Pragmatic solutions to complex problems improve patient care

Jocelyn Palmer, Programme Director for OneLondon, discusses the challenges and successes of joining up information to improve health and care in the Capital.

What is OneLondon

Making the right information available to health and care professionals at the right time can save lives and improve the safety and quality of the treatment and care you receive.

Shared information can also help improve the way we plan our health and care services for the future, meet the needs of all of London’s communities and give you more control over your own care.

OneLondon was created in May 2018 with the aim of transforming services by joining up information to support fast, safe, effective care. We are a collaborative of London’s five Integrated Care Systems (health and care partnerships formed by NHS organisations and local councils) and the London Ambulance Service. We are supported by NHS England (London region), the Greater London Authority and London’s three Health Innovation Networks.

OneLondon is all about collaboration and partnership working across the Capital. At its heart we are trying to support better patient care by joining up and sharing information.

Sharing is caring - How the London Care Record is making a difference

Within OneLondon one of our flagship programmes is the London Care Record, which has now been in place for a number of years. It is used across London and we also connect to partners in Milton Keynes, Hertfordshire and West Essex, due to the number of patients referred to specialist care in London.

Most GP surgeries and hospitals in London can use the London Care Record and share information in it. Some local authorities, community health and care services, the London Ambulance Service and other NHS 111 and mental health services also use it.

We now regularly see over one and a half million views a month of the London Care Record, by over 100,000 different health and care staff. We know that the London Care Record supports them in providing safe and effective care more quickly. This includes supporting safe prescribing of medications, quicker hospital discharges and helping staff spend more time with patients.

Saving time and improving the quality of patient care

While we see and hear about the difference the London Care Record is making, last year we commissioned Queens University in Belfast to undertake an independent economic evaluation to focus on benefits relating to time-saving, quality and safety outcomes.

Now we have some excellent, quantifiable evidence of its value, including the value of time saved estimated to be up to £44.4 million, based on 27 million uses of the London Care Record up to March 2023. The safety benefits are harder to directly attribute to the London Care Record and we need more research to do this.

Universal Care Plans the next step

Another one of our key programmes is the Universal Care Plan (or UCP). The London Care Record provides past medical history for patients within the capital. The UCP takes this one step further, and provides a way for health and care staff to plan care collaboratively, across organisational boundaries.

The ability to work together on planning the care for an individual is really important. UCP has been live since July 2022. Last month we went live with UCP from within the NHS App, which means that patients can now see their plans are being communicated to other staff, providing reassurance that it's been done according to their wishes.

The UCP has really benefited from strong clinical input and leadership to the programme. We are now planning to move UCP into different sorts of clinical or health and care pathways, for example, to support patients with sickle cell. But we're also looking at how it could support care for other long term conditions too for a more holistic approach to health that doesn’t treat each illness or disease separately.

Collaboration underpins success

All of the work in OneLondon is about collaboration and how we work together

This can bring challenges…across the Capital we know that everyone has the pressure of budgets and priorities…and then on top of that it takes time to build trust and to build relationships. I think probably anybody that works on programmes like the London Care Record or the UCP will say that a big part of the endeavour is how you build and maintain trusted relationships. Overall, in London we have a real ‘partnership approach’ and a lot of consensus about the benefits of pan-London sharing and of working together to take a London-wide approach.

A positive community

Looking outside of London – then across the country most ICSs have now got flourishing shared care record programmes with a really positive community around it.

What connects us as a community is that we all believe in the importance of the work and we all know what’s involved.

A good example of the spirit of this community is the conference event or summit that launched last year. This is a forum to learn from each other, with sponsorship from some vendors and attendees sharing their work. This year I’m looking forward to hearing the different approaches from across the country and we will also have some international speakers for new perspectives. And OneLondon projects will also be headlining some of the sessions!! You can find more details and register for The Shared Care Record Summit 2024 here, if you’re interested in learning more.

Making the complex simple

One of the challenges for health and care professionals is that if you don't have the full picture and the information you need, it is much harder to make a fully informed decision to provide the right care. Maybe in an ideal world, we would not see so many different electronic care record systems / IT systems. But that is the landscape we have and arguably the type of system needed by adult social care is very different to what a GP would want or need.

The London Care record and the Universal Care Plan are pragmatic solutions to encourage collaboration and sharing to support better, safer, more joined up care.

It can be challenging working with multiple organisations, teams and different vendors. Our work involves everything from clinical engagement, to information governance…technology and data to finances and funding. This means it’s never dull! And even with this complexity it is still possible to keep on making progress and that is what we've really demonstrated in London. We have many first-hand stories about how this work is supporting better patient care and that is the real motivation behind our work, even when the challenges may sometimes feel overwhelming.