Dr Arvind Madan CEO Hurley Group Politically sensitive Out of hours care Reforms WebGP Work reducing technology Nursing Homes Premises Increasing regulation Turnaround of Failing practices London focus 1M appts annually Size of 2 hospitals 400 staff Pharmacy Increased patient demand 18 General Practices 100,000 patients Practitioner Health Increased complexity 10 Urgent Care sites 350,000 patients a year School Health Refugee Care Substance Misuse services Reduced funding Higher performance targets Recruitment crises
Technology But not general has changed practice most industries Shopping Banking Leisure Travel Waiting for the doctor in 1907 Waiting for the doctor in 2014 The Case for Change in General Practice 1 M appointments a day Increasing complexity Recruitment crisis Poor estate and infrastructure Increased regulation and targets Financial squeeze Low adoption of technology?
Patient journey into general practice COME CALL Existing model of general practice Appointment booking CLICK? Online Transactions Symptom Checkers Repeat prescriptions Viewing records Online Pilot 133K patients 20 practices Self-help content Written Videos No work for practice 10 London Boroughs Sign post Pharmacy 6 months Online CBT Nurse call back 24/7 within 1 hour E-consult 100 common symptoms, conditions or scenarios Less Work
Patient visits your website Example banner can be linked to any GP website Booking appts, Repeats, Self-help and nurse call back Practice specific identifiers boost patient confidence Simple flow guide Commonest conditions on home page 100 more conditions available
Patient select their condition
They select from the various options presented Why not just allow GP open up their email addresses to patients? GP cannot verify identity Poor clinical governance e.g. GP response times Patient selects Medicolegally risky Any locally commissioned option for GPs Too easy for offer can be sign patients? posted Emails lead to banter Risk of supply-led demand Doesn t optimise data capture No closure of communication loop
How does a patient e-consult? Personalised message explaining: What happens next? When will I hear back? How will I be contacted? What can I do to help myself in the meanwhile? What to do I do if I get worse?
Patient submits completed questionnaire to the practice generic email box as a GP summary report. Staff then workflow or print e-consult for GP to review Triangles highlight positives, key negatives and free text GP report or e-consult takes an average of 2.9 minutes for GPs to process 40% result in prescription 20% result in phone consult 40% still need to come in
Patient submits questionnaire from their practice website Admin phone patient to collect prescription or give appointment By the end of the next working day Admin print off e-consult or workflow it to the GP GP prescribes, phones or recommends an appointment
36,000 visits in 6 months 27,000 unique visits 9,000 used self-help 18% self-managed avoiding an appt. 80% 111 calls closed 60% e-consults closed Over 2,000 e-consults 400 GP hours saved Pilot Results Did patients use it? Who used it? Top 10 symptoms or conditions Did patients like it? 95% patients said website was good or excellent 83% FFT recommend 2/3 rd < 45 1/3 rd > 45 57% women 25% BME 28% English Second language 11% unemployed When did they use it? Templates by hour of day 00 02 04 06 08 10 12 14 16 18 20 22 Cystitis (female) Depression Contraception (restarts) Knee pain Earache Asthma Sore Throat Rectal Bleed Shoulder pain Cough What did GPs think? 100% GP confidence 83% GPs said good for patients 78% GP want in own practice E-consults took 2.9 minutes on average
Very detailed - clear and concise, very good! Resolved my issue quickly without needing a face-toface appointment and wasting time (either mine or that of the doctor). This site is fantastic! Finally a GP that has caught up with using decent technology! It was perfect. Fast and efficient. I didn't have to take time off work to go & see my GP in person. very quick follow up Efficient, this service works for working individuals that don't have time to be put on hold over the phone or arrange an appointment during work hours It allowed me to avoid spending time on the phone or traveling to the practice, while still having my condition looked at. Got the required prescription that I requested.
Amplification Effect For every e- consult For every 3 e-consults (= 1 appointment) 5 patients use self-help 2 patients use pharmacy advice 1 patient requests a nurse call back 1 patient uses the symptom checkers 15 patients use self-help 6 patients use pharmacy advice 3 patient requests a nurse call back 3 patient uses the symptom checkers Up to 10 patients benefit Up to 30 patients benefit 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 or A&E 14% Nothing, wait and see 3%
Summary There is much talk about how general practice is unsustainable, but very few provide solutions WebGP provides: Better access 24/7 self-help content Sign posting alternate offers Open 24/7 Symptom checking Nurse call back e-consult from their own GP by the end of the next working day Better outcomes Comprehensive history gathering Robust clinical governance Earlier intervention in illnesses Digital disinhibition for mental health issues Better use of practice resources Reduced demand by empowering patients to self-care Triages patient need and steers practice use of appointment capacity Efficient e-consult process Commissioner savings Reduces use of urgent care services Reduces morbidity through earlier intervention