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Transforming General Practice
Online access for patients= efficiency for GPs
Harry [email protected]
@harrylongman
Demand by time of day, painful.
Rydal GP, charts by PA Navigator
Rem
ote
Asynchronous
Which mode?Synchronous
Loca
l
££££
£££
££
RemoteAsynchronous
RemoteSynchronous
LocalAsynchronous
LocalSynchronous
Triage to appropriate mode
Mrs Brindle is at home, with a sore knee, describing the problem to seek help from her GP
Dr Hannan receives the history instantly, decides to call.
Chief Complaint [Female Patient] is a 52 year old female. The "sore knee" screening questionnaire was administered. The following are her responses. History of Present Illness #1. "sore knee" Duration She reported: Knee stiffness 1 week to 3 weeks. Knee problem 1 to 3 weeks. Timing She reported: Knee stiffness started with a specific activity, started suddenly or quickly, and at no specific time of day. Knee problem began with a specific activity and at no specific time of day. Severity She reported: Knee stiffness slowly improving. Knee pain severe (7- 8/10) yesterday and moderate (5- 6/10) today. Knee problem slowly improving.
Mrs Brindle takes the call from Dr Hannan: reassurance and a prescription to pick up. Takes 2
minutes
Exploring symptoms to give a structured reportExample, “chest infection”
The patient reviews the history & sends.GP can now make fully informed decision.
ConsultTriage
Document
80,000 questions…
Traditional model, see all patients
36 x 10 min = 360
min
36 calls
Total 360 min
Telephone all patients
15 x 10 150 min
Total 330 min, saving
30 min
36 x 5 min180 min36
calls
All patients access online
11 x 10 min36 x 1
min
7pts
7pts11 x 5 min
36 submissions
Total 210 min, saving
150 min
Demand turns out to be stable, predictable and manageable, GP telephone led
Rydal Group practice
Average wait time to see a GP falls off a cliff
Bourne Galletly MP, charts by PA Navigator
The limit of performance in a telephone led system?
Rydal GP, charts by PA Navigator
14 minute median response time is
stable. Little benefit in improvement
Demand shifting from phone to online over 30% in two months. 2/3 medical, 1/3 other
Phone message changed
Website live
New phone message by GP
Replacement, not additional demand.Face to faces have dropped 15%
Website live
New phone message by GP
All ages are using it, 0 to 94 years old.60/40 female/male split is usual GP demand
Most users are patients, but parents and carers are important too.
An idea of clinical conditions: very varied,long tail distribution. 83% are symptoms.
20% by type are 50% by volume. Top 10:
• Skin condition• Chest/throat infection• Cough• Ear/nose/throat• Back pain• Digestion• Abdominal pain• Rash• Anxiety• Headache
Patients are happy to spend their own time giving their history, most between 2 and 12 minutes.
Some feedback left online…
This seems like a good way not
having to explain your private
symptoms to the receptionist.
I like this; I don't have a lot
of time to wait on the phone so would
prefer to deal online. I can see myself using this all the time now.
Used because of
difficulty
contacting
practice while I
am at work. It is
not always
convenient to
discuss personal
issues.
been excellent so far!
I used this system because of the
delay in a telephone call to
the surgery taking a long time to
answer.
I felt as if it asked a lot
of questions, some
didn't appear to me as
a lay person to be
relevant
While 79% present one problem, 21% with more than one is significant.
Most users want help from any GP, just 22% ask for a named GP
Ease of use
All demand
Rapidservice
Keys to
success
"Listen to your patient, he is telling you the diagnosis"
WilliamOsler
on a screen
Measurement,Analysis,
Demand & Capacity
GPSoC Clinical Systems
Integration
Leadership,Teamwork& Training
NHS Digital Agenda
PPG & Patient
Communications
EnablingTechnology
Continuous Improvement
Independent Research
Cambridge/ RAND Europe
GP-patient relationship
