Proof of Concept: Unsustainable workload pressures are a key concern in general practice.

The high ratio of care homes to GP practices in the East Riding of Yorkshire led to a soaring number of resident referrals for assessment and treatment, placing excessive demand on practice teams.

To overcome these challenges, Yorkshire Health Partners led an online GP consultation pilot scheme using Engage Consult to successfully enhance efficiencies and improve access and turnaround, to facilitate better ways of working for GP surgeries and care homes.

Care Home Online GP Consultation Pilot Improves Efficiencies and Access to Services 1

Background
Yorkshire Health Partners (YHP), a federation of independent partner-led GP practices and a local partner of Humber Coast & Vale sustainability and transformation partnership (STP), aims to improve access to primary care services for patients across the East Riding of Yorkshire. It comprises 11 local member practices, and growing, across East Yorkshire, with a combined patient list in excess of 133,000 supported by 50 GPs.

As part of YHPs’ commitment to making it easier for patients to access GP appointments, the team collaborated with Humber Coast & Vale STP to run a pilot programme to assess the impact of using online consultation platform, Engage Consult, as the first point of contact for care homes to general practice.

As Primary Care Networks (PCNs) embed Directed Enhanced Services (DES), there are obligations to deliver new service specifications, and the development of online services is a national priority. “The pilot programme supported the delivery of the PCN service specification of enhanced health in care homes while complimenting the NHS Long Term Plan of key digital advances in primary care,” explains Alison Tite, general manager at YHP.

Challenges
Bridlington, East Yorkshire, has a high proportion of care homes to practices. As a result, GP practices in the area received a disproportionately high number of calls from the care homes compared to other areas, creating significant pressure on practices and their staff, and inefficiencies for care homes and residents.

“To support digital enablement in primary care, a different way of working was needed. GP surgeries were under a significant amount of pressure from the number of care homes, and in some cases, GP practices closed their lists to new patients,” said Alison at YHP.

To tackle these issues, establishing a single point of contact for care homes was needed, whilst also supporting digital enablement for care homes. The aim of the pilot programme was to identify whether a remote resource could alleviate the day-to-day pressures for local practices, by dealing with routine administration and clinical requests generated by care homes. Alison continues, “Care homes often spent considerable time on the phone trying to reach GP surgeries. These delays took up valuable time that staff could be spending with residents and led to complexities in accessing services.”

The pilot programme also sought to address the recruitment and retention challenges of clinical staff in the area. “Nationwide recruitment and retention issues in general practice, and largely due to workload pressure, and YHP required a solution to help overcome this issue, as well as improving efficiencies and access,” adds Alison.

Solution
Within a limited timeframe, online and video consultation platform Engage Consult was fully implemented. “Initially, two GP practices and ten care homes participated in the programme, and as positive results quickly surfaced, this increased to all six GP practices and 27 care home homes (supporting 595 residents) in just three months,” confirms Alison.

Administration and clinical staff at YHP manage incoming requests logged online by care homes using Engage Consult to streamline processes. Initial actions include dealing with admin queries, assigning to a paramedic, or assigning to a YHP clinician for telephone or online video consultation if necessary. Secondary steps involve assigning to a GP practice if a home visit is required, or referral to the community team, emergency service, frailty team, or secondary care.

Alison provides greater insight, “Our service team use Engage Consult to access the online request which has a direct interface with the patient’s medical record directly through the practice clinical system. This is updated in real-time with full access to the patient’s record, enabling the clinical team to deal with requests end-to-end.”

Benefits
Engage Consult optimises operational efficiencies for GP surgeries and care homes by significantly streamlining processes. As Engage Consult also supports a remote workforce, the clinical team is not confined to being on-site, therefore reducing recruitment barriers. “Engage Consult is a more efficient option. It has removed the complexities and is incredibly simple, safe and easy-to-use for GP practices and care homes, as well as overcoming clinician recruitment barriers,” said Alison.

Through undertaking online video consultations at YHP, practice teams experienced a substantial reduction in calls and queries from care homes. This has reduced the time practice staff spend on administrative duties, while the data captured via Engage Consult ensure GPs have the right information available if patients are referred; ultimately achieving better outcomes for patients and residents. Graham Wood, Primary Care Network manager, explains, “Implementation of Engage Consult has allowed GPs, nurses and other members of the PCN to have more time available for other cohorts to benefit the wider community; substantially reducing GP caseload and enabling us to concentrate on other health inequalities. We have also experienced a ten-fold increase in communication between the PCN and care homes which is incredibly positive.”

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Care homes are now digitally enabled as part of the pilot programme. Engage Consult enables a responsive service that facilitates a single point of contact (SPOC) and opens up different consultation methods as an innovative solution. It eliminates the need for paper-based recording and the subsequent time needed to phone requests through to GPs. Instead, care home staff record in real-time using online forms on any digital device; reducing administration and enabling staff to concentrate on frontline care. “We don’t spend as much time on the phone trying to reach the GPs, ordering medication is much easier. Engage Consult has streamlined the whole process, which means we can spend more time with our residents,” explains Andreea Gheorghief, a clinical lead nurse at Foresters Lodge nursing home.

Other care homes agree, with a spokesperson from The Conifers stating, “We think it’s amazing and have found the quick replies are brilliant.”, while Bridlington Lodge commented, “It works lovely and is great to have local doctors on hand.”

Enhanced collaboration with other services has also been achieved, enabling greater access to more specialist care such as the frailty team. “Strong relationships have been forged with other services, and we hope to build on this further, such as through developing links with community pharmacies,” shares Alison.

Alison adds, “The implementation of Engage Consult has enabled us to demonstrate that the care home DES can be delivered by a third party, remote from the PCN. This helps enhance how the service is delivered, as it’s not dependent on having local resources available; essentially where resources are scarce, the service can be provided by a team utilising Engage Consult, in another area.”

Way Forward
The results of the pilot demonstrate the value of taking the programme to the next stage. “There are several developments in the pipeline: plans to expand the programme further and develop the pilot as the DES model of care in Bridlington; plus, a further long-term goal to ensure a multi-disciplinary team is available to refer people to.”

This successful pilot can be replicated, and as a strong example of best practice, YHP shares learning with other PCNs that have adopted the same model for the SPOC element of the care home DES. Alison concludes, “Our plan is to extend this to a permanent contract and provide Engage Consult as part of the solution for the DES.”