditions to remain eligible when the time came for their intended procedure and asked the RAIDR team at NECS to support.
Our response
Utilising RAIDR’s Waiting Well dashboard, York Health and Care Partnership were able to quickly identify a cohort of 30 patients across the ICB who were highlighted as having unmanaged hypertension. Practices, to which the patients were registered, were able to extract the clear NHS numbers from the RAIDR dashboard and by importing these NHS numbers into their GP clinical systems, were able to obtain patient contact details.
Text messages were also sent to each of the patients identified via the Waiting Well dashboard who were given the option of either being directed to the Nimbuscare website for self-management resources or to request a call back from the team.
Outcomes
Following these calls, referrals were made to health trainers or social prescribers, based on the individual’s needs. In some cases, BP monitors were delivered to patients to support them in managing their health.
The team has now developed a monthly process for identifying a cohort of patients to support through the programme, with a dedicated web resource and allocated social prescribing time for patients on waiting lists who request a support phone call.