Apollo Epic at GSTT and Kings

Changes for primary care

On 5 October 2023, Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts are jointly introducing a new electronic health record (EHR) system.

The new system, powered by Epic as part of the Apollo programme, will replace multiple clinical systems in use across both Trusts with a single, integrated and comprehensive electronic health record. It will also improve the consistency and timeliness of information being provided to GPs.

As a result of the changes in IT infrastructure, there will be some changes in the way primary care interfaces with secondary care. Please have a read of this briefing document to provide you with an overview of the steps we are taking to minimise disruption to you and your colleagues, and to answer questions we anticipate GPs and GP practices will have ahead of launch.

As part of the launch, we have worked with primary care colleagues to re-design letters to GPs. Letters will now have a clearer layout, with GP requested actions and patient advice highlighted more clearly at the top. You can view example new patient and sample follow-up letters.

Ahead of the go live date (5 October) for this new electronic health record (EHR) system, we ran a series of virtual drop-in sessions to provide an overview of the changes to primary care and an opportunity to ask questions. If you were unable to join, you can watch a recording of one of the sessions below.

As a result of the sessions, a FAQ document has been created to address the points raised.

In addition, you’re invited to join a primary care supper for GPs and primary care clinicians working in south east London practices which will focus on the new system. The event is taking place on Thursday 28 September and you can register here.

If you were unable to join a drop-in session, watch the recording below

We are aware that the implementation of Epic has resulted in several changes for primary care. To support you during this transition period, we are boosting the capacity and opening hours of our support teams. 

Between 5 October – 21 October 2023, the SEL ICT service desk and Bromley Healthcare ICT service desk and will be open between 8am – 8pm Monday to Friday and Saturday 9-5pm. You’ll be able to call us, use the service portal or email us as usual. Staff will be on hand for all technical issues in this period, including issues relating to: 

  • Apollo eg letter format, advice and guidance 
  • ICE – radiology orders. As a reminder, ICE is only going live for KCH and GSTT from Oct 5. For LGT, referrals remain business as usual. 
  • T-Quest – pathology orders and results 
  • DocMan – letters from Trusts to GPs 
  • Referrals – NHS eReferral service 

The GP IT service desks will not be able to respond to issues associated with activity reduction, including for Synnovis. GPs with concerns here will have their concerns logged but will be asked to contact the Trust or Synnovis directly to discuss. 

We strongly encourage you to check your relevant Halo portal in the first instance for service updates or SEL wide reported issues. As a reminder, please don’t share patient identifiable data with the service desk. 

As a reminder, the contact details are below: 

SEL ICT service desk: 

Email: ICT@selondonics.nhs.uk 

SEL ICT Tel: 020 8176 5400 

Self Service Portal: https://nhssel.haloitsm.com/portal/home 

Bromley Healthcare ICT service desk: 

IT Service Desk Tel: 0208 315 8702 

Self-Service Portal: BHC Self-Service Portal (haloservicedesk.com) 

IT Service Desk Email: BHC.ITHelpdesk@nhs.net 

Due to the transition to Epic at GSTT and Kings, existing electronic links for requesting and receiving Radiology reports will end on 5th October 2023 when Epic goes live. A new electronic requesting system (ICE) is being deployed and will directly link between EMIS and Epic. It will allow requests to be made instantly, and reports to be viewed as soon as they’re authorised.

For GSTT and KCH, the ICE go-live date is October 5. Following a robust clinical review, a decision has been made to delay the ICE go-live for the Lewisham and Greenwich NHS Trust (LGT). Patient safety remains our primary concern and we are keen to ensure configuration is finalised and secure ahead of switching over to ICE for LGT. In the interim please continue to use your current radiology referral process for LGT and we will share a revised timeline in the coming weeks.

What is ICE?

ICE is an electronic requesting system that will be linked to EMIS. It allows requests to be made instantly, and reports to be viewed as soon as they’re authorised. ICE will also enable digital clinical decision support which will assist in the appropriate selection of examinations. The ICE system offers enhanced security and will show patient demographics in context in EMIS.

What does it mean for me?

Work is underway to link ICE with EMIS which should hopefully streamline the process and remove the need for additional logins and passwords. The roll-out will impact professionals within the practice differently, particularly around training requirements.

IRMER regulations underpinning NMR imaging requests

The implementation of ICE has highlighted that we need to move towards a more robust clinical governance system to ensure we are meeting regulatory and CQC requirements in relation to Non-Medical Referrers (NMRs) requesting imaging scans.

To support this implementation, SEL is developing a SOP which details compliance with IRMER regulations for NMRs in GP practices. The SOP will state that within six months all NMRs and GPs will need to have completed the IRMER training course outlined in detail here. There will be a local audit process to confirm this. This timeframe takes into account the current pressures on primary care and overall patient safety considerations.

What happens next?

In order to ensure you have all the information you need for the ICE go-live, we’d encourage you to watch this 8 minute training video which provides a straightforward demonstration of ICE.  You can also read this FAQ guidance document. If you experience any issues at go-live, please contact your IT lead in the first instance to ensure that you’ve been set up correctly.

Practice Super Users will be identified across SEL. They’ll be contacted in due course and asked to attend 2-hour Teams sessions where CliniSys will deliver the training. Sessions will run from 21st August onwards and into September. Expectations of Practice Super Users will be to provide support and guidance internally within their practice and to ensure that suitable colleagues attend their End User online training. Practice Super Users will not be asked to deliver training themselves to End Users.

Where can I find more information?

