The North West London Acute Provider Collaborative is a partnership across the four acute London trusts designed to strengthen collaborative decision making in several agendas, including digital transformation. The collaborative serves a population of 2.2 million people, with 35,000 staff and a £3.5bn annual turnover.
Bringing together four organisations under a single board has its challenges, but also opportunities. While there is a single board operating across the provider collaborative, which is our ultimate decision making forum, our governance structures starts at trust level and are focused on local delivery of high quality care. Building a successful large-scale collaboration and partnership has required a focus on people and processes, with digital and data core to this work.
Since establishment in April 2022, we have focused on two main digital strands: a joint electronic patient record system (EPR) across the collaborative (expanding the current Cerner system from two to four trusts) and a single shared data platform (Foundry). Our joint EPR will allow us to redesign clinical pathways around the needs of the patient, rather than the needs of an organisation. It is the first time that I have seen doctors genuinely excited about the opportunities of a shared patient record system. The single data platform and reporting system will allow us to have an integrated view of patient care across organisations and ensure that patients receive timely care, according to their needs rather than their location.
More recently, at an NHS Providers Digital Boards event, we shared our reflections on the digital successes of the collaborative and the underlying principles that have enabled this success.
Be bold, some change can be mandated
Crucial towards our success has been our ability, as leaders, to be bold and mandate change, where appropriate. A key driver of the collaborative is to reduce the 'postcode lottery' of care and ensure that a patient in Uxbridge would have the same access to care as a patient in Fulham. Creating a single source of truth for data within our integrated care system is crucial towards this goal, linking us with mental health, community and primary care services.
As a board, we were clear that sharing data across the four trusts through a single data platform was not optional. Remarkably, by deciding rather than leaving the space for debate, we received no push back, and people have bought into the sense that we are serving a population not an organisation. The leadership across the four trusts recognise that using digital and data to drive improvement and reduce variation is at the core of our strategy.
Build on existing opportunities and look for areas to join up
During the Covid-19 pandemic, the benefits of sharing a single system became even more apparent, not just for the sharing of information, but crucially for the speed in which we could implement change, and the opportunities it gave to deliver care across the sites. This solidified our decision to move London North West and Hillingdon onto the same electronic medical record as Imperial and Chelsea.
The pandemic focused the NHS on the needs of populations and patients rather than institutions. Data and digital were vital tools for quickly getting patients to the right care, ensuring the right equipment and consumables were available and speeding research into treatments and the vaccine. It is incredibly important that we do not revert to pre-pandemic attitudes and we maintain a view of digital as an enabler, not a barrier.
Focus on and agree design principles
Our digital collaboration also rests on some clear agreed design principles, which extend further than just our EPR programme. As a group board, we have agreed processes to smooth integration of our digital systems including alignment of clinical systems. For example, the first trust that needs to refresh a technology system that isn't covered by our EPR does it on behalf of all four, with the remaining three trusts moving onto that solution when they themselves come up for tech-refresh. This allows us to build a coherent suite of clinical systems over time that are used systematically across the collaborative.
Be clear on benefits
We are already seeing measurable benefits from the deployment of our Foundry data platform, even though this is still in the early stages. Theatre productivity, cancellations and waiting-list management have all improved because of the integrated data platform and visibility of benchmarking across our four trusts has driven multiple areas of improvement.
It is too early for us to demonstrate measurable benefits from the EPR across two sites, but we are confident that these will be realised when extended to all four trusts and it will accelerate the work within the acute provider collaborate to eliminate unwarranted clinical variation. The real benefits – in safety, quality, and patient and staff experience – take time, which means we need to continue to invest and build our digital portfolio. EPR's do not deliver benefit 'by magic'. The real benefit from the EPR will be discerned when workflow changes are embedded across the collaborative. If we do not invest in these necessary changes, then we will not see true transformation for patients.
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