What did the doctor say? – I wasn’t really listening.

In 2012 the NHS Grampian Health Innovations team ran some workshops with Glasgow School of Art to test how much patients understood about their diagnosis. The results were quite revealing – many newly diagnosed patients were unsure of their diagnosis and it’s implications.

I know that from my experience with my mum, a razor sharp 85 year old, she seems to drift off at the doctors and is either not listening – in her case probably not hearing or distracted by the fact that she’s hearing bad news. Living 400 miles away, it makes it hard for me to help when I can’t get any extra information from her GP practice.

NHS Grampian came to me while I was working at Digital Life Science with this challenge – how do we help patients understand diagnoses and help them to start to make appropriate changes to their lifestyle without the delay of waiting until their next appointment.

The idea was to use video and it reminded me of a project we’d worked on in 2008 – a BBC Food show called Get Cooking with Madhur Jaffrey, Sophie Grigson and Mich Tonks.


The website format was simple: there was a main video which, step-by-step took users through a recipe. When there was a specific technique mentioned that you were unsure of, such as filleting a fish, you could skip across to a technique video showing how to fillet a fish, or you could ignore it and stay on the main video. After launch we had 8 million unique users per month and won a shed load of awards both national and international.

This seemed the perfect format for delivering a basic diagnosis by a clinician plus more in-depth information where required. It could be reviewed by a patient at leisure, be watched over again and over again and shared with family or carers if appropriate.

No Delays and the Prescribe Platform

The project was called No Delays and instead of recipes we created video presentations and built the ability to post (email) them like postcards. All sitting on a platform called Prescribe. The stated aim of No Delays is to transform the way in which patients interact with their GPs and health professionals.

We started a pilot, and this went well so we released a fully functioning Alpha product was developed with NHS Grampian to support delivery seven specialties (diabetes, gastroenterology, child health, sexual health, dermatology, respiratory, ear, nose and throat). For each condition, an interactive video postcard is created by a health professional comprising of an introduction to the condition from the local specialist, along with videos on self-management techniques from specialist nurses, physiotherapists or pharmacists as appropriate, as well as one or more expert patients. And this is the key – the packages could be created with combinations of information specifically to meet the need of an individual patient and their carers.NoDelays

A ‘noreply’ email with a link to the postcard is send to the patient.

We found one of the unexpected benefits was that by using local consultants and multi-disciplinary care teams in the video, patients got a preview of the actual people they were going to meet and hear specifically how that team or practice or hospital treated the condition.

The No Delays supported service redesign activities enabling health teams to integrate tools such as no delays into GP practice and health professional processes.

It contained high-quality video and text content tailored to the patient’s own health needs and designed to improve patient education, with interactive exercises and self assessments.

Current Situation

In May 2014 DLS released a further beta development of No Delays focusing on sexual health, child health, and updated content for COPD, including a customisable remote pulmonary rehabilitation courses. Additional content for palliative care, diabetes, and cardiology is due for release in early 2015 along with platform developments linking Prescribe with online access to health professionals and supported self-management tools including the health journal, A Better Plan.

“No Delays has the potential to improve patient understanding and the doctor-patient relationship, during and after consultation.

No Delays offers health and care organisations the opportunity to add value for the patient by offering internet-based intermediate steps in a mixed economy with face-to-face consultations.”

Dr Jamie Hogg: Clinical Lead for Modernisation, NHS Grampian

Over 350 digital postcards have been prescribed to patients in the first 6 months, and it’s now being evaluated by Aberdeen University.

Results so far

Six months into the live deployment of three specialties in NHS Grampian (respiratory, sexual health and child health), early indications show that:

  • over 450 health professionals have No Delays accounts
  • 250+ packages of personalised content have been sent to patients
  • patients spend an average of six minutes using the online service
  • having access to a personalised online pulmonary rehabilitation course has increased access from 30% to 70% of patients
  • several other specialties are keen to deploy No Delays to achieve their own service redesign needs

There is now a version of No Delays and the Prescribe Platform in the Modality Partnership in Birmingham with a focus on Diabetes and we are hoping that other regions will follow soon.

Like all the projects I’m involved in I think this is a brilliant idea but what’s special about this project, just like our BBC cooking project, is that we’ve got great numbers to get started with.

By the way, Get Cooking launched about 6 months before iPlayer. When iPlayer arrived, Get Cooking was pulled apart into its component parts of recipe video and techniques and became just some more BBC Food videos.

Anyway, I know No Delays won’t make my Mum listen to her doctor but it might help me be a better son… and I need all the help I can get.

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