NHS England has set out comprehensive guidance on virtual wards in order to reduce the ‘variation’ which resulted from their ‘rapid expansion’.
Earlier this year, NHSE committed to further expanding the use of virtual wards following an evaluation in the South East region which showed more than £10m savings.
A new ‘operational framework’ has now been published which sets out requirements for the virtual ward model, including that they are led by GPs, consultants or consultant practitioners, but not advanced practitioners.
Virtual wards, which are designed to treat acute conditions in the home as a ‘substitute’ for hospital care, must not replace ‘regular GP-led or urgent care’, the guidance clarified.
Since virtual wards are expected to run only from 8am-8pm, ICBs must ensure that there is sufficient support out of hours to manage any patient deterioration, which will likely involve ‘integration’ with services such as GP OOH or 111.
NHS England also told ICBs to ensure that when patients are discharged from a virtual ward – after up to 14 days – information about changes to a patient’s medication are shared with their GP.
‘Suitable arrangements should be made for transferring care from the virtual ward to alternative pathways, including those led by primary, community or social care.’
The framework also required ICBs to work with ‘providers’ such as GP practices to ‘improve the flow of referrals to virtual wards’.
NHSE recommended that ICBs track the number of referrals from primary care as one of the ‘improvement area indicators’.
In order to reduce ‘unwarranted variation’, the NHSE also suggested that ICBs consider ‘provider collaboratives to deliver virtual wards across community, secondary and primary care’.
This would help to ensure there is a consistent admission and discharge criteria across the whole ICB area.
The guidance said: ‘Virtual wards are now available in every integrated care system (ICS), although there is variation in the models and pathways they deliver.
‘This is due to pre-existing service arrangements to address local need, and because national policy has supported a diversity of approaches to enable rapid expansion.
‘Some local variation will remain appropriate; however, evaluation suggests that greater consistency nationally in the components of virtual wards would maximise benefits for patients and the wider system.’
Virtual wards are ‘suitable’ for a range or acute conditions including respiratory problems or exacerbations of frailty-related conditions.
In November, NHS England asked ICBs to expand their use of virtual wards to include patients with heart failure.
Requirements for virtual wards
A virtual ward is defined by:
- effective governance and clinical leadership, with consultant physician/consultant practitioner/GP oversight
- operating hours (8am–8pm, 7 days a week at a minimum) and out-of-hours provision
- clear admission criteria and assessment processes
- personalised care and support planning and shared decision-making
- daily board rounds involving a senior clinical decision-maker, medical input and the wider MDT
- hospital-level diagnostics
- hospital-level interventions/treatment
- technology-enabled care, including remote monitoring
- pharmacy, medicine reconciliation and optimisation
- clear discharge processes, including monitoring of length of stay
Source: NHS England
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Will ‘virtual’ wards mean fewer ‘real-life’ deaths in queues in ambulances outside A and E? Or perhaps a duplication of GPs efforts, or possibly more like an obstacle to ‘real-life’ admissions to a hospital for deteriorating patients who already wait too long
Our much trumpeted ‘virtual ward’ didn’t set up a method to request blood tests, preferring to avoid the cost, and wrote blood forms for acutely unwell patients fraudulently in the name of GP practices so we got the results. Commissioners and regulators were quite uninterested!