In November, like all other ICS’s across the Country, we were tasked with setting up an Oxygen@Home service.  In Mid Nottinghamshire ICP, the Community Urgent Response team were asked to deliver the service.  The team leader had previously utilised Flo within other patient cohorts and recognised that Flo was the most effective and safest tool to use to ensure good quality of care to this patient group, while having the least impact on staff workload.

Florence & Oxi@Home: Northern Care Alliance NHS Group and University Hospitals of North Midlands NHS Trust /Midlands Partnership Foundation Trust launch virtual ward for Covid-19 patients

The Northern Care Alliance (NCA) virtual ward model supports patients post COVID admission for up to two weeks post discharge, and NCA have designed three specific pathways tailored to areas within the organisation’s geographical reach and ensuring local clinical relevance.

The pathway is now enabling clinical teams at NCA to be able to safely discharge patients home earlier whilst maintaining a sense of connectedness between the patient and clinician that provides both reassurance and confidence for patients to be able to understand when, and if further clinical intervention is required and clinicians to provide a supported discharge.

Ashfield PCN implements Florence Covid-19 Virtual Ward in only 5 Days!

The Community of Practice underpinning Florence has enabled Ashfield North PCN to be able to access and build upon the learning shared from other areas who have recruited Flo to their COVID virtual ward team.  With similar ambitions, Ashfield [North] PCN have been able to provide access to Florence to support safe and early discharge of Covid-19 patients within five working days.  Clinicians are now able to support patients to safely manage any symptoms for two weeks post discharge, and clear pathways are defined to enable timely escalation of care should this be required.

Jayne Birch Jones, Change Management Lead - Assistive Technology, Connected Nottinghamshire says: 

Uncontrolled hypertension is the largest manageable cause of stroke and myocardial infarction.  Despite the effectiveness of anti-hypertensive medication, many patients still have uncontrolled blood pressure (BP).

Having previously demonstrated that Florence encourages medication use and is effective at lowering BP in this cohort, NHS Lothian’s award winning Scale-Up BP Team led by Professor Brian McKinstry expanded their scope to understand if integrating Florence directly into the clinical workflow would increase adoption even further, what impact this would have on clinician workload, and if study participant changes in BP would match those of randomised controlled trials (RCTs).

NHS Lothian subsequently developed an integrated system providing regular summaries of patient home-monitored BP readings via Florence to routine GP data management systems accessed by their general practitioner.  Patient home-readings were delivered alongside routine laboratory results for clinical review.

The number of participating practices grew steadily following the launch, and by July 2019 75 practices had participated and recruitment reached 3,200 patients with established hypertension.  Expected challenges to the adoption of new technology were mitigated well by the project team by engaging frontline clinicians in development of Florence’s use, activating local champions, and strong continuous support from a facilitator team.  The success of practices who recruited large numbers of patients acted as a stimulus for other practices to follow; patients liked Florence and there was a low rate of discontinuation.  Previous studies have been in the context of RCTs with practices contributing relatively small numbers of patients that are relatively easy to manage however within this study some practices were recruiting hundreds of patients.

Along with Florence’s uptake, change in BP and participants’ views, a key objective of the study was to understand the impact on changes in clinician appointment use.  Compared with the previous year, the study demonstrated that there was no increase in practice workload, specifically:

• participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not supported by Florence.
• total consultation time for participants fell by 15.4 minutes, compared with 5.5 minutes in patients not supported by Florence.

Empowering patients to feel confident and supported in managing their health can be a key role for technology-enabled care (TEC) such as Flo, with robust evidence citing the benefits to both patients and clinicians.

To encourage more wide-spread adoption of TEC, Staffordshire Sustainability and Transformation Partnership’s (STP) Digital Workstream have introduced a TEC programme aligned with the national ambitions for STPs using Flo as an exemplar.  Focuses of the programme include:

• Strengthening prevention and early intervention
• Improving productivity
• Tackling variations in care
• Developing enablers
• Upskilling the workforce
• Redesigning and improving healthcare services in all settings

The programme has now rolled out nationally supporting general practices to become more digitally-enabled whilst supporting respiratory conditions at scale.  Promoting TEC and digital care not only gives patients the reassurance and confidence to manage their health at home, but it can also upskill clinicians, improve patient safety and improve clinical capacity.

Around 300 attendees have taken part in workshops so far across the country, giving them the opportunity to discuss the learning developed during their local TEC implementation.  A number of attendees provided feedback that they would like to improve their digital capabilities, such as:


To find out more about the programme, take a look at the full article available via RCNi’s Primary Health Care journal, to read examples of how Flo is supporting respiratory patients please see here

Based on 10 years of healthcare quality and safety learning through clinical innovation with Florence, ethical development company, Bitjam Ltd are featured in the new issue of Lifestyle Industry Magazine sharing how they are working with us at Simple Shared Healthcare to deliver telehealth with a human touch worldwide.

Community of practice members from East London NHS Foundation Trust (ELFT) were some of the first to recognise Flo’s role in their local COVID-19 response and begin developing pathways to support patients during the COVID-19 pandemic.

The ELFT Telehealth Team is aware that people may be overwhelmed with the amount of official information and updates, and confused by misinformation spread via word of mouth and social media.  However, it was of the utmost importance that members of the public adhere to and follow up-to-date official advice in order to reduce the likelihood of further transmission of the COVID-19 virus.  As a result a pathway was developed to provide reassurance to patients with a confirmed diagnosis of COVID-19 who were well enough to be discharged home, and patients that were at the extremely high risk group in the community.

Recognising the increased levels of anxiety around both their physical and psychological wellbeing during COVID-19 within these patient cohorts, Flo’s regular friendly prompts are reassuring patients, keeping them safe and helping them to feel cared for, connected during this difficult time and getting a holistic intervention in the community at the right time and thereby avoiding hospital admissions where appropriate.

In addition to interactions with Annie bringing a sense of connectedness and reduction in anxiety, a decrease in avoidable contacts with the VA was evident with Annie as an extra member of the team, allowing clinical resources to focus on those Veteran’s most in need.  Of the 1,134 Veterans who answered the question ‘Would you have taken any of the following actions if you were not receiving Annie’s Coronavirus Precautions messages?’, 532 (47%) reported they would have otherwise reached out to the VA in at least one way (either secure message, phone call, visit or some combination of those).  In addition, 159 (14%) Veterans report they would have interacted with community (non-VA) care (called or sought care).

Patient quotes: