How long will it take and who is involved?

The Data Privacy impact assessment is usually performed by the Caldicott Guardian or Data Protection Officer. Although anyone can complete it, it is usually signed off by the above roles. This should take approximately two hours to complete.

What is a DPIA?

DPIAs are required whenever you embark on any kind of work involving the sharing of data; such as an eHub. It’s part of the Data Protection Act 2018 (also known as GDPR). In addition to this being the legal requirement, it also helps you consider things you might miss when setting up new systems. 

Why is it important?

It is vital that the DPIA is completed to mitigate breaching the Data Protection Act 2018.

How to get started:

• Start off with the template provided. It is important to remember, that although the template has examples for you consider, each eHub is unique. 
• Consider how a data breach might occur in your particular system, particularly by accident.
• Consider how you can safeguard against the possible breaches you have identified.

How long will it take and who is involved?

The time taken for the creation of the data sharing agreement will be dependent on your expertise, we recommend including your data protection officer in this task. In addition, it is important to account time for each practice, within the eHub, agreeing and signing the data sharing agreement. Therefore, we suggest allowing a week for this to be completed.

What is a data sharing agreement?

Data sharing agreements set out the purpose of the data sharing, cover what happens to the data at each stage, set standards and help all the parties involved in sharing to be clear about their roles and responsibilities.

Why is it important?

The risk is that you breach the data protection act, which could result in putting your patients data at risk and/or lead to a significant fine. Your data privacy impact assessment (DPIA) will highlight that eHubs are sharing sensitive patient data across organisations. To comply with the Data Protection Acts (2018), you will need to have a sharing agreement in place. 

How long will it take and who is involved?

Ideally, Senior Management, Senior Clinicians and IT team should be involved to in the development of business continuity plans. This should take approximately two to four hours.

What is a business continuity plan?

A business continuity plan (BCP) is a document that consists of the critical information an organisation needs to continue operating during an unplanned event. The BCP states the essential functions of the eHub, identifies processes that must be sustained, who to contact for support and how to communicate.

Why is it important?

Anticipating potential scenarios and eventualities enable the eHub to be prepared in the instances. This can mitigate clinical risk to patients, financial loss and reputation damage.

How to get started:

To assist you in getting started the Business Continuity Plan Template, fill in fields and add any additional fields that may be missing.

Practices within the eHub may want to review individual practice's current business continuity plan to combine and cross reference.

How long will it take and who is involved?

eHub senior management, information governance leads and data protection officer should be involved in the process. With the help of our Patient Facing Privacy Notice, this should take one to two hours to reference and complete.

What is the eHub privacy notice?

An eHub, in most instances, involves sharing patient data. This requires being transparent with patients about how their data is used, which is a requirement of the Data Protection Act 2018.
It should also explain the purpose of which the data is collected, how the data is used and disclosed, how long it is kept and the controller’s legal basis for processing.

Why is it important?

The privacy notice will inform patients, within your eHub's member practices, their  digital rights and how their data is collected and processed. Additionally, patients will be able to make informed decisions about their preferences and consent. Most importantly, without doing this the eHub will be Breaching the Data Protection Act 2018.

How to get started:

You can use the example to add to your privacy notices. Be aware it may not cover all data usage instances of your particular eHub. You may want to ask your Data Protection Officer to write or review your Privacy Notice.

How long will it take and who is involved?

Usually it is a responsibility of the senior eHub management with input from a senior clinician. This should take approximately 30 minutes, although you may wish your Data Protection Officer (DPO) to review each of these documents. 

What does it involve?

If your eHub will be making use of Smart Inbox there are additional data sharing requirements to your usual eConsult set up and you need to be aware of these changes.

Why is it important?

Not being aware of the data sharing implications and breaching the Data Protection Act 2018 as the responsible Data Controller.

How to get started:

When you sign up via the order form you will be asked to read and accept:

• Smart Inbox Terms and Conditions
• eConsult Service Specification - this sets out what is provided. For example:
  • A practice side, cloud-based Smart Inbox
  • A practice side, locally installed desktop toolbar
  • A range of demand management features
  • Integration with core clinical systems (EMIS Web, SystmOne and Vision)
  • Integration with NHS App and NHS login (England only)
• Smart Inbox Data Protection Agreement
  • How patient data is protected
  • Information on compliance with the Data Protection Act
  • Length or retention of patient data
  • What happens in the event of a data breach
• eConsult Patient Privacy Policy
  • A privacy policy specifically for patients to read and understand about how their data is used with eConsult

How long will it take and who is involved?

Senior management of the eHub and clinical and management representatives from Practices should be involved. This can take two to three days.

What are SOPs?

SOPs are a step-by-step set of written instructions that must be used and followed to perform routine task. The documentation aims to mitigate mistakes and miscommunication. SOPs ensure reliability, efficiency, and consistently hitting quality standards in regular work activities. 

Combined, SOPs are often referred to as a playbook, operations manual, or operational handbook. 

Why is it important?

