Nearly half of all national cases of monkeypox (MPX) last month were in the North West London locality (128 out of 257 cases nationally). To respond to the demand, and support our wider sexual health services, a pathway to remotely manage MPX from a single site in NWL was set up in just 10 days to respond to this public health crisis.
Although the majority of patients are mildly infected (and some are asymptomatic), some patients were presenting to sexual health clinics with infection and pain from the rash, which rapidly leads to pustules and then scabs. Patients can be highly infectious at this stage. The remote monitoring hub team was acutely aware of the need to balance careful monitoring of these patients with ‘wrap around’ support for the duration of the three week infectious period - and isolate accordingly.
The process entailed the establishment of an NWL Standard Operating Procedure (SOP), based on NHS England’s national model, with other stages prioritised and approved over just 10 days. The success of the remote monitoring service, accessed through the app, can be seen by the fact 531 patients were on-boarded in the first month - and by the end of July this had reduced to 185.
The rapid roll out of this service was only possible by our local health teams, led by decisive clinical leadership of Dr Rachael Jones at CWFT (Chelsea and Westminster Hospital Foundation Trust) and the NHS North West London remote monitoring team, led by James Bird (across ICHT and CWFT) – and the willingness of LUSCII, the technology provider to set up the patient monitoring app at pace. The instructions from initial set up to test stage (by clinicians) were achieved in just one day!
The app is accessed by patients and monitored by nurses from 8am to 8pm, seven days a week. The patients feel reassured by the regular follow ups and they can also flag if they have any new symptoms – or need reassurance or support.
Kate Sendall, Programme Delivery Manager- Local Care, says: “We really were keen to support the emotional as well as the physical health of patients with MPX who needed to isolate at home.
“A typical case might be a patients presenting with a really painful sore/ wound. Through the app, they can upload photos of their wound via to their patient record and get it reviewed by the right specialist the same day. Patients are over the moon to receive this high level of personalised patient care.
“I would like to pay credit not just to Dr Rachael Jones and the remote monitoring hub team for providing this support, but to all the clinicians involved for being so engaged in the set up and delivery of remote care for MPX. This has undoubtedly helped other health teams by preventing patient with MPX symptoms from coming into hospital.
“The remote monitoring hub is a testament to the cross service teams all working together to achieve with one goal. It’s proved that you can move quickly to support patients via remote monitoring if the need arises - and how seamless this service can be.”
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Notes to editors
In July the World Health Organisation (WHO) declared monkeypox (MPX) as a Public Health Emergency of International Concern (its highest level of alert)
The North West London Integrated Care System (ICS) brings together all parts of the local NHS and the eight local authorities in North West London.