NHS bosses are to look at developing digitally enabled care pathways that “increase inclusion” as part of the next phase of the NHS Covid recovery plan.

In new guidance issued by NHS England on phase three of the health service’s response to the pandemic, leaders were also instructed to review who is using new 111, primary, outpatient and mental health digitally enabled care pathways in a bid to improve inclusivity.

The NHS has experienced “unprecedented” uptake of digital services during the pandemic which has provided an opportunity to create a more inclusive, flexible and accessible system, according to the guidance.

“The shift needs to be carefully designed to ensure it does not affect health inequalities for others, due to barriers such as access, connectivity, confidence or skills,” it states.

NHS bosses have until March 2021 to develop agreed actions to ensure all patients receive the same level of access and care regardless of their digital preferences.

“To monitor this, new care pathways should be tested for achieving a positive impact on health inequalities, starting with four: 111 First; total triage in general practice; digitally enabled mental health; and virtual outpatients,” the guidance states.

“For each, systems should assess empirically how the blend of different ‘channels’ of engagement (face-to-face, telephone, digital) has affected different population groups, including those who may find any particular channel more difficult to access, and put in place mitigations to address any issues.”

Digital tools to ease the backlog

Adopting patient-initiated follow-up (PIFU) process in secondary care, alongside digital-first approaches, can play a “key role” in enabling shared-decision making and supporting patients, the guidance adds.

It provides advice on implementing PIFU services which “can be used for patients of any age, provided the patient and their clinician agree that it is right for them”.

Such services encourage patients to “engage” with their health; helps clinicians manage their caseloads; provides confidence that patients know how to contact service; and can reduce waiting times and ‘did not attend rates’.

Clinical specialities encouraged to look at using PIFU services include oncology; dermatology; cardiology; ophthalmology; physiotherapy; and respiratory.

This will become especially necessary as the health service works through a backlog of appointments postponed or unattended during the pandemic.

Scientists have predicted Covid-19 could cause an extra 35,000 cancer deaths due to delays to diagnosis and treatment during the pandemic.

GP’s and hospitals have also seen a reduction in appointments during the pandemic, further adding to concerns a spike in appointments is likely as lockdown restrictions ease.

The NHS has been encouraged to look at IT and digital solutions to address the backlog of appointments.