Case Study: White Horse Medical Practice (WHMP) is a semi-rural practice in South Oxfordshire with a 16,500+ patient list size.
They run a same day service with no book ahead appointments if this can be avoided. Exceptions are always made for those with the greatest need such as adults with learning disabilities.
There is a multidisciplinary team of GPs, Practice Nurses, Paramedics, ANPs, Pharmacists, Physiotherapists, Physicians Associates plus access to CCG commissioned community services with self-referral to MSK, Child Psychology, Adult Psychology and minor eyes services as examples. As a result of this complexity, right patient, right service, right time is a challenge that only experienced clinicians can meet.
Using Engage Consult for Total Triage
From mid-April 2020, White Horse began using Engage Consult as their Total Triage engine for the surgery. The system is used to log incoming telephone requests for consultations wherever possible. White Horse Patient Service staff either signpost callers to the website to complete an Engage Consult request themselves or take a request over the phone, logging the outcome in the Engage Consult workflow.
In total there have been 18449 completed requests between 30th March 2020 and 20th September 2020 (see Table 1), 78% are medical problems and 22% are administrative queries. 71.5% of all demand is via Engage Consult online access and 28.5% of demand is taken over the phone by White Horse Patient Services staff.
In the 24 surgery days from Monday 24th August 2020 to Friday 18th September 2020 (not inc. the bank Holiday on 31 Aug), the practice averaged 170 Engage Consult requests daily. The non-bank holiday average for Mondays over this period was 182.
Demand by the hour on Monday 20th September 2020 (medical requests are closed at 4.30pm)
There is still an early morning peak (see Table 2) as one would expect.
In excess of 4000 (25% of registered patients) patients have now set-up and used an Engage Consult account.
Managing Engage Consult Consultation requests
All requests are triaged by a GP. Patient Services staff are tasked with assisting patients that perhaps do not have access to the internet or are unfamiliar with how to access or use the Engage Consult software. If required Patients Services staff will fill in the information for a patient.
At White Horse practice, GP’s are seeing 24 patients per day that require some form of significant clinical intervention above and beyond a simple message response via Engage Consult or SMS. Pro-rata reductions are made for GPs working less than full-time, time out for training/tutorials, management time for partners etc.
Significant clinical interactions include telephone, video or face-to-face consultations, or asynchronous interactions such as a complex letter or a discussion with another healthcare professional elsewhere, for example.
All GPs monitor the Incoming Messages box in Engage Consult workflow and pick their cases until 10 am each morning.
Thereafter, there are two GPs assigned to monitor the requests and triage for the rest of the day. Otherwise, GPs are free to organise their day as they like.
Managing Partner, Dr Rob Russ, said: “The triage GPs do as much of the simple responses via Engage Consult messaging or SMS as possible. Increasingly, our messages back to patients include a “please try again and answer the questions this time as they will be very helpful” type response as we have increased our confidence in using the Engage Consult reports. Amazing how “GP asks” in a reply gets more answers than the personalised practice message asking for this as they are entering their request… “
There are no defined clinics; this approach relies upon a team committed to supporting any colleague under demand pressure. Team working is fundamental to the White Horse practice operating model. Reducing stress on colleagues, as far as is reasonable, is the central aim and an important outcome measure. Job satisfaction, retention and stress among clinical staff remain at good levels considering the strains imposed by Covid-19 over recent months.
Continuity of care is a high priority and Engage Consult 2-way secure messaging is used regularly where patients need to be informed that their usual clinician is not available on that day and that their request will be dealt with when they are next available, or by another clinician on that day if preferred.
Rob Russ said: “The patient is sent a note via Engage Consult to say what has been suggested and give them the opportunity to decline to wait and request same-day access with another clinician on that day. This improves continuity and patient-centred care while not affecting the ability to deal with the day’s workload or put too much stress on a GP. It’s often only one or two cases, and then only when someone has been out for a few days.”
Recent Patient Feedback
- Since 30th March 2020, 2836 patients have provided feedback, 15.4% of all users.
- 68% of those that left feedback stated that they would recommend the service, only 11.5% would not.
- 6% of people who left feedback had used the service more than once.
“It was a very good feeling that I was being asked the right questions and in good hands compared to the country I have come from”
“The service is very good because the doctors are so responsive and I do not have to convince anyone who answers the phone that I really need help. I feel my privacy is under better control and the role of the secretaries is kept separate from medical triage. I am very pleased.”
“This service is brilliant, would really like to see it continue post-Covid-19. Well done Faringdon Medical Practice doing a good job”
“When you have 3 small children it’s quick and easy to use and I always get a fast response.”
“Easy to use, and probably gathers more information for the Dr to see pre-calling than just speaking to a receptionist which is a good idea.”
“Easy to use, way better than being on the phone waiting for an appointment and then having to go into the GP’s.”
“Excellent! Never have any issues & always a prompt service! I now use this most times I need anything from WHMP!”
“Quick and easy to use and much less frustrating than being in a queue for the practice telephone line.”