Case Study: Implementing Engage Consult in Primary Care – Harry Dudson 2nd year medical student.

This is my experience of training, establishing and managing Engage Consult within a GP practice.

During March, just before lockdown started, I was given the opportunity to help implement Engage Consult at a practice where I had previously had part time work. The challenge was to transfer the practice to online consultations, and improve access for patients whilst ensuring their safety during the Covid-19 Pandemic. I was very keen to get involved.

My initial task was to fully understand practice protocols and procedures so that I could implement the same process via Engage Consult. It was important to take time to work with the practice team to establish a system which satisfied both patient and practice needs. We launched Engage Consult at the beginning of the pandemic to reduce the amount of patients being called in, give increased access to healthcare and reduce the pressure on the phone lines.

Online consultations help surgeries during pandemic and beyond 1

After an initial two weeks and a few adjustments, we were happy with our procedures and I suggested that we send texts to all of our patients to alert them to the new system and to ask them to use this for all new medical requests. This increased the usage from 7-18 requests per day to 20-40 per day! We moved away from having a set time for the duty doctor to deal with the requests, to assigning appointments evenly across the doctor’s clinics. This allowed equity in work.

The first notable impact of launching Engage Consult was that it allowed patients to make requests online which decreased the overwhelming volume of calls to the reception team. What was quite surprising to me was that many patients felt that their queries were not ‘important’ enough to ‘trouble’ reception with ‘during these times’ and so felt reassured by being able to submit an online query. They didn’t have to queue on the phone for the reception team and had unlimited time to sit at home and write down their questions. This relieved the pressure of feeling like they were burdening reception as well as allowing staff enough time to gather relevant information. It ultimately made an efficient, successful system for both the patients and staff members. Patient feedback showed some examples of this, “It has put my mind at rest. I have been worried about contacting the surgery as I know how busy it is.” and “I really like it and it is much quicker than waiting on the phone.” Another patient, when we first launched Engage Consult said “The practice should think about making Engage Consult a permanent form of contact as it’s highly efficient and has been extremely easy to use.”

A key benefit of Engage Consult is the amount of information that the patient is able to submit within their online request with the inclusion of photographs. A patient can submit a request at any time, and has plenty of time to fill in a detailed history prompted by the medical questionnaire. The online questionnaire guides the patient to give more relevant information. This is presented clearly to the clinicians with positive responses presented in bold, negative responses are also shown which help to inform the clinician. The patient also has free text questions which allows patients to express their opinions and expectations. Giving the patient the opportunity to submit information which they feel is relevant provides them with an element of responsibility and involvement in their own care.

Online triage allows the clinical consultation to start with a significant amount of information but it is more than just a platform to upload photographs or health data. As it enables the patient to give the doctor background information in advance, the consultation can be more patient focussed and there is more time to discuss the issue itself. It makes the consultation more efficient.

I was concerned about the technical ability required to submit an online request and made the assumption that it would be predominantly used by younger patients. I was quite wrong. There is a huge age range of patients that use Engage Consult, from late teens to late 80’s. Some patients inevitably found it more difficult than others and needed a little help to get started. We have recently added the Engage Consult Patient Guides to our website and now direct patients to these. My phone line is always open to help patients, I usually only receive 3-4 phone calls per week which are usually to help a patient upload a photograph as requested by their doctor. In our feedback, patients say that Engage Consult is “not as difficult as I thought it would be” and that they have “No problems. Easy and quick to use”

Patients have the opportunity to comment on the Engage Consult system when submitting their request, we look at this on a regular basis. Our April figures show that 82% of the 159 patients who submitted feedback would recommend the new Engage Consult service. A piece of interesting feedback came from a mother who came in to collect her son’s prescription. She wanted to praise the surgery as she explained that due to his mental health condition, her son rarely took responsibility for his own care as he would avoid telephone calls, but Engage Consult allowed him to access care independently. Improving access for patients experiencing mental health problems was an unexpected but very welcomed outcome for me. A patient with anxiety problems submitted the following comment “Brilliant way to be able to say what you need, really helpful for someone like me who has anxiety and finds it difficult to talk to people as I get mixed up with panic. Really good. Hope we can keep this as I will use it instead of appointments if I need advice.” These are just two examples, the feedback received is overwhelmingly good.

From a personal perspective, I believe that online consultation is a fantastic addition to the clinician’s toolkit. Many people, including my medical student peers, fear the possibility of ‘traditional’ medicine being replaced by computers and artificial intelligence, but in reality Engage Consult has shown me how it can enhance clinical interactions. In many instances, the doctor will still give the patient a telephone call but having some background information prior to the interaction gives a certain amount of insight. Overall, my experience as an Engage Consult ‘lead’ has been a very positive one. Due to our successful launch, I have been given the opportunity to help multiple practices implement Engage Consult and so far everyone is happy moving forward and going live.

Despite the incredible pressure of trying to maintain the highest quality of care in the midst of a pandemic, we were able to work together as a practice to establish what has turned out to be a very successful new service and I am very grateful to have been involved.