Improving access for patients

Tower Family Healthcare

Tower Family Healthcare, an NHS GP practice with four sites in Bury, have seen “transformational” changes to the way they operate appointments and services since they rolled out online consultation and workflow system askmyGP in March.

“Before we introduced our online consultations we were experiencing the same issues as most GP practices across the country with capacity and workflow, with patients experiencing telephone queues and delays for routine appointments” said Dr Simon de Vial, GP and Chief Executive of Tower Family Healthcare.

The team at Tower Family Healthcare set about researching online consultation platforms and how it would impact workflow before selecting askmyGP. A launch date of April was then set to go live with the new digital-first solution, however the impact of COVID-19 and the urgent need for remote appointments accelerated their implementation plans from five weeks down to just 10 days. Now more than 1,500 patients have used the system and the feedback has been overwhelmingly positive.

Dr de Vial added: “This has been the most transformational change to the way we work that I’ve seen in 28 years as a GP. Patients are able to send a request online or by phone and receive the right care much quicker than they would have done previously. It saves patients time and hassle of waiting in telephone queues and it enables us to treat patients quicker as they have already briefed us on their symptoms online, meaning we can provide more time for patients with complex conditions. It is also having benefits for patients who are not online as our telephone lines have been opened up, allowing them to get through to the surgery quicker and easier than before.”

Using a digital-first approach has also supported the GP practices to plan for the capacity better.

Paul Massey, Executive Partner of Business Development and Finance at Tower Family Healthcare, said: “We have exceptional clinicians and staff, so we always felt that we could offer a better service to our patients. The new system has allowed us to do that using data and the ability to predict the demands on our services and adjust our capacity to support that. We now know the days and times when we are likely to be busy, when the number of requests will peak and when it will begin to reduce, and we can accommodate for that. It has also been vital to ensure that we worked with our GPs and staff to ensure they were supportive of the new workflow and I’m pleased to say some of those who were more cautious about the change have become the biggest advocates after seeing the benefits first-hand in their own work.”

Supporting the homeless population during digital innovation

Dr Chris Nortcliff, Salford

Dr Chris Nortcliff says “horizons have been broadened” as primary care rapidly adapts to digital technology during the COVID-19 pandemic.

Dr Nortcliff, GP and Head of Practices at Salford Primary Care Together CIC, believes that there is a desire to implement more digital solutions and access for patients but there had not been an urgent need until the pandemic began.

“Before COVID-19 there was a bottleneck in terms of people seeking access to our services, with telephone queues and delays accessing care,” he said. “There was lots of careful planning for digital innovation taking place but 99% of our patient access was still through telephone. Primary care was heading in a digital direction, but now we have had a reason to speed up those plans.”

Rapid acceleration has seen the SPCT practices in Salford begin to use video consultations and online consultations, which allow patients to complete a short form online when requesting support.

“The video consultations have been revolutionary and have given a new option for us to see our patients.”

He added that it has been particularly useful in their homeless practice, a specialist commission by NHS Salford CCG to improve care and services for homeless people. The practice has provided mobile phones to shelters in Salford, with the tech set up to allow people register and have a consultation with a GP over the phone or video.

“COVID-19 has highlighted in particular how digital can exacerbate access problems for some people without access to technology or data, not enhance it,” he said. “Introducing the mobile phone to shelters means we can remove barriers to people accessing care, including making the registration process digital and flexible without the need for documentation or travel to the practice. It is only small numbers of people, but it has shown in a real way how easy it is to get people the support they need in a new way.”

Dr Nortcliff added that there had been some challenges during the pandemic, including securing the digital resources and technology at a time when demand has been unprecedented and ensuring everyone is confident and willing to embrace change.

“Speak to most GPs and they’ll say that in the last five to ten years there has been an increasing burden placed on services, with GPs seen as the main route to access a professional. People were worried that opening digital channels would open the floodgates but, in my opinion, it will actually make things more manageable,” he said.

“Online consultations allow us to signpost to more appropriate resources and manage our workload in a new way, allowing people the chance to access the right care at the right time and in the right place. Embracing digital care has also been a great opportunity for us to work with other GP practices in a way we haven’t done before, getting advice and support from those who are further down the line with digital solutions and may have implemented them before COVID-19.

“We’re still learning and finding our feet but we’re really excited about how it is going to continue to change how we work. It’s a new way of doing things but our horizons have been broadened by seeing how much we’ve accomplished and changed in such a short period of time when we have needed to adapt.”

Encouraging patient empowerment through digital

Dr Paul Jackson, Trafford

Dr Paul Jackson, a GP partner at Boundary House Medical Centre in Sale, Trafford, had already begun to use digital services and felt well prepared to adapt to the challenges of COVID-19.

The practice had been using online consultation and workflow system askmyGP for 6 months before the pandemic allowing patients to contact them digitally or over the phone.

Dr Jackson said: “We were consistently seeing 75% of people contact us online and 25% over the phone. Both were able to get fast same-day access to a clinician of choice with no more long waits for GPs. Feedback was overwhelmingly positive.”

He added that since the pandemic, contact using the digital route has increased and less people have requested face-to-face appointments, decreasing from 36% to less than 2%. The practice has also supported home working through new kit and virtual team meetings taking place.

“Our clinicians have become more comfortable managing patients remotely and we continued to offer fast same day access. It has energised the workforce, made us more resilient and fit for the future. There are no long waits for primary care contact and most patients get to the right person first time. Clinicians can offer appropriate amounts of time to those that need it.

“We’ve also been able to monitor potential COVID-19 patients by loaning out SATs monitors and daily contact by call, text or video to monitor vital signs. This has proved remarkably successful and we’ve been able to pick up deterioration rapidly.”

Patients have also embraced the new technologies and have been more willing to self-monitor conditions at home, such as blood pressure, and discuss with the practice.

He added that the biggest challenge has been managing the change to digital. “Unpicking years of working patterns and challenging the way we operate has been very hard at times,” he said. “Clinician confidence in working in new ways needed to be managed carefully.”

Next steps in the development of the digital roll-out include continuing to improve the skills of clinicians in the new tools and ways of working, as well as working closer with care homes to enable remote monitoring of the vulnerable.

Dr Jackson said: “We are also looking at data analysis to match capacity to demand always so we continuously offer a speedy responsive service with continued high levels of continuity with the clinician of choice.”