Unity Health Case Study

About Unity

  • 3 surgeries in City of York
  • 7 partners
  • 39 staff
  • 23,000 patients

Before eConsult

  • 2-3 week wait to see a GP
  • 10%+ DNA rate
  • 89% dissatisfaction rate with the service provided

Since implementation of eConsult

  • 150-200 eConsults per day
  • 87% of first contact through an eConsult
  • 3-5% DNA rate
  • Same-day appointments
  • 2/3 of eConsults solved without need for GP appointment

“Since we implemented eConsult, patients are engaging with their own healthcare, and we are empowering them to do that, which has to be the way forward.”

How they implemented eConsult at Unity

The decision was taken that an eConsult would be every patient’s first point of contact. Nurse practitioners would triage each eConsult and decide on the most appropriate clinical care; a GP appointment or telephone call, pharmacist advice or an email to the patient with a self-help leaflet. By deciding on the most appropriate course of action for the patient, nurse practitioners were able to free-up GP appointments for those who really needed them.

For patients who were offered a GP appointment, as the clinician already had the pre-consult history, making the face-to-face time far more efficient and effective for everyone.

Care for high-risk patients

One group that benefitted from this efficiency was a cohort of 500 high-risk patients with complex needs. Many of the patients have two or three long term conditions and, if these are managed well, they can live independently. But if they become ill, they deteriorate very quickly. For these people it would be inappropriate to be told that they have to wait three weeks for an appointment. A direct dial phone number to the nurse triage team was set up as it was felt that it was inappropriate to ask these patients, many of them elderly, to fill in an online consultation form.

Maintaining standards at launch

Deciding that, with this one exception, eConsult would replace all other methods of access for the surgery, was a bold move. The practice decided to work with the local Healthwatch patient representative group to ensure the new approach was giving everyone the best possible service. Healthwatch worked with the practice to create a patient questionnaire about the new service, written by one of the practice’s own patients.

Following three months of planning, Unity Health went fully live with eConsult on 19 September 2016. The launch was planned during the summer months when demand was slightly lighter.

Communicating the change was a priority, staff and patient engagement events were held. All the receptionists wore bright pink polo shirts to get the attention of patients visiting the surgery and to tell them about the new system. Leaflets were circulated explaining the new system as well as activity on the practice’s Twitter and Facebook accounts.

Now that the system has bedded in and patients are familiar with it, eConsult is providing an increased level of efficiency for the practice, which is in turn leading to improved morale and a better patient experience.

“Staff feel happier about the new system – it helps make their workload manageable again, and having the eConsult prior to seeing the patient keeps the consultation focused.”

It has also had a positive impact on our DNA rate, previously if a patient booked an appointment more than five days in advance, the chance of DNA increases by 50%. By moving to an on-the-day system this has been halved and the practice is experiencing days with no DNAs at all, which had never happened before.

What can we learn?

The considerations from the  Unity Health case study are clear:

  • Be really proactive in working with patients;
  • Run your communications past them to see what they think – raising awareness is crucial;
  • Whet patients’ appetite right from the start, so they feel involved;
  • Get your staff using the system ASAP and get them to try and break it – then you’ll see how robust it is;
  • Ask your GPs to pretend to be patients and go through an eConsult – putting it to the test.

The front line teams at Unity Health are positive about eConsult. “Our nurse triage team were previously reacting patients as they came into surgery. Now they can make a clinical decision about the best course of treatment for each patient via e-Consult. The team works together too, which is good for shared learning and decision-making.”

Meanwhile, the reception team has responded well to the introduction of a new care navigator role, aimed at making them expert sign-posters.

“We’ve started with a small group that’s embedded in the nurse-triage team to deal with cases that don’t require clinical input. We’re working on this with Dr Chris Jones from West Wakefield, who pioneered the care navigator role and training. Now the majority of York practices want to take it up too, and we are looking to GP Forward View funding to roll it out.”

Next steps

Impressed by the success that Unity Health has had with online consultation, the Vale of York CCG is also hoping to use GP Forward View technology funding to implement eConsult across the whole estate. “When they see A&E figures for this quarter, and how significantly the reduction could impact on money and resources, I think they will be even keener.”

“Since we implemented eConsult, patients are engaging with their own healthcare, and we are empowering them to do that, which has to be the way forward.”

See for yourself how simple it is for patients to use eConsult with our interactive live demo.