Case Study: To support the transformation of its service delivery, and ahead of NHS England’s recommended requirements for GP practices to move to a total triage system, Langport Surgery embedded the online consultation platform, Engage Consult.  In response to Covid-19, the Surgery further optimised usage of Engage Consult; establishing a remote total triage model to provide care in a different way, whilst ensuring staff and patient safety and improving workload efficiencies.

Langport Surgery: Embedding a remote total triage model with Engage Consult 1

Background

Situated within the Somerset Clinical Commissioning Group (CCG), Langport Surgery, which comprises five GP partners supported by a strong team of clinical and back-office staff, serves the needs of 13,300 patients across a large rural catchment area.  With a slightly higher proportion of patients over the age of 65 than the national average, the Surgery also provides services to 125 patients in nursing and residential care homes.   

To facilitate the transformation of clinical service delivery, Langport Surgery had already altered the way that patients access its services through using a mix of telephone and online consultations.  As a vital operational priority, the Surgery subsequently progressed to using Engage Consult as a single point of access total triage platform.  Engage Consult was provided by the CCG before the pandemic outbreak, the Surgery undertook a phased implementation approach, gradually moving demand online with Engage Consult.   

With the online platform already in place, Langport Surgery was in a strong position to rapidly embed the solution further and take it to the next level during the pandemic to support the remote triage and remote management of patients.  Today all patients at the Surgery are triaged using Engage Consult, either by phone or online.  

Challenges

To meet Covid-19 restrictions and guidelines, Langport Surgery needed to minimise the number of face-to-face consultations to keep patients and staff safe and reduce the risk of infection.  With a growing team of clinical and support staff, triaging patients remotely to ensure they are directed to the most appropriate person in the best way, was paramount.  

Langport Surgery accelerated its move to a remote total triage model of care to minimise footfall and ensure a high volume of demand could be dealt with efficiently and effectively.  “At the very beginning, some staff expressed concerns that this approach would increase workload, through needing to assess online as well as seeing the patient in person.  Instead, it has enabled the triage of patients which we weren’t previously undertaking, and this helps overcome some of the pressures,” explains Charlotte Norris, Operations Manager.

Flexibility was another important factor as the solution needed to support patients and GPs remotely, including during self-isolation. Along with the challenges of the pandemic, there were other pre-existing pressures to manage.  Waiting times, telephone queues, and limited face-to-face appointments are key challenges that resonate across primary care.  At times staff may also feel overwhelmed with the level of workflow. Digital transformation is critical here to help overcome the most common challenges faced by patients and staff.

Solution

The implementation of the online consultation platform, Engage Consult, into Langport Surgery’s existing clinical systems and processes supported new ways of working.  It facilitated a complete appointment system change, utilised by staff at all levels across the practice, both clinical and admin as well as dispensary, along with a large proportion of patients.  Its ease of navigation and secure functionality means that it is used by a diverse age range of patients. “Overall, patients have been pleasantly surprised with Engage Consult” confirms Charlotte.

The Surgery recognised total triage as a sustainable way to manage workflows and improve access. “As well as submitting medical queries, patients submit administrative requests, ask questions, and report symptoms for self-care support.  For patients without a digital device or internet access, the reception team follows a workflow to capture key patient information quickly and easily, guiding patients through the same process over the telephone, or in person, in exactly the same way,” states Sue Oliver, Data Quality and Office Manager.

Each message is allocated an EMIS slot, which is triaged in order of priority, enabling the right teams to deal with messages in the right order.  The solution captures a patient’s history and symptoms asynchronously and allows patients to send photos and documents; this provides useful clinical information at the point of triage and subsequent consultation.

Benefits

The pandemic has driven the benefits of using remote online consultation to the forefront, and as a result, Langport Surgery supports a high volume of patients through Engage Consult.  

Convenience and time-savings are the overriding benefits for patients who are now able to send requests via Engage Consult, safely and securely.  It eliminates the need to phone or walk into the surgery, and instead, is a simple and fast process for patients. “With queries often dealt within the same day, patients avoid the waiting room, which cuts waiting times.  Many patients have found the service to be quicker than a routine face-to-face appointment.  It also provides an element of reassurance for patients; if we think the patient should be seen, we ask them to come into the surgery,” said Sarah Poyntz-Wright, Business Manager.

Engage Consult has provided Langport Surgery with full control of its appointment system which has improved efficiency, patient access and patient satisfaction.  It has also facilitated a large shift in workload, “There has been a significant impact on workload.  It has been possible to increase online and telephone triage capacity. A high number of consultations that were previously face-to-face have now been converted and resolved by online or video consultations.  There are also significant clinical and administrative time savings; with less time spent documenting and better data capture, creating efficiencies,” affirms Sarah.

A wider range of services are available as the Surgery signposts patients to appropriate care pathways using Engage Consult.  Patients are conveniently directed to the most appropriate care; be it pharmacists, physiotherapists, self-care, or another member of the multi-disciplinary team such as nurse practitioners or health visitors.

Way forward

Engage Consult is constantly evolving and as a Partner Practice, Langport Surgery is helping to shape innovative new features which are key to the platform’s future development.  It is actively involved in prototyping product updates to support the delivery of an enhanced service to patients, and to help other GP practices integrate Engage Consult into their systems and processes in the best possible way.

In the months ahead, as the uptake of online consultations increase, Langport Surgery will continue to optimise usage of Engage Consult and streamline processes as part of its successful improvement journey.

Langport Surgery: Embedding a remote total triage model with Engage Consult 2