1. A collaborative approach to support Primary Care demand management: In-hours GP Triage
Lynn Huckerby, Associate Director, Service Transformation and Digital, NHS 24.

2. Overview Strategic Context A Collaborative Approach
‘Test of Change’ Aims
In-hours GP Triage
Lessons learned
Short video clip
Next steps

3. Strategic Context
Multi-disciplinary, multi-sectorial urgent care coordination – Urgent Care Resource hubs
OoH Services ~ 24/7
Co-location, co-working, co-production and co-learning

4. Strategic Context continued
Health & Social Care Delivery Plan
Right Care, Right Time
Once for Scotland
Practising Realistic Medicine
Personalised Approach to care
Improvers & Innovators
Digital Health & Social Care Strategy
Use familiar tools and tech to support health & wellbeing
Technology as the enabler
New GMS Contract
Multi-disciplinary team
GP as expert generalist

5. A Collaborative Approach
Change Model
Stakeholder Engagement (public, partner & staff)
Project Management
Quality Improvement
Evaluation

6. ‘Test of Change’ Aims
Demonstrate a new way of working, both for NHS 24 and local GP practices
A reduction in the numbers of patients requiring ‘same day’ face-to-face consultation
Support primary care demand management
Enhance patient experience and raise awareness of alternatives to care provision
Improve patient experience

7. Overview of the GP Triage Service
The formal test of change provides the basis to develop a coordinated, scalable solution through an outbound GP Triage model during the in-hours period for patients requesting a same-day GP consultation. The service effectiveness and patient experience will be improved when the handover points become seamless and more responsive, enabled by the incremental evolution.
The test of change evaluated a 5 month period from mid-November ‘17 to April ’18 across practices in Branchalwood (NHS Lanarkshire) and Riverside (NHS Lothian).
Branchalwood (patient list 5,775) was identified as a practice experiencing operational challenges and Riverside (patient list 19,040 post merger 1 of the largest now in Scotland ) is developing an Integrated Primary Care Hub. Both of these changes required significant operational support from NHS 24 to manage patient demand.
The patient journey has been captured on the diagram below, which shows how practices liaise with NHS 24 for patients to receive care. While this differs between practices, this should provide a high-level overview of the stages involved for a GP surgery to engage with NHS 24.

8. Data: NHS Lanarkshire
Branchalwood – Outcomes, Nov to 21 April 2018

9. Data: NHS Lothian
Musselburgh – Outcomes, to 20th April 2018

10. GP Triage tests of change: impacts
GP satisfaction
GPs have reported a marked increase to overall wellbeing and job satisfaction as a direct result of appropriately redirected workloads
6,288 calls
Improved patient education
NHS 24 triaged over 6,000 calls across the two practices in a 5 month period from November-April
As patients become more familiar with the service, they recognise that that there are alternatives to GP appointments including other professionals and the use of digital self-service
8.27 minutes
70% GP appointment reduction
The average call time for NHS 24 staff engaging with patients was almost identical to the business case assumption of 8 minutes
NHS 24’s triage service directed over 90% of demand for same day GP appointments to more appropriate services at Riverside practice in February 2018
Enhanced patient experience
GPs have been able to increase average consultation time to 15 minutes as patients with more complex needs

11. GP Triage: lessons learned
Key areas to focus on as the service develops
Technology
Operational staff need resolution to key IT issues (e.g. access to patient records)
As the service evolves, technology should be embedded to increase process efficiencies
Need for relevant alignment between 111 service and GP triage service
Data capture methods need to be established for the practices and internal NHS 24 data requires to be more accessible
Operational partners should receive automated reports from NHS 24 systems
There should be appropriate alignment of clinical and information governance support as this service develops
Data
Patient experience
While informal qualitative information on patient experience has been captured, this needs to be supported by regular and robust data capture through an evaluation framework
Empowerment towards self-care/self-management through ‘redirection’
The patient journey must be mapped and reviewed to maximize benefit and efficiencies
Staffing
Effective senior leadership and senior clinical decision making at the front end - is vital to the ongoing success of this work across the system

12. Link to Video

13. The next steps
Plans for further development of the GP Triage model 1
Sustainable model
The current call model for the GP service relies on an outbound call model. We will evolve the service through co-design based on the patient, partner and staff needs to deliver a safe, effective, patient-focussed service. 2
Enhance technology and digital access
An improved technology capability will enable more efficiencies across care pathways. 3
Extend practice listings
Results to date point towards a potential positive impact across the Health & Social Care landscape should this be extended.

14. Thanks for listening CONTACT: Lynne.Huckerby@nhs24.scot.nhs.uk