North Tyneside CCG has worked with stakeholders since the CCG’s inception to continuously improve the quality and access to the services it commissions.
A recurrent theme from the public has been in relation to access to GP practices. The CCG has listened to patients and invested significantly in GP practices directly as well as in technology to support care delivery. This investment was to improve access, improve patient’s experience of care and improve the wellbeing of staff delivering the care.
At the start of the Covid-19 pandemic the CCG recognised that a different complementary digital solution with additional GP capacity may help to improve access across 7 days a week, and release time for practices to focus on patients who need face to face appointments. It was also hoped it may also release pressure on the urgent and emergency care system.
In July 2020 the CCG commissioned Livi on a pilot 12-month basis to offer additional GP access. Patients have also been directly involved, via the Patient Forum, in the process of commissioning Livi.
Livi is a digital application that enables patients to book directly and see a GP by video appointment on a mobile phone or tablet. Whilst Livi brings the technology, more importantly, it also brings additional GP capacity to respond to patient’s needs. This new application supports the North Tyneside health economy to offer additional capacity within the system, providing GP appointments during the day and also in evenings, weekends and on Bank Holidays.
Patients have to consent for the Livi GPs to access their records. If patients do not give their consent, they cannot be seen by the Livi GP. All consultations by Livi are recorded in the patients GP record. In the event the GP assessment identifies that a patient needs to be seen face to face by a GP, this is communicated to the practice. Similarly, where a patient requires diagnostics, e.g. a blood test, this is also communicated to the practice and the practice will undertake those diagnostics. Livi GPs follow the same clinical protocols as all North Tyneside GPs and can refer to other services, prescribe and provide fit notes.
Update – September 2021
North Tyneside CCG, following an evaluation exercise, has extended the Livi pilot contract while it procures a ‘Complementary GP Video Consultation Service’ for North Tyneside. The timescales for procurement have not yet been finalised given the changes in CCG’s and Integrated Care System. Details of the procurement timeline will be published on the website once it has been confirmed. The approach has been supported by the Local Medical Committee (LMC) noting that this needs to happen alongside a wider piece of workforce and transformation work in general practice. Our commitment remains, to work together to ensure that the residents of North Tyneside consistently have timely access to health services seven days a week to meet their health needs. A key part of this is to ensure consistent timely access to see a GP where the majority of initial contacts in the health service happen.
Read the Livi: Complementary GP Video Consultation Service Pilot Evaluation here
Is the CCG privatising the NHS?
It is important to understand the nature of our commissioning contracts. We commission a variety of providers in the same way as all public sector organisations do, including Local Authorities. These take several forms including:
Direct public sector contracts, such as contracts between the CCG and NHS Foundation Trusts, Ambulance Services, Fire Services.
Independent contracts such as contracts with GP practices
Private organisations, such as out of hours GP services (VOCARE Ltd), Tynehealth Ltd (GP Federation) Care Homes, Domiciliary Providers, Ramsey Treatment Centre, Nuffield Healthcare, GP IT services as well as the community and voluntary sector. Without the independent, private sector and the community and voluntary organisations the NHS system would not function.
The NHS is free to patients at the point of delivery.
What consultation has been undertaken by the CCG ?
The CCG has worked with patients, partners and stakeholders in relation to piloting this service and this has been communicated in a range of forums. This has included the Patient Forum, Community Health Care Forum, Healthwatch North Tyneside, North Tyneside GPs, LMC, VODA, local hospital trusts and North Tyneside Council officers.
Why didn’t the CCG inform the Adult Social Care Health & Wellbeing Sub-Committee?
The CCG is happy to discuss the Livi pilot with the Sub-Committee members. Ordinarily, we would discuss healthcare service developments with the Adult Social Care Health & Wellbeing Sub-Committee where there is a major change to an existing service. In this instance we are neither stopping nor changing an existing service. This is an additional new service.
Patients have a choice to use this service or not and this is a 12 month pilot which will be evaluated throughout.
Why didn’t the CCG write to elected members and the Officers in the council to tell them about Livi?
The CCG wrote to senior elected members and the CEO of the Council with information about the Livi pilot on the 31st July 2020. Local Authority officers have been engaged in ongoing discussions at the Future Care Programme Board over the last 9 months.
Why is tax payers money going to a private company in Sweden?
The contract with Livi is with Digital Medical Supply UK Limited (Livi) a UK Company.
The parent company is Swedish and the technology and subsequent infrastructure has come from Sweden but this is no different to a lot of IT and clinical solutions used throughout the NHS such as Cerner (US) or Roche (Swiss).
Do patients have a choice about accessing Livi?
Yes. Using Livi consultations is entirely down to patient choice. To use Livi patients need to download the app and register and also give their consent for the Livi GP to access their patient record.
Patients can still access their GP in the usual way if they want to do so; Livi offers an alternative way to see a GP.
Will patients records be shared with Livi without their consent?
No. Livi has not been given access to any patient records without the patient’s consent.
Can patients be seen by a Livi GP if they don’t want their GP to know?
It is not possible to be seen without the patient’s GP practice knowing. Livi GPs are an extension to patient’s GP service and if they want to be seen, they must give consent for the Livi GP to access their record and document their consultation in their GP record.
Can patients be seen by a Livi GP without the Livi GP being given access to their GP record?
No. Patients cannot be seen without giving consent to access their record in order to ensure continuity of care and is important for patient safety.
What happens if patients who have used (or would like to use) Livi experience problems with it?
The Livi service is a pilot therefore there may be some teething problems which will be rapidly responded to as issues emerge. All patients are asked to rate their experience and give feedback. The CCG also receives feedback via the CCG website which we also respond to.
Are practices forcing patients to use Livi as a triage tool before they get an appointment?
GP practices are using a triage system to prioritise how best to respond to patients e.g. telephone appointment, video consultation or a face to face appointment.
Is this just another fad?
Using technology to support patient care delivery is a national priority for the NHS as described in the NHS Long Term Plan. By 2021, all practices are required to offer video conferencing appointments, telephone consultations and face to face appointments in order to respond in the best way to patients’ needs.
Does Livi just send patients back to their GP?
The current patient feedback score suggests otherwise and has been very positive.
There will be occasions where patients need further investigations such as diagnostic tests, or after speaking to a Livi GP, need to be seen face to face in their GP practice or another setting if this is identified by the GP.
Why can’t GP practices and pharmacists do this instead: we don’t need Livi?
Feedback from both patients and GP practices suggests that extra capacity within the system would be welcomed. Livi offers additional day time GP appointments as well as evening, weekend and Bank Holiday GP appointments. We could not offer this extra capacity and greater access just using the same GPs and Pharmacists that we currently use, as they do not have enough capacity to do this themselves.
Is information taken by Livi secure?
During patient consultations, the Livi GP will document in a patient’s own medical record. There is not a different record.
All of the North Tyneside GP practices have signed up to the stringent data governance arrangements. Through data sharing agreements and patient consent, Livi has access to the patient record. Continuity of care is therefore maintained and the integrity of the patient record remains with patients not having to repeat their story.
Does Livi ‘sell on’ my data to other private companies?
No. Livi does not sell on any patient data and the way they access and use patient data is subject to the same rules and oversight as local practices.