1. Background and Aims
1.1 About the evaluation
This evaluation was conducted during June-October 2020 by a research team based within the Interdisciplinary Research in Health Sciences (IRIHS) unit at the University of Oxford. It was commissioned by the Scottish Government to provide timely, robust information on the TEC initiative for the rapid rollout of video consultations in the context of the COVID-19 pandemic.
The TEC programme's video consultation workstream is delivered through the Attend Anywhere platform, a bespoke VC system which has been used to drive the integration of VC into health and social care in Scotland. Developed in Australia, a national licence was procured for Scotland in October 2016 and formally launched in December 2016.
Near Me is now the public-facing name for the video consulting service provided on the Attend Anywhere platform in Scotland. Near Me clinics have been established in all 14 local territorial NHS boards and in the Golden Jubilee National Hospital (NHS Scotland's National Waiting Times Centre), as well as in a range of Health and Social Care Partnerships, Local Authorities and third sector organisations.
In 2019 the University of Oxford was commissioned by the Scottish Government to deliver policy and practice-focused outputs to inform future investment decisions, programme management and national support activities for remote video consultations across Scotland. In particular, the evaluation reviewed progress and achievements in relation to the use and outcomes of Near Me, helped develop an understanding of the implementation experience to date and made recommendations relevant to future scaling-up, spread and sustainability activity. The field work was done between August 2019 and early March 2020, before the COVID-19 outbreak. (see  for full report).
Prior to the pandemic, there was already strong policy support for the scaling up of Near Me. The Scottish Government's Programme for Government (2019-20) featured Near Me (Attend Anywhere), and committed to opening up health and care services to those who may struggle to travel due to their condition, by using technology such as video consultations . But in March 2020, early in the COVID‑19 outbreak, the rollout of Near Me was further accelerated to help reduce the need for face to face appointments and enable access to health and care services via the option of video consultations. Rollout of Near Me continues to form a key part of healthcare transformation and features in the national remobilisation framework , as well as in the current Programme for Government for 2020-21 .
Building on the previous evaluation conducted before the pandemic, this current evaluation aims to provide timely and robust information on:
a) The experience of the rapid implementation and delivery of the rollout programme to scale-up and spread Near Me clinics, in the context of the COVID-19 pandemic.
b) Lessons from this experience, including approaches taken; and barriers to and enablers of the accelerated implementation and uptake.
1.2. Background on Near Me
There has been a long established strategic intent to use video for remote consulting in Scotland, as a means to improve citizens' access to health and care services and, ultimately, to improve their health outcomes [9-11]. In the context of Scotland's unique geography, video consulting has been seen as enabling the pooling of expertise and provision across the country to ensure a better patient experience that reached people in the farthest corners of the country.
The Scottish Government established the Technology Enabled Care (TEC) Programme in 2014, which included a series of workstreams to drive the widespread adoption of technology to support self-management, access to care and remote management within health and social care. The programme's VC workstream focused on the rollout of video consultations across Scotland. In 2015, the TEC team became aware of Attend Anywhere; an internet browser-based video technology that can be accessed by a member of the public using their own device, be it a laptop, tablet or mobile phone. It has been designed to match the consulting workflow. One of the defining features of this model for video consulting is the 'inbound' (or 'person-centric') workflow, which seeks to emulate the ways in which patients physically attend their appointments. For example, a single button on a website (or consistent weblink address on an appointment letter or electronic communication) offers a consistent channel or 'front door' for patients to access a 'virtual waiting room' (potentially managed by a receptionist), before being joined by the clinician on the video call. This is illustrated in the diagram below.
Image showing the process for a patient attending an online video consultation with a clinician. It starts on the left with the patient entering the online waiting area, and ends on the right when the patient and clinician meet in the online video consulting room.
Based on the success of co-design and quality improvement projects in Highland (and other unfunded developments), the video consulting service using the Attend Anywhere platform was branded nationally as Near Me. In November 2018 the TEC programme launched the £1.6 million 'scale-up challenge', to support wider rollout across all health boards.
As described in the previous evaluation report, the ways in which service teams used Attend Anywhere to connect with patients and service users varies across settings and specialties, and can involve three different models of use:
- Hub-home, in which the clinician connects from the clinic to the patient at home (or other locations on personal devices),
- Dyadic hub-spoke, in which the clinician in specialist 'hub' centre connects to patient in remote 'spoke' health or care site without an additional staff member present (e.g. in an unstaffed kiosk)
- Triadic hub-spoke, in which the clinician in a specialist 'hub' centre connects to patient in remote 'spoke' health or care site with an additional staff member (nurse, GP, healthcare support worker [HSW]) present.
These three models were used to support remote consulting of patients within a single Health Board and for consultations across Health Boards, including the provision of services from mainland hospitals to patients living in the Islands and services provided by the Golden Jubilee National Hospital. Further details on the history and development of Near Me before COVID-19 are provided in the previous evaluation report .
1.3. Structure of the report
This report presents the key findings and lessons on the rapid rollout of Near Me across Scotland in response to the COVID-19 pandemic. The remaining sections in this report are structured around three main parts:
- Methods: including sampling strategy, data collection and analysis.
- Findings: including national activity data (collected though the Near Me platform), survey data (collected through online user experience surveys and stakeholder/public engagement), and qualitative analysis across eight health boards. The qualitative data is presented across three different care settings (hospital/other community care, GP services and care homes). Data synthesis is presented through the NASSS framework domains.
- Discussion: including opportunities and recommendations for future implementation.