by Dr Mark Harmon

doctor first

Better patient access, less pressure on GPs – yes please!

Teaming up to make things even better

Digital healthcare may be the future, but patients and clinicians are still finding their way with the new technology available to them.  People want better access to GPs, including advice and appointments when they need them, but they don’t always know about the different ways to get the help they need.  A new collaboration between eConsult and Productive Primary Care, the developers of Doctor First, aims to change that.

It’s easy to see why telephone consultation has become popular with some practices.  It builds on the use of the telephone for triage or practice-initiated calls to discuss issues like test results with patients and avoid the need for a 10-minute appointment.  In the past 20 years or so, many people have come to consider phone consultation the norm, preferring to talk to a GP whenever possible, rather than take time out of their busy day to visit the practice in person.

But will patients take to electronic consultation as readily? The difference, says Steve Clay, clinical director at Productive Primary Care, the leading provider of phone consulting solutions, is that people feel comfortable with calling their surgery – it’s the way most of us initiate contact if we have a health problem.  From there, it’s a short step to persuading patients to talk to their GP over the phone about their health concern, rather than coming into the surgery.

If you give people access to a high quality e-consulting tool, that could reduce the GP workload even more

“People take the easiest route to medical care,” explains Steve.  “Right now it’s not so obvious to them that they can access their GP via the internet.  We need to make patients more aware of the advantages solutions like eConsult can offer, including online triage and trusted healthcare information for self-help.  And of course it’s available 24/7, unlike telephone consultation with their GP which necessarily takes place during surgery opening hours.”

Dr Murray Ellender, CEO of eConsult, adds:  “Digital is now a part of our everyday lives – 25% of eConsult patients are over 65 years of age.  Accessing their own GP online enables patients to start a consultation with their GP at any time rather than waiting one to two weeks for an appointment.  The GP will then review their eConsult by the end of the next working day and if the patient requires an appointment, the surgery will book them one.”

Steve, a Leicestershire GP, introduced telephone consultation into his own practice back in 2000 to help deal with demand.  “We didn’t have enough appointments and we had no space in the building to enable us to recruit more GPs.  Initially we set up phone consultation just to talk to people who couldn’t get an appointment.  That worked well, but there was still a two-week wait to see a GP.”

At that time, Steve was involved with the National Primary Care Development Team, which was to become the NHS Improvement Foundation.  “We were looking at advanced access, the concept of ‘doing today’s work today’, which seemed an impossible nirvana for most GPs.  And unsurprisingly we found that if we could speak to people on the day they presented with a health issue, and see anyone who wanted to be seen on that same day too, everyone was happy.”  The problem was that with most practices, all bookable appointments were already taken – the challenge was to deal with the backlog.

Steve and his practice colleagues focused on catching up with their appointments so that they could offer telephone consultation to everyone calling the surgery, with same day appointments for anyone who needed to be seen by a GP.  And when they found that telephone consultation resulted in only half the number of people they spoke to actually wanting a face-to-face appointment, they knew they had done the right thing.

“The average surgery has about 1,800 patients,” explains Steve, “whereas we have over 3,000 and we don’t have any problems at all.  If someone had said that to me 20 years ago, I wouldn’t have believed them.  But if you do the maths, you can see why it works.  It takes three hours to see 18 patients.  If you talk to them on the phone instead, you can help three people in 10 minutes.  So what used to take three hours now takes two, which means instead of helping 18 people in three hours, you can help 27.  And with Doctor First, we find that only one third of all callers actually want to come into the surgery for an appointment.”

Pooling expertise

Doctor First was introduced to the market when Steve teamed up with Dillon Sykes, who he met during his time as clinical lead for the East Midlands with the Improvement Foundation.  “We didn’t want all our new knowledge and expertise to go to waste,” he says, “so we set up Productive Primary Care and we have been helping practices improve their efficiency ever since.”

Spotting the similarities in objectives and success rates, the teams at eConsult and Doctor First have been pooling their knowledge to see how the two solutions can help improve patient access and relieve pressure on GPs to an even greater extent.  This summer, Doctor First initiated trials at two practices.  “We have a brilliant database of information which reflects true demand, rather than simply measuring activity.  So we know that if we put eConsult into a practice that had not offered electronic consultation before, and started measuring the traffic, we could assess just how much of an impact this new option was having.  Even if no-one used it to consult online with a GP (which is hardly likely to be the case), we would be able to see if they used the information available on eConsult to help themselves.”

The team at eConsult are keen to see the results too. “We are very happy to be working with Steve and Doctor First,” says Murray Ellender.  “Doctor First has helped lead the transformation in primary care, and we look forward to seeing the potential benefits of both systems.”

“If you give people access to a high quality e-consulting tool, that could reduce the GP workload even more, so they have even more time to see patients who need a face-to-face appointment,” concludes Steve Clay.  “We’re just a few weeks into the trial.  We’ll be measuring demand and we’ll be able to see whether there’s a drop in the number of people wanting to see their GP, and if that figure keeps improving.”

Watch this space for an update in a few months’ time.