Clear and up-to-date SOPs for each process, within the eHub, can mitigate the occurrence of clinical and operational risks. Risks such as; severe injury and even death; ineffective way of working indirect way of loss of profit. 

How to get started:

• Review current SOPs
• Include context in the SOP to add clarity
• Use the optimal format for readability and approve
• Confirm the team receive and read SOPs
• Test the team on SOPs to verify comprehension
• Regularly ask the team if they're using the SOPs
• Ensure that the team are reading and reviewing relevant SOPs periodically

How long will it take and who is involved?

Implementation of your workflow processes will depend on your team and can take up to three weeks to do so effectively. It’s important that you communicate progress and changes effectively in order to keep your team members empowered and included. You should ensure to involve all key stakeholders within your implementing process, including but not limited to, eHub team, practice team, clinical leads etc.

What does it involve?

Process implementation is the strategic approach to helping your team adapt to the new procedures within your team to incorporate your eHub. It’s important that you determine what your eHub’s goals and key variables are, this will help you to create your bespoke plan for your workflow and processes. You will also need to determine the key roles and responsibilities within your eHub and identify any skill gaps or need for additional training. 

Why is it important?

Process implementation is needed to ensure that you and your team are working to the same standards and will help you to develop and improve by monitoring your progress and adjusting your processes as necessary. By implementing your new workflows and processes effectively within your eHub will help you to succeed and reach your desired outcomes.  

An impact of not implementing your eHub processes will result in your team not working to the same standards, which could possibly result in reputational risk and poor patient feedback. Another risk would be needing to extend your launch and not meeting your go live date.

How to get started:

• Set your goals & define your key objectives
• Clearly communicate your process to your team & get feedback
• Determine roles & responsibilities & delegate
• Roll out process & monitor progress & performance
• Take corrective action (adjust as necessary)

Who is involved? 

This stage ideally will include senior management and frontline clinicians. Clinical input will enable a safe service delivery whilst also aligns with the goals of the eHub set out by the eHub's senior management. 

Why is it important?

Clinical Service involves the development of a care navigation team who care safely and efficiently signpost patients to the correct services. These may be off-site e.g. CPCS referral, within the hub (depending on staff present and remote closure capabilities), or back to the patient’s base practice. It enables a better patient journey, better use of primary care resources and improved demand management.  

How long will it take and who is involved?

This will be variable and will involve HR and the clinical lead for your eHub. 

It is important to have the model of the eHub decided prior to determining the roles required, so you can accurately map our the roles required. (For example a Clinical Triage model will require a different staff skill mix to that of an Admin led eHub). By not taking the time to do this stage of planning the eHub will not function, develop or follow SOPs. Ultimately this will potentially impose clinical risk.

How to get started:

• Design the job specification and responsibilities
• Identify internal potential candidates and upskilling opportunities
• Begin your recruitment process by creating post and advertise

How long will it take and who is involved?

This is an ongoing process and can take years to refine, however to get started we recommend two weeks of planning. It is advised that this process involves GP Lead, frontline clinicians and Administrative triage team.

What does it involve?

The care navigation team will assess all incoming activity and signpost the patient to the most appropriate clinical service (triage). There are a number of outcomes that the care navigation team may choose e.g. Remote closure, CPCS referral, telephone appointment, face to face appointment. They will have to decide on acuity and the best clinician to manage the patient.  Some of this function can be performed by non clinicians, such as paperwork requests but will depend on the eHub model and SOP in place.

This team will need upskilling in order to manage risk and provide efficiency. Try and agree a target for how many eConsults you feel can be signposted to additional services other than a GP. You may have to run for several weeks before this becomes apparent. 

Why is it important?

It is important to develop a care navigation and triage team, it is essential for patient safety in addition improving efficiency.

How to get started:

• Decide on appropriate individuals to be involved in the care navigation and triage team
• Ensure your SOPs contain details on how you plan to run this
• Clinical material and training for admin staff - such as crib sheets, care navigation toolkit
• Consider factoring in time for clinicians to support, advise and educate the care navigation team on complex submissions during clinical sessions
• Build capacity cases that are too complex for ARRS role, that are passed back to the practice team
• Develop a Business Continuity Plan for sickness and holiday within the team
• Identify governance arrangements when things don’t go to plan
• Plan your monitoring requirements
• Set up a regular meetings with the care navigation team to help feedback and optimise your process

How long will it take and who is involved?

There will be a constant development for care navigators and clinicians with regard to Remote Closure. The rate of remote closure should be audited and fedback.

What does it involve?

Remote closure is a key component of a triage system using a structured information gathering template. Remote closure is when patients' issues have been dealt with, without having to attend the practice. This could be a message that you send following their eConsult submission or signposting to alternative services. This depends on your demographic and/or your model.

For instance, if you ran a total triage model then you may have a remote closure rate of 60%. However, if you ran a minor illness eHub then your remote closure percentage could be 90%.

