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Anne Hooper - Event Facilitator, CCG Lay Member for Patient Engagement
Purpose of event:
What: One Health Lewisham Patient Participation Group Event
Who: Group made up of local PPG representatives
Why: Input in to local general practice At scale developments
Focus: This meeting will focus on Access - helping people to command appropriate health care resources in order to preserve or improve their health.
Welcome
12.00pm Lunch and market place stalls
1.00pm Welcome and housekeeping
1.15pm Primary Care in Lewisham, Dr Rowland
1.35pm The GP Extended Access Service Improving Access to General Practice, Dr Egboh
2.00pm OHL Innovations and Sensely application (E-consultations), Dr Politi
2.30pm Comfort break
2.40pm Activity: Developing e-consultations in Lewisham
3.20pm Final remarks and close
Housekeeping: Registration, toilets, fire alarm, photo consent and questions
Format of event
Primary Care in Lewisham
Dr Marc Rowland
GP and Chair, NHS Lewisham CCG
Tuesday 27 March 2018
Constantly evolving and
adapting since 1948
• Technological advances
• Heart transplants
• Immunisations
• Better diagnosis
• More care outside of hospital
Health inequalities in
Lewisham • Life expectancy lower in some areas e.g. in Crofton men typically
live for 5 years longer than in New Cross and women for 5.3
years longer.
• Fewer black women are screened for breast cancer than others.
• HIV infection is often diagnosed later in black African
heterosexual men
• White men and women are more likely to be admitted to hospital
for alcohol related problems.
Patient access
• GP Extended Access - GP and nurse appointments 7 days a week 8am- 8pm
• GP Online services – booking appointments, repeat prescriptions and access to
medical records
• E-consultations – on-line video consultations and symptom checker
• Pharmacy first - providing advice, treatment and medicines for common ailments
at local pharmacies
• Evaluation & improvement - practices have undertaken a self-assessment of
current arrangements and developed action plans to improve access
• Self management programmes for Long Term Conditions
(LTCs) - supporting patients to better self-manage their conditions.
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Our focus for 2018/19 In 2018-19 we will be focusing on redesigning services to:
• Improve people’s access to information and advice and participation in activities and opportunities for health and
wellbeing
• Join up the care and support that is delivered at a neighbourhood
level and in people’s own homes
• Provide the urgent and proactive care people need in times of
crisis or when they need more care and support for a short period
of time
We will be looking closely for example on how we can make
improvements in these areas for frail and vulnerable people, those
with mental ill health and those with specific conditions such as
cancer and diabetes.
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You can help by:
• Looking after yourself - leading a healthy
lifestyle
• Managing any health conditions you have
• Choosing the right NHS services
• Using emergency services for emergencies
only
• Getting involved and helping shape future
services
Make a pledge
My pledge to help improve primary care in Lewisham is ….. What will you pledge?
Questions?
The GP Extended Access Service Improving access and the patient journey
Dr A Egboh
GPEA Clinical Lead
1. Illustrate the patient journey
2. Summarise what can be seen in the service
3. Share key information about access to the service
4. Share some recent achievements
5. Get input from you
Introduction
I a ’t ait that long for
an
appointment
……. I need to see
a doctor!
M ……. “o if I go to the GP
Extended Access
Service, I can
have a booked
appointment
after work today
at .30p …..?
Let’s see ho eas this pla e is to fi d…. They told me to:
1. Go to the Yellow Zone
2. Follow the corridor up
past the reception desk
a d M Coll’s shop
3. Turn right after the shop
and look for the signs
In the
Yellow
Zone
Past the
reception
desk and
M Coll’s shop
Here it is
Hello, el o e to the GP extended
Access Service. How
a I help ou?
Hello, I’ e got a appointment with Dr
Anthony Egboh at
7.30pm.
My GP practice
ooked it for e
Please take a
seat in the
waiting area
and wait to
be called in
Not too ad so far I suppose……
• Convenient appointment time
• Easy to find
• Comfy waiting area
A children's
area…… Children can
also have
appointments
here
There’s one of the nurses; Friendly,
professional
GP Extended Access Service Nurse Appointments:
• Wound care (Adults): Patient are required to bring
their dressings with them where possible
• Ear Irrigation (Adults only)
• Injections – Patient has to bring the Drug with them
• Flu Vaccines
• Whooping Cough Vaccine for Pregnant women
• Immunisations
In development: Sample taking – e.g. cervical smears
Hello, I’ Dr Egboh, nice to
eet ou
Only with your
consent can
your records be
accessed
Private and
secure
Access all your
records
A seamless service
The service has remote access to your
GP medical record and is able to save
consultations to this
Referrals: We complete all referral
documentation and forward to your
practice to make the referral.
Prescriptions: We prescribe in the
service using prescriptions that can
be taken to most pharmacies.
We are able to make test requests
(e.g. blood) as you would do in a
practice. All results go back to
registered practice for ongoing
management of care.
Tha k you.
Can I come
here next
ti e?
“Yes you can, but you would have to
book an
appointment
through your
registered GP
practice as we
cannot book
appointments
here.”
I’ll defi itel e coming here again.
It’s ope a -8pm
7 days a week
That was a really
pleasant
e perie e…. No where is my coffee?
