Channel Shift in General Practice Dr Arvind Madan CEO Hurley Group demo.webgp.com 100,000 Patients 250,000 18 Practices Minor illness and injuries 10 boroughs 8 London locations Hurley Group Community Services Sick doctors service Substance Misuse School Services “Telehealth” Online GP appointments Online specialist advice General Practice – Case for Change • • • • • • • • • 1 million appointments a day Increasing complexity Reducing finances Archaic delivery model Demoralised workforce Weak technological and estate infrastructure Substantial regulatory burden Outdated commissioning models Limited links with social care => Industrial revolution required Start with a frontline problem! Turn new work from inefficient, medicolegally risky patient e-mails into an online service that improves patient access, health outcomes and practice efficiency. The Resource • 18 months • Funding from CCG, NHS London, Hurley Group • 5 GPs in core group and reference group of 30 GPs • Software programmers • User Experience expert • Project support team • Design Council • 133,000 patients in 20 practices (5 non-Hurley) • 6 months Breaking the Triangle? How do you improve access and quality whilst reducing cost? Offer patients who plan to attend to: • transact online (appointment book) • stratify themselves (symptom check) • manage themselves (self-help) • use other services (sign post) • take phone advice (nurse callback) • e-consult (structured history analysis) Access The Iron Triangle Quality Cost (All with medicolegal approval) A link from any GP’s practice website Nurse call backs and self help information highlighted Practice specific pictures to boost patient confidence Commonest conditions visible on home page Potential for over 100 more condition templates to be built e.g. blood tests and screening tools Explanatory video of how e-consults work Options for patients who don’t know their condition Use search box, from common conditions, A-Z or by body part Options for what to do if your condition isn’t listed On selecting condition, patient chooses between self-help, sign posting, nurse advice now or econsulting their own GP with a response before the end of the next day After completing some personal details which the practice uses to confirm the patient is registered with them, the patient completes a comprehensive set of questions about their condition and what help they are looking for Red-Flag questions stop the process and redirect the patient to urgent care if they identify a dangerous symptom e.g. severe shortness of breath Patients can email themselves a copy of their answers or a leaflet on their condition before submitting to the practice Patient advised on what will happen next and what to do if they get worse while waiting Patient submits completed questionnaire from website which arrives in practice generic email box as a GP summary report. Staff then workflow or print report for GP to review. GP report or e-consult takes an average of 2.9 minutes for GPs to analyse GP Options on Reviewing the Report You can offer this pa ent a prescrip on and ask recep on to inform the pa ent You may signpost to an alternate service via recep on (e.g. pharmacy) You may wish to telephone the pa ent to close the consulta on You may ask recep on to book an appointment with GP or nurse Prac ce decides to Proceed with WebGP: Pa • • • • • • • ent Marke ng WebGP Link to website Word of Mouth/PPG Leaflets/appt. cards Prescrip on slips Posters/Jayex Board Surgery phone message Email/Texts Pa ents Encouraged to “click first” Pa ents use Symptom Checker or Condi on Finder Wri en and Video Self-Help Content 100% managed remotely Sign Post to Alternate Services e.g. pharmacy 100% managed remotely 111 Nurse Call back within 1 hour (24/7) 80% managed remotely Pa ent e-consults from prac ce website. 