Channel Shift in General Practice Dr Arvind Madan CEO Hurley Group demo.webgp.com.

Channel Shift in General Practice

Dr Arvind MadanCEO Hurley Group

demo.webgp.com

100,000 Patients18 Practices 10 boroughs

250,000Minor illness and injuries

8 London locations

Community ServicesSick doctors serviceSubstance Misuse

School Services

“Telehealth”Online GP appointmentsOnline specialist advice

Hurley Group

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delivery model• Demoralised workforce• Weak technological and estate infrastructure• Substantial regulatory burden• Outdated commissioning models • Limited links with social care =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

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

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.

Access

Quality

The Iron

Triangle

Cost

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)

(All with medicolegal approval)

A link from any GP’s

practice website

Practice specific pictures to boost

patient confidence

Commonest conditions visible

on home page

Nurse call backs and self help information highlighted

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 e-consulting 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

1000E-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)

60% E-Consults closed remotely

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”)

Results of Pilot

TOP 10 CONDITIONS

Cystitis (female)Depression

ContraceptionKnee painEarache

AsthmaSore throat

Rectal bleedingShoulder pain

Coughs

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 self-care

Time saved

from sign posting

Time saved from Nurse

call backs

NET Time saved

from E-Consults

Significant reductions in GP face-to-face appointment hours

in 6 months (@£220K pa)• 50% to practice and • 50% to Commissioners

Equality Impact Analysis

25% Black and Ethnic Minorities

4% Retired

28% English Not First Language

75% Employed

62%Age 25-44

57% women

4% Age 18-24

11% Unemployed

7% Students

43% men

Age

Sex

Race

Status

2%Over 65

32%Age 45-64

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Templates by hour of day

GPs very or fairly confident with managing e-consults online

Confident it has benefited their patients within the pilot

Confident it has benefited their practice within the pilot

Of GPs would like their own practice to offer the service

GPs believe e-consults offer them sufficient information

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

How do Practices Feel about the System?

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