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NHS England - Transformation Directorate

Maximising the benefits of mobile working when covering a large geographical area

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) introduced a user-friendly, easily-accessible mobile working solution. The Trust covers a geographical area of 4,800 square miles with a local population of more than 1.7 million. The Trust employs more than 7,000 staff and operates out of more than 70 bases. As well as clinical team bases, staff from community-based services work in patient homes, GP surgeries, public buildings and spaces, and other NHS and social care settings.

CNTW patients are often high risk and vulnerable, with teams such as crisis, psychiatric liaison and street triage dependent on good quality, up-to-date information when attending an appointment where presentation and situations may be hazardous. Staff are frequently required to travel to multiple appointments and contacts each day, often with no ability to return to base to seek information prior to meeting patients.


Following the introduction of the Trust’s electronic patient record (EPR), in order to leverage the full benefits of this investment, the Trust required a secure remote access solution for clinicians.

The Trust serves a large geographical area with a large part of day-to-day business conducted in the community. Clinicians needed a reliable mobile solution which replicated the access available at work bases and which could be many miles from the point of care. While previous solutions had been tried, there were multiple challenges to be overcome, such as issues with 2-factor authentication, use of tokens, VPNs and frequency of reconnecting.


The aspiration was to maximise the benefits of mobile working by implementing a solution that overcame previous challenges, making processes more efficient for the benefit of patients and staff.

Solution and impact

This solution provides a reliable, authenticated, secure and bi-directional connection to the Trust's EPR. DirectAccess, available as part of Windows 10, is an ‘always on’ solution which allows connection regardless of location.

Linkage to the EPR also allowed access to GP data remotely and the ability to instigate changes to medications and treatment regimes in real time.


Access to Microsoft Teams enabled staff to attend meetings more easily. This has negated the need to travel, producing cost and efficiency improvements for the Trust.

Device security improvements were gained through encryption technology (Microsoft Bitlocker). Limitations of original solutions such as tokens and VPN were overcome.

The technology really proved valuable during the COVID-19 pandemic. Due to the cost-effective and scalable nature of the system, the Trust was able to support more than 3,000 members of staff to work from home literally overnight, which provided continuity of care for patients.


  • Real-time access to the EPR, enabling clinicians to make instant, informed decisions
  • Clinician time saving - no need to return to base
  • Enabler for innovation and service improvement
  • Increase in time available to see patients due to decreased travel time


  • Technical requirements for this solution included hardware that supports Windows 10 and Windows 10-compatible applications
  • Offsite connectivity was provided via WiFi or mobile networks, necessitating provision of cellular SIM cards


  • Real-time access to the EPR
  • Ability to conduct team meetings remotely
  • Cost effective - able to scale to provide secure remote access to every Trust laptop user


For use in community-based clinical care.

Key learning points

Use of an external specialist to review the Trust’s current set-up ensured that best practice was followed.

It was vital to identify support contracts for applications being used in the Trust. Updates were required for systems running over DirectAccess and for compatibility with Windows 10.

It was important to keep training simple. Extensive training had taken place for earlier solutions. As this solution was more accessible, less training was required.

Find out more

Case study: Maximising the benefits of mobile working (requires login)

Key contact

Dr Jonathan Richardson, Chief Clinical Information Officer, Consultant Old Age Psychiatrist, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Mike Jones, Associate Chief Clinical Information Officer, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust