FAQs for GPs and Practice Staff

  • Essentially, all online consultation platforms suggest that they can deliver the long sought after productivity gains for GPs and surgeries by meeting some, or all, of the following aims:
  • Making much better use of GP time – getting the patient to be productive in their own time, not the GPs, to provide useful, well-structured information that radically speeds up the decision-making process for next steps: call in, phone with advice, refer or prescribe
  • Streamlining administrative tasks – can we use these applications to make sure the right task is assigned directly to the right person immediately without any intervening paper-shuffling or misdirection?
  • Signposting patients to self-care services – can we give many patients (with minor, self-limiting illness) good enough information so that they no longer seek an appointment to see or speak to a GP?
  • Driving patients to use patient-facing services more broadly – to help meet the goal of 80% of patients using patient-facing services by 2020 (prescription renewal, appointment booking, use of patient records etc)

NHS England has a stated aim to achieve the goal of 20% of patients using online consultations in general practice

The unwell patient visits the surgery website and clicks on the link to online or online consultations. Unlike other vendors, this entry point does not have to be badged as a branded Engage Consult service. They will then start the consult process by entering basic personal details (this is called claimed ID), use a name and password if they are returning so that they don’t have to enter all their details again, or finally, via their patient facing services login details – if they have them (they are then a Registered Online Services User or ROSU and will be able to access other online services such as appointment booking, repeat prescription ordering, access to medical records – as well as doing an online consultation).

Having accessed Engage Consult they’ll be informed that using the system is not for medical emergencies. Once they have acknowledged this they can proceed. Engage Consult will then ask the patient to record their symptoms simply, by providing answers to a series of multiple choice questions, where each question asked will depend on the answer given to the previous question – a genuine “history taking” approach using branched logic operating on a vast database of questions about symptoms.

It’s important to note here that there is no presumption from the outset about what is actually wrong with the patient. When the questionnaire is completed – or when the patient has decided they have answered enough questions (the vast majority of questionnaires take 5 to 10 minutes), they can add their own comments and then simply press “send report”. At the conclusion, they will be given information about what will happen next, which can be configured by the practice.

Like all e-consultation systems, Engage Consult provides you with a summary report about the patient’s problem. This sent via a pdf to a secure nhs.net email address at your practice, or via our secure two way messaging platform – EnCompass LT – the report can then be viewed without first having to open a pdf.

You will need to have a designated “landing point” for the information and our suggestion is that would be managed by a receptionist. The receptionist will either monitor and forward emails to GPs or nurses or admin as appropriate, or monitor EnCompass LT and move the message to different work groups (GP, nurse, admin, pharmacy etc) within the platform as required. This is a much simpler process which has the added benefit of reports not having to clamour for attention above the usual email traffic.

The recipient views the PDF or the message in their EnCompass LT group and decides on their course of action. For the GP this is going to be: ask reception to make an appointment, call with advice, refer to a fellow GP, nurse or AHP, or prescribe.

If it’s medical problem, the report then needs to be attached to the patient record and here is where Engage Consult is unique compared with other systems. This is an overhead for administration, so the trick will be to ensure it is as simple and elegant as possible.

Engage Consult already integrates with EMIS and Vision via commercial interfaces, with TPP SystemOne expected March 17 as part of the GPSoC program.

If the practice is using EnCompass LT for workflow and messaging, then attaching the record directly into the patient record is achieved by the click of a button. It’s less straightforward if the practice elects to receive the report as a PDF via email – attaching the PDF directly to the journal or as scanned TIF files is the solution here, depending on the clinical system in use. This will take longer, and is certainly less straightforward and requires confidence in using more advanced functions in the clinical system. This is, nevertheless, a workable solution – one shared with all other e-consult systems – if not ideal.

There are 3 key ways to use an Engage Consult e-consultation:

  • A daily triaging tool to help you decide quickly, effectively and safely how best to treat a patient.
  • As a communication channel for patients with non-urgent queries where a 1 to 2-day wait is acceptable for a response from the surgery
  • As an outbound consultation tool to help you improve the quality and consistency of care for your patients with long term conditions.

These are not mutually exclusive, of course. What is obvious, though, is that unless you are making significant use of online consultations neither you or your patients will benefit from the efficiency gains. With that in mind – and with aim of putting some hard numbers around the process, it’s probably simplest to look at the case of using Engage Consult as a triage tool.

In terms of numbers, that will be very much up to you. Suppose you aim to deal with 10% of your daily demand for GP consultations via Engage Consult. Suppose also that you are an average sized practice (c.7800) and that you demand is pretty average, too (c.7% of the list calling per week). That means you would need to handle something like 55 online consults a week, and the daily number would look something like this:

Day No. consults Time (mins) Percentage
Monday 15 103 28%
Tuesday 11 77 21%
Wednesday 9 63 17%
Thursday 9 59 16%
Friday 10 66 18%
55 368 100%

We know that only about 30% of those Engage Consults you’ll actually need to see, about 60% you’ll be able resolve over the phone and about 10% will be referred to a nurse of other AHP. Factoring time for reading the reports and referring/prescribing, it’s clear that a GP can save about 30% of their time – all other things being equal, when compared to doing it all by face to face consulting.

In fact, that pretty much true of all your demand. Trying to divide up demand meaningfully into urgent/routine and acute/existing/follow-up is never easy or straightforward and, by and large, practices are dependent on patients to accurately self-classify. We know that this system is often is gamed to gain access sooner rather than later by some patients, whilst others who really do need an urgent appointment may well be unable or unwilling to press their case. An Engage Consult reports put the decision-making firmly with the clinician and on clinical grounds only.

The rub is that to realise the full benefits you DO need to created dedicated opportunities in the clinical day to actually make deal with Engage Consults – on the day.

Click here to see what efficiency gains your practice could make using Engage Consult.

If you simply continue to fill your day with face to face appointments and treat online consults as “extra” work neither you or you patients will benefit from the productivity gain. You will resent it and your patients will be uninspired and turned off by poor response. A classic “non-virtuous” circle. You certainly can just operate a service where you agree to get back to the patient by the following day or within 48 hours, but we guarantee your usage will be minimal and your productivity gain – if any – will be simply unmeasurably small. On the other hand, if you can organise a robust, trustworthy same day response (within defined hours, e.g. 2 hours before the practice opens, and 2 hours before the practice closes) you can certainly reap genuine and measurable productivity gains.

There is a myth around supply led demand based on the indisputable evidence that Walk-in Centres and services like 111 don’t have seemed to have impacted greatly – if at all – on the need for GP services. So what is all this extra demand? Well, simply, it isn’t extra demand at all – people are being referred away from general practice – but to services that mostly do not resolve the issue at hand but act as temporary destination. In most cases, those patients that do naturally resolve are simply referred back to the GP overwhelmingly. So, there is not extra demand, there is repeated demand – and that simply helps no-one.

E-consultations in contrast are a means by which patients can interact with their own practice in their own time – immediately. Providing they receive a timely service, they will be happy to use it and you can trust the vast majority not to abuse it, just as you can trust the vast majority of your patients not to abuse your systems as they don’t now.

Do you REALLY believe anyone who claims you can transform your working life without having to change anything? One thing you can be very sure about – if you don’t change, nothing else will.

But maybe you have to make less of a change than you realise…

Engage Consult puts signposting to self-care front and centre – we link to NHS Choices, the leading NHS resource for patients wanting to find out about their condition and opt for self-care, if that is appropriate. We believe firmly that educating patients in self-care is vital, but we do not believe this will impact on demand any time soon. The reason for this is clear – NHS Choices and Dr Google already account for more patient interactions on a daily basis than those provided by GPs – and the number is growing all the time. But has anyone notice a reduction in demand? We thought not. Beware all claims that online consultation systems are persuading patients not to seek consultations – the independent evidence strongly suggests this just doesn’t happen – and other evidence is thin on the ground, to say the least.

According to Ofcom figures, by the end of 2016 nearly 80% of UK adults owned a smartphone, and nearly 60% use it to access the internet. Industry figures suggest it’s actually nearer 85%.

Ofcom puts broadband at home at 81% of adults. The numbers are growing strongly across all age ranges, and the UK does more shopping online than any other country.

Patients will still be able to phone in – the only difference will be that at patient will not be able to book a same day appointment without either an online consult first or a triage call.

By reducing pressure on the phone lines via online consultations, those still wishing to use this access mode will be benefit by the reduction of pressure on phone lines.

Nowadays it is not unusual for most practices to offering at least 30% of their appointments for on the day consultations – many practices now routinely manage 50%+.  This is achieved partly by ring-fencing bookable on-the-day appointments and partly by phone-based triage, bringing in patients for so called “urgent” appointments with the duty Doctor.

The problem with ring-fencing same day appointments is simply that you provide access based not on need but on the patient’s’ ability to be sufficiently organised to claim a slot, or convince reception that they have to be squeezed in. Clinical need is not the determining factor.  Triaging is a sensible approach because it means you do not see people you don’t actually need to see.

Our view is therefore not to have on-the-day bookable appointments at all without triage and to make your online consultations an integral part of the triaging process – and extend the amount of clinical time devoted to triage by reducing the number of bookable appointments every day in favour of triaged appointments. That way you will have fewer DNAs and be surer that you are only seeing those patients you need to see.

So, if the average practice wants to manage 10% of in’s underlying demand by online consults, that will be 55 consults a week, the daily breakdown –  as we’ve already seen, looks like this:

Day No. consults Time (mins) Percentage
Monday 15 103 28%
Tuesday 11 77 21%
Wednesday 9 63 17%
Thursday 9 59 16%
Friday 10 66 18%
55 368 100%

We recommend that clinicians share and ring-face this amount of time every day between them to manage the Engage Consult channel – two thirds of the time in the morning and one third of the time in the afternoon. If each clinician staggers their Engage Consult dedicated times throughout the day, then the channel will be constantly monitored ensuring fast response and this in turn will drive usage – and thereby increasing efficiency. In time you can increase your target patient % via Engage Consult by promotional campaigns to patients – in fact they will drive that increase anyway if you service is good – in this way, your productivity will grow naturally over time.

So, we do suggest a modest change to your working practice, but in the example above, if you did, you would be able to deal with nearly 20 extra patients per week.

We’ve spoken to the insurers, all of who have referred to general GMC (and associated Royal College) guidance around history taking and associated documentation. Engage Consult uses computer interviewing to take a medial history from a user of the system who presents with a medical problem.

The system does not attempt to make a diagnosis and there is no claim that every question that could be asked, is asked. Clinicians using the system do so as an aid to a usual consultation with the medical history providing a useful narrative in a standardised and recognisable form, often including fully referenced Standard Instruments and peer-reviewed clinical scales.