Central & North West London NHS Foundation Trust meets patients where they are with remote programmes

CNWL NHS Foundation Trust has received compensation in exchange for the testimonials in this article.

As part of the National Health Service, England’s public healthcare system, the Central and North West London (CNWL) NHS Foundation Trust serves nearly a quarter of a million people. Its diverse patient population includes a third of London, the surrounding areas of Milton Keynes and Buckinghamshire, and prison health services across the southeast of England.

CNWL believes in a community-based approach to care, providing health services to citizens throughout their lives in clinics, the community, and patients’ own homes.

When the pandemic hit, CNWL had to reimagine its community-based model to make group work possible for those most vulnerable to COVID-19. Rob Clarke, head of long-term conditions, shared how Zoom enabled CNWL to continue reaching patients in their homes, providing virtual services to help them manage chronic health conditions.

Pulmonary rehabilitation (PR) can help patients with chronic obstructive pulmonary disease (COPD) improve their quality of life by managing symptoms like shortness of breath. Before the pandemic, CNWL clinicians would run weekly PR sessions in a gym space, leading patients through light exercises and breathing strategies to help them self-manage their condition.

When pandemic-related lockdowns began in the U.K., the COPD team designed a remote PR programme that patients could access using Zoom Meetings.

“We only started to do patient group activities over Zoom once the pandemic started,” Clarke explained. “Now, we can tailor groups more specifically, and many patients feel more comfortable doing things in their own home.”

More than 20 months since the start of the pandemic, CNWL has been unable to resume face-to-face group sessions for COPD patients, whose condition puts them at higher risk of complications from COVID-19. The remote PR programme has been essential for helping patients manage their health during this prolonged period without increasing their risk of exposure.

“The inevitable delay would have meant that many patients would be without PR for a period of time. This, in all probability, could have resulted in a decline in their health and an increase in their breathlessness,” Clarke said. “Zoom has enabled us to reach out to vulnerable and isolated patients.”

According to Clarke, a few other benefits of using Zoom include:

• Time and money saved on travel: “Previously, patients would have to travel to a group session and some people needed help to pay for that, so there’s a cost saving.”
• Scalability and efficiency: “We could hold much larger groups, up to 20 or 30 people in a session, which we wouldn’t do in the real world.”
• Improved patient experience: “If you have COPD, it can be difficult to get on and off a bus or even to go up and down stairs. If patients can receive some input in their own house remotely, that is great for them.”
• Flexibility: “[In the future,] we may have some patients who want to attend the programme in person, but next week it’s snowing or raining, so they don’t want to leave the house — they can do it over Zoom.”
• Mental health benefits: “Patients can use this time to socialise and share how they’re managing day to day.”

As Clarke noted, the NHS has been moving toward a “digital-first” strategy for years as a way to expand access to patients and improve communications along the continuum of care.

In addition to group activities, CNWL uses Zoom for multidisciplinary team meetings and communication with other organisations. “We can talk to people from other health services across all boroughs who aren’t part of CNWL. If we want to talk to a GP (general practitioner) about a particular patient, we can do that on Zoom. We can do it on the phone, of course, but it’s better to do it on Zoom,” Clarke said.

“There are potential savings with a digital approach, and across the NHS, there are various teams that provide digital support to patients,” he added.

CNWL and the NHS have developed and launched support services to help patients access healthcare using technology. Clarke said that patients who have trouble joining their Zoom PR sessions could call a tech hotline for directions from a live volunteer. When a patient doesn’t have an internet-connected device available, CNWL can organise to have one delivered to them. Programmes like these open the door for CNWL and other healthcare organisations to engage with more patients digitally; this compliments face-to-face contact. 

Clarke’s teams have expanded on the Zoom PR sessions to develop virtual groups that support patients living with other long-term conditions.

“Our stroke and neurology team use Zoom to do rehabilitation groups, which is a mixture of physio and occupational therapy. Our diabetes team does education using Zoom, mainly for people with type 2 diabetes,” he explained.

Even when COPD patients can return to in-person PR sessions, Clarke plans to continue offering a separate remote programme for those who want it. “It will always be a blended approach, so patients will have the face-to-face option, but they’ll have the remote option too,” he said. “I can envision in a couple of years that over half of our group activities will be done using a remote platform.”

In the future, Clarke said he could also see the need for a group programme for people dealing with what’s known as long COVID, which are symptoms that continue for weeks or months after a patient recovers from an initial COVID-19 infection.

“The potential to expand and offer more group activities is definitely there,” he said.