Channel Shift in General Practice
Dr Arvind Madan
CEO Hurley Group
demo.webgp.com
100,000 Patients
250,000
18 Practices
Minor illness and injuries
10 boroughs
8 London locations
Hurley
Group
Community Services
Sick doctors service
Substance Misuse
School Services
“Telehealth”
Online GP appointments
Online specialist advice
General Practice – Case for Change
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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Outdated commissioning models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
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.
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
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)
Access
The Iron
Triangle
Quality
Cost
(All with medicolegal approval)
A link from
any GP’s
practice website
Nurse call backs
and self help
information
highlighted
Practice specific
pictures to boost
patient confidence
Commonest
conditions visible
on home page
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 econsulting 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
You can offer
this pa ent a
prescrip on
and ask
recep on to
inform the
pa ent
You may
signpost to an
alternate
service
via recep on
(e.g. pharmacy)
You may wish
to telephone
the pa ent to
close the
consulta on
You may ask
recep on to
book an
appointment
with GP or
nurse
Prac ce decides to Proceed with WebGP:
Pa
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ent Marke ng
WebGP Link to website
Word of Mouth/PPG
Leaflets/appt. cards
Prescrip on slips
Posters/Jayex Board
Surgery phone message
Email/Texts
Pa ents
Encouraged to
“click first”
Pa ents use
Symptom
Checker or
Condi on Finder
Wri en and
Video Self-Help
Content
100%
managed
remotely
Sign Post to
Alternate Services
e.g. pharmacy
100%
managed
remotely
111 Nurse
Call back within
1 hour (24/7)
80%
managed
remotely
Pa ent e-consults
from prac ce website. 60% of
GPs review and
cases
prac ce rings pa ent managed
within 1 working day remotely
Posi ve feedback to keep using
Results of Pilot
60% E-Consults
1000
closed remotely
E-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)
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”)
Cystitis (female)
Depression
Contraception
Knee pain
Earache
Asthma
Sore throat
Rectal bleeding
Shoulder pain
Coughs
TOP 10 CONDITIONS
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 selfcare
Time
saved
from sign
posting
Time
saved
from
Nurse call
backs
NET Time
saved
from EConsults
Significant reductions in GP
face-to-face appointment hours
in 6 months (@£220K pa)
• 50% to practice and
• 50% to Commissioners
95%
91%
“Excellent” or “good”
on-site experience
Patients “extremely satisfied”
with consulting online
78%
83%
Patients said
service saved them time
Patients extremely
likely to recommend service
PATIENT SURVEY DATA
Equality Impact Analysis
Age
4%
Age 18-24
62%
Age 25-44
32%
Age 45-64
2%
Over 65
Sex
57% women
43% men
Race
25% Black and Ethnic
Minorities
28% English Not First
Language
Status
7%
Students
75%
Employed
11%
Unemployed
4%
Retired
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We are confident Urgent Care pa ents will opt to use it
Harold Wood
In our pilot, user
numbers were highest
from our sites with
Urgent Care services –
even where registered
pa ent numbers were
low.
New Cross
Peckham
1800
1600
1400
1200
1000
800
600
400
200
0
Templates by hour of day
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How do Practices Feel about the System?
GPs very or fairly confident with managing e-consults online
GPs believe e-consults offer them sufficient information
Confident it has benefited their practice within the pilot
Of GPs would like their own practice to offer the service
Confident it has benefited their patients within the pilot
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
Link to our online
offer skinned
to match their own
prac ce’s iden ty
- Pa ent selects
condi on
Pa ent visits their
own prac ce website
Pa ent always called back
to verify iden ty and
close communica on loop
9% use Nurse or
Pharmacy call back
20% called back by GP to close case
80% called back by admin team to collect
prescrip on (44%) or book appointment (36%)
34% use self-help
and sign-post content
7% self-manage
6% submit
E-Consult to own GP
from the website
Online GP
Services
Anyprac ce.co.uk
Wellness Checkers with link to
pa ent record and technology
Transac onal e.g. booking GP
appointments
Symptom Checker and Condi on
Finder
Urgent Care Direc on if needed
Self-help
Wri en Material
Sign-Post
Sign-post to
Pharmacy
24/7 Telephone
(linked via 111)
E-Consulta on
with GP
Nurse
Remote care of 60%
of Minor Condi ons
Videos
Open Access, Selfreferral Services
Pharmacy
Long-term
Condi ons
Apps and Tools
Social Prescrip on
Services e.g.
benefits advice
Dental
Face-to-face
appointment
required in 40%
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