A FAQ document has been created to address questions you may have. We appreciate this change is happening at an accelerated pace, particularly over a busy summer period. Work is underway to make this as seamless as possible, but please be assured support will be available throughout the training and go-live period. High-level System Support will be available from 2 trained ICE System Administrators and GP Practice Support will be available from GP Trainers / GP System Admin. The central SEL Project Team will be available online to provide support and CliniSys will also be available to provide Go Live support.

If you have any further questions, the central ICE Project Team are contactable via SELGPordercomms@rbht.nhs.uk

What is changing?
  • Beaker LIMS: Epic will see the introduction of a new LIMS (laboratory information management system)
  • tQuest Consolidation: The multiple versions of tQuest will be consolidated into one
  • GSTT Haematology: Haematology analysers at GSTT are being replaced with new analysers
What does that mean for me?
  • Activity Reduction: Pathology laboratories will have a significantly reduced capacity and it is vitally important for primary care colleagues to stop non-urgent pathology. No routine samples can be processed from 5 to 9 October. The last routine samples must be collected before your last Synnovis courier collection on October 4.
  • Beaker LIMS: There will be changes to reference ranges, tests and calculations across all sites.
  • tQuest Consolidation: A standardised microbiology test catalogue across SEL primary care. GPs benefit from an expanded, fully electronic process and a more resilient network.
  • GSTT facing GPs: Haematology reference ranges will change at GSTT and for GSTT facing GPs. There will be minor delays during the swap out.
What do I need to do?
  • Activity reduction: Stop non-urgent pathology from 00:01 5 October to 00:00 on 9 October. Divert resources or appointments during this window for other activity. Noting that there is often a delay of up to 7 days for a patient to attend phlebotomy clinic, we advise non-urgent requests are reduced leading up to October 5. Please notify patients to not attend phlebotomy for routine blood tests between 4 and 9 October.
  • Beaker LIMS: Colleagues across south east London should familiarise themselves with the changes to reference ranges. These will be shared online and in our newsletter throughout September.
  • Raising orders: You can still raise orders from 5 to 9 October. It is critical to the efficient operation of laboratories – and the expedient turnaround of test results – that all tests are ordered electronically. We will continue to accept samples accompanied by paper booking forms, but would note that turnaround times will be notably slower for these samples owing to the additional admin required.
  • tQuest consolidation: There will be actions for practices to take in order to prepare for the consolidated IT system for example, run down existing saved orders. Your practice will be contacted directly by Synnovis and the ICB where specific actions are required. The processes of ordering tests and receiving results will not change.
  • GSTT Haematology Reference Ranges: Colleagues in GSTT facing practices should familiarise themselves with the changes to haematology reference ranges. The table of changes is in our regular newsletter In SYNc and on our website now.
Disruption to service
  • Activity Reduction: No routine tests will be processed between October 5 and October 9. There will likely be some disruption to the service while the new processes are fully embedded. We will continue to communicate with primary care colleagues throughout the transition. We will continue to phone through any abnormal or critical test results directly to the practice as per standard operating procedure.
  • tQuest: There will be planned tQuest downtime between 19:30 on 4 October until 08:00 on 5 October. If you need to request tests during this period, please do so using the downtime forms which can be found on the Synnovis website here.
  • GSTT Haematology: There will be a disruption to the service overnight on October 4th which we anticipate will be approximately 5 hours, resulting in a delay in issuing results of up to 1 hour. The disruption will end when the new analysers go-live, this will be at the same time that Epic is made live. The laboratory team will prioritise all urgent samples during the period of disruption.
  • Logistics: Synnovis courier routes and collection times will remain unchanged throughout the activity reduction window to ensure the timely collection of urgent samples.
Who do I contact if I need further support?

For issues and queries relating to tQuest, please contact tquest@synnovis.co.uk

For issues and queries relating to EMIS, please contact the EMIS helpdesk or ICB helpdesk

For any other queries, please contact customerservices@synnovis.co.uk 

The activity summary provides an overview of the impact of these changes

As part of the Epic roll-out, MyChart will be launching. MyChart is a new online service for patients that makes accessing health records easier. People can use the MyChart app on their mobile, tablet or computer.  It is a positive step forward for patients and will give them access to investigation results and letters, facilitate direct communication between patients and their hospital teams, and ultimately empower our patients to get more involved in decisions about their health.​

Take a look at this guide that has been developed for primary care – it outlines the benefits for practitioners and patients. A patient letter has also been created to help support practices should you have any questions raised.

​MyChart allows people to securely and easily access their health record, giving them more control over their care. They can:​

  • Find test results and letters in one, easy place. ​
  • Get more time in appointments by telling us what we need to know beforehand. ​
  • Save time travelling by having a video appointment. ​
  • Keep their medical information up to date.  ​
  • Share their health record with the people who matter. ​
  • Support their friends and family by helping to manage their healthcare. 

​What is changing?

In the long term Trusts will send letters to GPs via MESH instead of NHSMail. There will be a phased approach to this change. In the interim period, from 5 October, GP practices already using DocMan 7 or DocMan 10 will receive letters from the Trust into their DocMan, and practices using MESH will receive letters via MESH.

Why is this happening?

At present, both Trusts send letters to GPs via NHSMail, which doesn’t enable GPs or either Trust to effectively track transmission and receipt of letters once they have been issued. From 1 July 2023, the tracking functionality of NHS Mail was further deprecated nationally, and Trusts and GP practices have been encouraged to move to MESH transmission. The launch of Epic gives us a superb opportunity to do this in a better and more streamlined way.

What does this mean for me?

We plan to send letters to GPs via DocMan Connect as an interim step, before we move to full end-to-end MESH transmission. This decision has been made as we have listened to feedback and concerns raised of an immediate full move to MESH.

Therefore in the short term there may be a move across to DocMan for GP practices. If you already use MESH the switch will be straight from NHSMail to MESH without the interim step.