60% of GPs review and cases prac ce rings pa ent managed within 1 working day remotely Posi ve feedback to keep using Results of Pilot 60% E-Consults 1000 closed remotely E-consults 210 calls a month for advice from Nurse 1,000 uses of symptom checkers 7,000 users of self-help and sign posting information Over 27,100 visits to website averaging 1,000 per week (21,000 unique patients) 80% Nurse calls closed remotely Ensures right service first time 18% of users planned to book an appointment and then didn’t Popular with Patients (83% FFT “extremely likely”) Cystitis (female) Depression Contraception Knee pain Earache Asthma Sore throat Rectal bleeding Shoulder pain Coughs TOP 10 CONDITIONS What about supply-led demand - We asked patients: What would you have done if the service hadn’t existed? Request of face to face appointment 79% Request a telephone appointment 4% Gone to walk in centre 14% Nothing, wait and see 3% What about reducing Practice Workload? Time saved from symptom checking Time saved from selfcare Time saved from sign posting Time saved from Nurse call backs NET Time saved from EConsults Significant reductions in GP face-to-face appointment hours in 6 months (@£220K pa) • 50% to practice and • 50% to Commissioners 95% 91% “Excellent” or “good” on-site experience Patients “extremely satisﬁed” with consulting online 78% 83% Patients said service saved them time Patients extremely likely to recommend service PATIENT SURVEY DATA Equality Impact Analysis Age 4% Age 18-24 62% Age 25-44 32% Age 45-64 2% Over 65 Sex 57% women 43% men Race 25% Black and Ethnic Minorities 28% English Not First Language Status 7% Students 75% Employed 11% Unemployed 4% Retired le r t o a be nr rfe oa ld dm y p ed r a c br ica c un sw l c e. ick ba ent web ca m rk re g do ssid ed an .we p.co ck ym ica ne bg m l la nd ed cen .we p.co ha sm ical tre bgp m ro ed cen .w .c e o ld ic w alc tre bgp m o o e .w . c dg ntr eb om p e gp h u w a l .w e . c o rle kin bg m isl an isla ycl .we p.co d n in b lib me dh ic.w gp m er d i ea e . c o ty ca lth bg m ne brid lcen .we p.c ne w ge tr bg om w cro ro e.w p. cr ss ad e co os g g b sh pw p.w gp m p riv ec ealt alk eb .com er kh hc in. gp sid am en we .c o st em gpw tre. bgp m er ed a w . c st nh ic lk eb om r e a al i n g at llla ce .w p.c ha n nt e b o m es re gp m pl ur .w .c ac g e e e s r y bg o m p u . w hi tr sts rge web .co te ed te ry g m c h e p .w p . a p g a h e eb c o el rpr ns gp m h e a .w . a l c c eb c o m th e g ce .w p.c n t eb o re g m .w p . c eb o m gp .co m al We are confident Urgent Care pa ents will opt to use it Harold Wood In our pilot, user numbers were highest from our sites with Urgent Care services – even where registered pa ent numbers were low. New Cross Peckham 1800 1600 1400 1200 1000 800 600 400 200 0 Templates by hour of day 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 How do Practices Feel about the System? GPs very or fairly confident with managing e-consults online GPs believe e-consults offer them sufficient information Confident it has benefited their practice within the pilot Of GPs would like their own practice to offer the service Confident it has benefited their patients within the pilot Average time to process an e-consult is 2.9 minutes Average time to phone the 20% of patients that need calling is 5.5 minutes Link to our online offer skinned to match their own prac ce’s iden ty - Pa ent selects condi on Pa ent visits their own prac ce website Pa ent always called back to verify iden ty and close communica on loop 9% use Nurse or Pharmacy call back 20% called back by GP to close case 80% called back by admin team to collect prescrip on (44%) or book appointment (36%) 34% use self-help and sign-post content 7% self-manage 6% submit E-Consult to own GP from the website Online GP Services Anyprac ce.co.uk Wellness Checkers with link to pa ent record and technology Transac onal e.g. booking GP appointments Symptom Checker and Condi on Finder Urgent Care Direc on if needed Self-help Wri en Material Sign-Post Sign-post to Pharmacy 24/7 Telephone (linked via 111) E-Consulta on with GP Nurse Remote care of 60% of Minor Condi ons Videos Open Access, Selfreferral Services Pharmacy Long-term Condi ons Apps and Tools Social Prescrip on Services e.g. benefits advice Dental Face-to-face appointment required in 40% Conclusion  Better Access • Better patient experience • Reaches the working population • Enhanced patient’s earning potential  Better Health Outcomes • Earlier presentation and intervention • Permits embarrassing presentations  Better Practice Efficiency • Keeps minor issues out of surgery • Siphons off self-help and sign-posting • Time-efficient e-consults replace email • Robust Clinical Governance • Medicolegally safe and approved • ROI for purchaser