You need to set a realistic target for remote closures. This involves having high levels of clinical skill; balancing clinical risk with patient and practice outcome. The eConsult templates gather a high level of clinical information, that is surfaced to clinicians at the first point of contact. 

Why is it important?

Developing processes and clear parameters for remote closures is important for efficiencies. Without doing this and working in a traditional model, practices may become saturated and subsequently there would be no benefit felt from the triage system. An example of this may be repeated “rework” - a patient doing an eConsult then having a telephone call and in addition a face to face appointment all for the same issue.

How to get started:

Clinical discussion is key in this setting. Often GP’s with experience in acute care or GP Out of Hours settings are used to remotely or quickly closing cases. We would recommend that your clinical lead monitors and discusses remote closure rates, barriers and anomalies with staff. It’s also key that your care navigation team appreciate remote closures and pass suitable cases to the triage GP as opposed to booking these cases into clinics. 

How long will it take and who is involved?

Communications lead, senior management team should be involved, this should take approximately one to two hour to complete.

What does it involve?

A communications plan enables you to effectively deliver information to appropriate parties. The plan will identify the messages you need to promote, to whom you're targeting those messages, and on which channel(s). 

There will be no clear plan of action therefore you may find that your campaign does not reach all of your required targets, resulting in slow or limited uptake when introducing your eHub.

How to get started:

• Identify the audience to whom you plan to deliver your communications plan
• Outline and write your plan, keeping your audience in-mind
• Determine the channel(s) on which you need to deliver your messages
• Decide which team members are responsible for delivering the message
• Estimate a timeline for how long each step should take
• Measure the results of your plan after presenting to stakeholders, and determine successes and areas for improvement

How long will it take and who is involved?

Creating the plan should involve senior management. It may be appropriate to include representatives from practices to be involved with planning this strategy, such as clinical leads and reception managers. This should take approximately two hours to plan. However, conducting the internal communications over the implementation period should be spread out over the course of your transformation.

What does it involve?

Internal communications are vital to inform your internal team on the upcoming changes. We suggest you conduct the internal communications as face to face meetings where possible to allow a forum for discussion and raising of questions and concerns. This can be done over several weeks and over the stages of the implementation, to update the team and provide transparency. In addition, written communications can be beneficial to follow up these meetings as documentation to keep everyone informed and a resource for reference. 

Why is it important?

Educating all relevant internal team members (i.e. GP’s/clinicians, GP partners, the eHub team, admin team) prior to going live with the eHub is needed and crucial for the whole process to run smoothly.  From the planning to the implementation, letting your teams know what is going on is key to enable buy in as well as enabling rapid redesign when things aren't working.

If the changes are not effectively communicated with your team, this risks the message and vision becoming lost. This could negatively impact the roll out and lead to: 

• Frustration 
• Confusion 
• Lack of efficiencies 
• Not being able to see the benefits 
• Not knowing what to do 
• Bad habits could form 
• Lack of standardisation 
• Lack of team collaboration 
• Your team wouldn’t benefit from the platform 
• Lack of motivation 
• Not reaching your desired goals

How to get started:

• Allocate specific time to plan how you are going to educate all relevant team members
• Think about your approach and the impact that it may have. Taking this into consideration it can support everyone with their understanding
• Allocate time for the delivery of the message, to wider team/all relevant internal stakeholders, whether that be meetings/sessions taking place or specific communications being sent out 
• Ensure that there is a strategy in place for training new starters and who to go to if they require support

How long will it take and who is involved?

The management team should be involved in creating a plan to communicate with patients, although this could be delegated within the team. Additionally, it may be useful to draw on the experiences from the members of the team that have frequent contact with patients, to understand effective means of getting the message across.

The time needed for this is dependent on a few different areas, such as; the amount of marketing you would like to carry out prior or post going live and the model that you are planning to run in your eHub. 

What does it involve?

Communication is key! It is recommended prior to going live, to inform and educate your patients of the eConsult platform; to enable your patients to utilise the eConsult platform with confidence and feel reassured. Ensuring that you have allocated time for communication strategies and campaigns is needed. 

Consider your eHub's target, specifically cohorts and if they require targeting/to be informed. Think about who you would like to know and how you would like them to be informed. Ensuring that your patients are informed and aware of the platform, its benefits and how to utilise the platform to their advantage. This can increase utilisation of the eConsult submissions and subsequently drive efficiency.

Why is it important?

It’s important to educate your patients of the benefits of submitting eConsults. Alleviating any questions or concerns patients may have will ultimately increase their usage and improve their experience. The advertising of the formation of the eHub is not essential.

Additionally, your patients may end up causing additional work for your practices if they are not educated and informed of this new way of working. By encouraging patients to submit eConsults, with your new eHub set up, they should receive a quicker response. Therefore improving the patient journey and inspiring future use.

How to get started:

Utilise our marketing materials and tailor them to the specific message that you would like to be shared with your patients. Patients will want to know what is going to happen and when. Think about having templated text messages such as, thanking patients for their eConsult submission. This will be dependent on your model.