Digital | Audit Scotland

What is it?

Near Me is a video consulting service used to facilitate remote consultations between patients and clinicians, clients and service providers, to improve access to health and care, with plans to extend it to other public services.

Who is involved?

It is led by the TEC (Technology Enabled Care) Programme within the Scottish Government’s Digital Health and Care Directorate. Initially trialled in the North of Scotland, it was rolled out across primary and secondary care, as well as social care settings across Scotland. The programme has now been piloted with housing associations as part of plans to extend its use to social landlords and other public services in Scotland.

What did they do?

Building on the success of the early adopters, in November 2018 TEC launched a £1.6 million challenge to support wider rollout of Near Me across all health boards. In March 2020, TEC launched a 12-week scale-up plan to support rapid deployment of Near Me services to maintain some level of service provision during the pandemic. This included targeted support for priority areas such as Mental Health, GP practices and care homes.

Use of the service rose from less than 1,000 consultations per month in February 2020 to almost 70,000 per month from June to September 2020. Hospital and community care services accounted for over 75 per cent of activity, with mental health services constituting over a third of this. Few GPs had embraced Near Me before the pandemic but around two-thirds did during the first lockdown. As the first lockdown eased, hospital and community use of Near Me continued to rise, while GP activity fell back with only around a third of practices continuing to use it, with telephone consultations preferred.

Uptake was lower in care homes due to connectivity limitations but care staff who did use it were generally very positive. An initiative has been launched to facilitate digital inclusion for residents in care homes – a collaboration with TEC and the Connecting Scotland Programme.

What went well and what were the challenges?

Patients and professionals surveyed found video consulting beneficial for both during the pandemic (eg, infection control) and longer term (eg, reduced travel times). Patient satisfaction was generally positive. Technical performance and call quality had a significant impact on patient-reported outcomes. Clinicians reported that video calls are clinically appropriate in certain circumstances but not others (for instance for rare/less predictable conditions or where physical examinations or medical tests are needed).

Digital workforce: It was a huge shift in working routines both for administration (eg, managing patients with entry to the virtual waiting room) and clinical staff. Good support was provided for technical set-up, and guidance and training for staff that was grounded in lessons learned from earlier roll outs.

Collaboration: Taking a quality improvement approach to continually monitor and adapt to rapid scale up. Having a large number of people from across many quality improvement teams helped support engagement, training and service implementation.

Technology: Having a single national platform and branding helped rapid scale up. There are still some challenges with infrastructure to enable video calling.

User focused / Digital access: Professionals had some concerns related to digital access and health inequalities, and lack of privacy within a patient’s home. Reasons for limited use in GP practices included the varied case mix seen in primary care and the challenge of incorporating the technology into time constrained appointments. Further work is needed to better understand how best to embed video consulting into GP routines.

Audit Scotland reported more broadly on digital health innovations in our NHS in Scotland 2021 overview report – Opens in a new window.

Source: NHS in Scotland 2020 – Opens in a new window and Evaluation of the Near Me video consulting service in Scotland during Covid-19, 2020, communication from Scottish Government, The Scottish Federation of Housing Associations – Opens in a new window.