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

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Presentation on theme: "Channel Shift in General Practice Dr Arvind Madan CEO Hurley Group demo.webgp.com."— Presentation transcript:

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

2 100,000 Patients 18 Practices 10 boroughs 250,000 Minor illness and injuries 8 London locations Community Services Sick doctors service Substance Misuse School Services “Telehealth” Online GP appointments Online specialist advice Hurley Group

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delivery model Demoralised workforce Weak technological and estate infrastructure Substantial regulatory burden Outdated commissioning models Limited links with social care =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

4 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 s into an online service that improves patient access, health outcomes and practice efficiency.

5 AccessQuality 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)

6 A link from any GP’s practice website

7 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

8 Explanatory video of how e-consults work Options for patients who don’t know their condition

9 Use search box, from common conditions, A-Z or by body part

10 Options for what to do if your condition isn’t listed

11 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

12 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

13 Patients can 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

14 Patient submits completed questionnaire from website which arrives in practice generic box as a GP summary report. Staff then workflow or print report for GP to review. Patient submits completed questionnaire from website which arrives in practice generic 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

15 GP Options on Reviewing the Report

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18 1000 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) 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

19 TOP 10 CONDITIONS Cystitis (female) Depression Contraception Knee pain Earache Cystitis (female) Depression Contraception Knee pain Earache Asthma Sore throat Rectal bleeding Shoulder pain Coughs Asthma Sore throat Rectal bleeding Shoulder pain Coughs

20 What about supply-led demand - We asked patients: What would you have done if the service hadn’t existed? Request of face to face appointment79% Request a telephone appointment4% Gone to walk in centre14% Nothing, wait and see3% 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 pa) 50% to practice and 50% to Commissioners Significant reductions in GP face-to-face appointment hours in 6 months pa) 50% to practice and 50% to Commissioners

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22 Equality Impact Analysis 25% Black and Ethnic Minorities 4% Retired 4% Retired 28% English Not First Language 75% Employed 62% Age % Age % women 4% Age % Age % Unemployed 7% Students 7% Students 43% men Age Sex Race Status 2% Over 65 2% Over 65 32% Age % Age 45-64

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25 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?

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28 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 Robust Clinical Governance Medicolegally safe and approved ROI for purchaser


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