Earlier this year the practice team at the Milton Surgery in Weston-Super-Mare decided to change the way they managed their patient caseload and adopted an online consultation system. In this in-depth article, practice manager Andy Lloyd explains what lay behind the decision to change, how patient care has improved and how he and his colleagues have now taken greater control of their working day
Like all local practices in Weston (and across the UK) we have struggled to provide the services our patients need. With appointments booked-up weeks in advance, patients unable to get through on the ‘phone and the reception team often bearing the brunt of their frustrations, morale at the beginning of 2019 was at an all-time low. An area-wide project aiming to support GP retention, and help improve services for patients, brought some welcome relief.
A significant aspect of the project was the implementation of an online consultation system called askmyGP. The system helps our clinicians change the way they provide patient consultations – and the implementation brought about a few challenges. An open-minded approach, coupled with an extremely positive response from our patients, has meant we were able to adapt to the new way of working within a few weeks. Here’s how the system works for us and the benefits it is bringing.
Working for patients
Today, our patients can choose how they contact the practice. To date, over 70% of patients contact us online using secure messaging This is the easiest method of communication for both patient and clinician; it means the patient can collect their thoughts and make a request in their own words at a time that suits them.
For those who are unable or prefer not to use an online service, the options to telephone or attend in person remain open. With so many patients choosing to use the online service, we have freed up call capacity so it is now easier to get through on the ‘phone. Regardless of the contact method, patients are asked three simple questions:
- What are their symptoms and any idea of the cause?
- What are their concerns?
- How they would like us to help?
How clinicians use the system to deliver patient care
A clinician reviews the patient’s description; other questions – for example admin queries – are routed to the appropriate person. Using the patient’s description of the problem, in conjunction with their medical history, the clinician then decides how best to help.
This means we can make best use of the range of skills across the practice team and use our resources to their full advantage. By sharing the effort among the team, and using secure messaging and ‘phone calls more often, we have found that we can deal with patient requests more quickly. This means a same day service – which is great for patients. At Milton our response and completion times are now measured in minutes, not days. Over a third of all requests are resolved within an hour.
Care for specific patient groups
We support a number of care home residents and, in the past, requests from the care home came by fax to the surgery. The new system allows care home staff to log requests online on behalf of their residents, making life for everyone a bit easier – not to mention hastening the demise of the practice fax machine! The care home staff receive notifications and advice more quickly, and the clinical team receive requests alongside all other patient requests, meaning we can triage and prioritise more effectively.
Likewise, those who care for young children, or elderly relatives at home, can make requests on their behalf, safe in the knowledge that their loved ones will get a service from us that is quick, safe and effective.
Capacity-planning to match demand
Before we started we had been worried that, by making it easier for patients to make contact with us, we’d be deluged with requests – but this hasn’t been the case. Demand from patients has proved to be predictable and stable, meaning that we know what to expect on any given day of the week. For instance, we know that we will, routinely, get 115 patient requests on a Friday, but 160 or so on a Monday, so planning to have the right staff capacity when it’s needed is now much easier.
It also means it’s easier to plan for the right amount of locum input to cover holidays – and to assign the right caseload to those locums – rather than ending up with more capacity than we need. This, and the ability to respond promptly, has reduced DNA rates. The result? Less clinical time wasted, partly because the same-day service means patients are less likely to miss their appointments.
Making extended hours more productive
Our improved response times mean that we are able to use our extended hours’ activity more productively rather than simply to cover the overspill from busy days earlier in the week. We are now finding that we can schedule appointments for people with less urgent needs around their working lives, or to fit clinics for chronic conditions around patients’ other commitments. Not only is this better for the patients, it’s a more effective use of our extended hours’ service.
We are now six months into using the new system and it has revolutionised the way we work. As well as improving patient care, all of us feel we have more control over our working lives.
I shall give the last word to our patients, whose feedback speaks for itself. “I love this service, as I suffer with anxiety. It’s great because sometimes I can’t talk on the ‘phone due to my anxiety so this is really useful to me,” said one. “The new system brings doctors’ surgeries into the 21st century. A great solution to free-up the waiting room,” added another.