Acts as an extension of general practice offering booked appointments to people registered with Lewisham GP practices
1749 GP appointments per month
744 Nurse appointments per month
Access to medical record enabling a comprehensive GP service
8am-8pm, 7 days a week offering a mix of same day and pre bookable appointments
Not a walk in service
Only booked via:
your GP practice
111/SELDOC
Redirected from UCC
Access to the GP Extended Access Service
New purpose built location central to the hospital site
Can see children
In March 2018 the service has seen at least one patient from each of Lewisham s 38 GP practices
98% of patients are seen within 30mins of appointment time
The service is supporting the wider healthcare system with the UCC and NHS 111 both booking patients in to the service daily
17% DNA rate, with a downward trend. SMS messages, calling patients, better signage and improved dialogue with GP practices
Service achievements since October 2017 PPG event
We ve expanded our GP and nurse workforce
Achieved recognition across London as an excellent service – Site visit from the Health London partnership (March 2018)
Access to interpretation service
Improved communication and processes – constantly under review
Achievements since October 2017 PPG event continued
Patie t’s experience of the service
• 87% Very satisfied or satisfied with the care they received
• 90% rate service as good or very good
Some of the feedback received:
O e of the best urses I have ever had the pleasure of eeti g. “he has taken care of me and been so attentive over the last 2 weeks. I am very
happy you have urses of this sta dard. Tha k you
XXXX has been a caring, attentive nurse that has been taking care of me. It
has been a pleasure to get to know her and she will not be forgotten.
Feedback received February 2018
• Late arrivals – unable to see patients that arrive more than 10mins late for their appointment
• DNA rate – We are constantly trying to reduce this so that appointments are not wasted. Currently sending SMS appointment reminders and calling all patients
• Dressings – limited storage and knowing what patients require prior their appointment is challenging
Private work
• Inappropriate referrals
– Patients being put to the nurse for GP issues
Referrals from UCC/Paeds/SELDOC/111
Relationship between own GP and patient
Some challenges
Thank you
Any questions
Pan-Lewisham Patient Participation Group
Dr Danae Politi
GP IT and Innovation Lead, One Health Lewisham
Summary
1. Aims of application (App)
2. Background and context
3. About the application
4. What s next
5. Your input in to further shape the application
Context: Improving Access to Health Care in Lewisham
We are promoting awareness of online access to general practice.
Another way to book appointments, order prescriptions, have access to
your records and reduce pressure on phone lines at peak times
Lewisham has gone from having one of the lowest rates of patients
online to one of the highest in south east London
“You can still call your surgery – online is just another option to make
things easier”
Now we want to further develop on this success!!
Aims
We want an application that:
Delivers patient satisfaction
Improves access to health care
Is clinically safe
Is NICE (National Institute for Health and Care Excellence) accredited
Is GP centric, helps manage growing demand on GP practices
Is technologically forward e.g. symptom triage, video consultation etc.
Has scope for further development e.g. chronic disease management
The Journey
18 months of market research
Options appraisals
OHL IT steering group
Bids / funding applications
The product: Ask NHS GP
Ask NHS GP Application
Developed by Sensely
Advanced, UK based company, has designed
the clinical decision support technology
NICE accredited
Red Flags included
Improves access to healthcare (especially out of
hours)
The product: Ask NHS GP
Symptom Checker: Determines the urgency of a patient’s case and
offers the appropriate pathway of care
Olivia: Offers dynamic advice to patients
Patients registered with a GP practice in Lewisham will be able to
download the Ask NHS GP Application for free
Android and Apple compatible; requires name and date of birth to
register
The Ask NHS GP application links the patient to their registered
GP practice
The product: Ask NHS GP
Symptom checker has voice and text recognition
Can be used at any time. During working hours, it will direct to your
GP practice based on symptom urgency
Out of hours, it will direct to out of hours services e.g. Seldoc
Olivia can safely advise patients about self care and links to the
NHS choices website for information
Ask NHS GP application offers access to routine appointments at
your GP practice
Allows you to book or cancel appointments
Contains information about local pharmacies
Uses live Google maps
Implementing Ask NHS GP
Piloting the triage application in Lewisham GP practices (May 2018)
Phased roll out across the borough (Autumn 2018)
Video consultation feature (Autumn 2018)
Engagement with patients and GP practices (Ongoing)
Future Developments
Chronic disease management
Manage capacity for GP practices
Family Wallet – parents, carers etc.
Ask NHS GP available from website, telephone line, Alexa etc.
Patients and groups working with Sensely to develop the
application further to improve patient experience and access
Currently mental health is not included as a symptom as the
pathway is being developed by Advanced
Please tell us your general thoughts and feedback
on the Ask NHS GP application?
Any questions?
46
Thank You
After the break, we ll be talking in groups about further improving access to general practice services using the Ask NHS GP application and the GP Extended Access Service
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Comfort Break
Workshop Questions
1. What support should we offer people to use the Ask NHS GP
application and what would stop you from using the
application?
2. Do you think the Ask NHS GP application will improve access
to general practice?
3. What can we do to make it easier for you to get GP Extended
Access Service appointments and what would prevent you
from going to the service to see a GP?
4. Can you suggest ways that we can further reduce the DNA
rate in the GP Extended Access Service?
Do you think the GP Extended Access Service improves access to general practice?
Yes
No
I m not sure
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Evaluation: Question 1 of 4
Do you know enough about the GP Extended Access Service to inform your friends, family or PPG members about the service?
Yes
No
I m not sure
50
Evaluation: Question 2 of 4
Do you think the Ask NHS GP App improves access to general practice?
Yes
No
I m not sure
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Evaluation: Question 3 of 4
Do you know enough about the Ask NHS GP App to inform your friends, family or PPG members about it?
Yes
No
I m not sure
52
Evaluation: Question 4 of 4
Notes will be sent to all attendees via Practice Managers
Questions will be answered and responses circulated
Please leave your details if you would like to be contacted directly about future OHL PPG events
Pledge cards
53
Close
Thank you for your input and for attending
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