Local operations manager Hamida Khan is using technology to help the Stratford Village Surgery in London manage increasing demand for appointments. Part of the First 4 health Group, a federated group of GP practices in Newham, it has adopted ‘online triage’.
Simplifying and streamlining the booking process has helped the practice improve efficiency, reduce demand and halve DNAs. In this detailed case study she describes the process the practice followed
We have almost 11,000 patients registered at Stratford Village Surgery, and, like other practices across the CCG (and the country), we are facing a heavier workload and increasing complexity and intensity of work.
With people queuing at the front door, and the ‘phone lines constantly jammed from 8:30 am, there was a lot of pressure on administration staff – the first port of call for both appointments and complaints. Unfortunately, once the appointments for the day had been filled, they had no choice but to turn patients away, or offer them one several weeks in advance.
The introduction of the online triage service, developed by Egton, part of EMIS Group, has enabled the surgery to manage patient demand much more efficiently and ensure that appointments are always available.
Commissioned by Newham CCG, online triage works as an effective filter system that enables GPs to allocate appointments according to information provided by the patient via a form on the practice website.
Patients are asked to fill in the form online, specifying their medical needs, and appointments are only offered to those who need to see a doctor face-to-face or over the ‘phone; others are dealt with by issuing a prescription, blood test form or by signposting to other services.
The online consultation can be completed at any time, 24 hours a day, seven days a week. There are 75 electronic forms covering 91 topics – the system ensures patients are asked relevant questions based on their symptoms and it takes just a few minutes to complete.
Some patients are automatically provided with information and self-help advice, while the remaining forms are examined by administration staff. They highlight any high risk patients and filter out reception queries, or those who require repeat prescriptions, before a GP goes through the final list and chooses how to respond to each patient
The huge benefit is that the surgery no longer turns away patients who genuinely need an appointment, and staff manage their time more efficiently, with less paperwork. It also takes pressure off administration staff who had the unpleasant task of turning patients away.
Of the 2,500 patients who have used the service since August 2018, just 25% needed appointments with GPs. Most requests for appointments could be dealt with in writing or by speaking to the patient on the ‘phone. There has been a 50% reduction in DNA appointment rates, and GPs only see patients who genuinely need their help.
Telephone calls have been reduced by 20% and – as patients can access online support 24 hours a day – they no longer need to navigate the Monday morning ‘phone congestion! There are also early indications this system is helping to reduce urgent GP appointment and A&E attendances, as patients can find answers to their queries online.
The practice did experience a few issues in the beginning, but all was running smoothly after about four weeks.
It was a complete culture change for staff, who were no longer offering appointments but directing people to a website. This needed careful management because, at first, patients did not like the idea that they could not pre-book an appointment. We ensured everyone was trained to deliver a specific ‘script’ which concentrated on the new, improved access to GP service.
There was also concern among the staff and patients about security of information, but we were able to reassure them that it sits within the same, highly secure system where their patients’ notes are kept.
We introduced the system slowly. Staff told patients about the change when they rang to make an appointment. The EMIS clinical system enabled them to text patients the website address during the telephone conversation. Those who had come into the surgery could scan a QR code with their smart ‘phone or simply take home a pre-printed slip with the address on.
Now the system has been in place for six months we are beginning to send text messages to other patients informing them of the change. The triage system filters out patients who habitually make appointments when there is no clinical need and it has halved the number of DNAs.
Now there is no need for patients to book ‘safety’ appointments, and if anyone did, it would be clear on the system that an appointment was already booked. As for the DNAs, we believe the rate has gone down because many patients are now getting the answers they need before they think of ringing up, so only those in real need are booking appointments.
As we encourage more patients to use online triage, and get them used to the system, we believe these figures will improve even further. However, online triage doesn’t completely bypass traditional appointment booking.
If someone is vulnerable, or has mental health issues, we are not going to send them away to fill in an online form, so the staff are still required to recognise how much support each patient needs. Likewise, if someone doesn’t have access to a computer, our reception staff will fill in the form for them.
Even so, the new system has helped the practice to manage patients better – and life at the front desk is much calmer. I used to take calls from staff worried about how many people were waiting and how much there was to do; now I simply don’t get them. It’s reassuring to know we have a robust process in place to meet patients’ needs.