eConsult - eHub

Bromley Connect Primary Care Network (PCN) – Creating a federated working model eHub using existing staff and the eConsult Smart Inbox 

eConsult eHub

• South East London Integrated Care Board
• 3 practices
• 40,000 combined patient list size
• Live with eConsult – 2022

Bromley Connect PCN set up a small eHub comprising three practices using their internal staff to help manage demand and work more efficiently and collaboratively. The team now has a central hub to review daily inbound eConsults and manage them as agreed using their collective resources. Dealing with eConsults centrally strengthens the overall working collaboration, shares resources, and sends a unified message to the patients. The introduction of the Smart Inbox gives the team far better visibility of eConsults and enables better prioritisation and efficient workflow processes.

Collaborative working was a key driver for change 

As a PCN, Bromley Connect is at the stage where they are starting to collaborate to provide joint cover for their PCN population. In the last year, this has covered Covid Clinics, Extended Hours, and eHub. The benefit of setting up the eHub is that they now have a central hub to review the eConsults each day and deal with them as agreed. This means the team can make better use of resources which has a positive impact on their work/life balance and can result in an improved patient outcome. 

Creating an eHub using existing staffing 

Bromley Connect PCN wanted to create an eHub using existing staff from within the PCN, instead of hiring additional staffing roles. This granted the whole team the knowledge, experience and clinical support to deliver an eHub. 

Bromley Connect PCN has a lead administrator within the eHub who is employed by the PCN through the Additional Roles Reimbursement Scheme  (ARRS), a GP assistant and an eHub rota of GPs. The average week is broken down into 10 sessions, these sessions are shared between the three-member practices. Three sessions of which are paid for by the Extended Access envelope from the PCN.

The sessions are then allocated according to the number of eConsults each practice receives.

The benefit for each practice is that the eConsults submitted to each individual practice are now being dealt with all week centrally, but the actual time each individual practice allocates is less. By taking these additional sessions the PCN have been able to bring a positive impact to patient access. 

The eConsult Smart Inbox is central to the eHub working 

Bromley Connect have received over 32,000 eConsults since they went live and currently processes over 1,000 eConsults each week. The majority of patient requests are administrative requests.

Clinical process:

The clinical eConsults are triaged by a GP through the eConsult Smart Inbox. The triage GP makes a recommendation of who they think should see the patient (GP, Physio, Pharmacist) and sets up a recommended timeline for follow-up and treatment. 

Once these decisions have been made the GP marks the eConsult as triaged in the Smart Inbox. An administrator at the ‘home practice’, who likely knows the nuances of the local patients presenting, allocates as suggested by the triaging hub GP. The appropriate appointment or follow-up is then booked at the ‘home practice’.

Administrative process:

Simultaneously, the PCN administrator completes the administrative requests within the Smart Inbox. Bromley Connect has worked together as a team and has written generic responses that are in keeping with the ethos of the practices and local services. This gives the administrator the ability to close remotely, a large number of the admin eConsults using pre-saved templates in the Smart Inbox.

The eHub administrator has stock responses for patients asking for advice about a range of administrative issues, such as details on Covid Clinics, how to use the NHS App, extended access, or queries for private referrals.

Each practice within the eHub is also using eConsult Lite. This question set has been specifically designed to enable reception staff to process phone calls as eConsults, which are submitted to the eHub Smart Inbox with other online consultations for triage. This helps remove further pressure from the PCN as more patient requests can be closed remotely. 

“Without eConsult’s built-in red flags, it would feel unsafe to run an eHub.”

Natasha Hoare, GP Partner and PCN Clinical Director, Bromley Connect

The structured data collected in each eConsult is key to driving the effectiveness of the eHub and baking-in efficiency:

1. The team can manage inbound eConsults without having to phone the patient, which saves time and is efficient for both the patient and the practice
2. The Smart Inbox enables the team to look at the eConsults based on the age of the patient, which helps to check on the children and elderly at the start of the session
3. The red flags allow the team to prioritise urgent eConsults first each day. Without eConsult’s built-in red flags, the eHub would not be safe. The ability to highlight unwell patients with a search function in the Smart Inbox is an essential safety-net for the team.

Collaboration is key to PCN improvement

Setting up an eHub has allowed Bromley Connect to work together as a team, sharing resources and improving their ability to mobilise and manage other local projects as they are now communicating daily. 

The eConsult eHub product has provided the ability to share risk across the PCN and to improve together by reflecting on the lessons learned. Staff training, including the ARRS staff members, ensures that everyone has the same objectives across the PCN, regardless of which practice they are working from. 

The data collected from the Smart Inbox has enabled the team to analyse and identify key themes on inbound eConsults. For example, patient questions about Covid Vaccinations or Hay Fever requests now have pre-defined written responses that can be sent to patients, which means many eConsults do not reach the individual practices but are closed at eHub level. This results in increased capacity to manage the triaged patients returning to each practice. 

The PCN administrator, a GP Assistant, is trained to manage the daily administrative requests. They are completed or allocated to the correct administrator in the member practice. 

“Creating an eHub has accelerated the maturity of the PCN – we are probably ahead in terms of infrastructure, team development and collaborative working as a PCN because of the eHub.”

Nina Jenkins, Practice Manager, Bromley Connect

Better visibility gives the ability to work smarter

While the workload from eConsults is still present, the team can now work smarter, effectively utilising all the ARRS staff members. Triage enables the team to get the right person to see the patient in the right timescale.

This now means the staff have a varied week with them undertaking GP clinics and triage sessions. Their clinics are varied with a mix of face-to-face, phone and eConsults. All of this has resulted in improved sustainability of the workforce, which is key in Primary Care.

Improve process efficiency means better patient care

One great benefit of the eHub is that the patients are now triaged more effectively, and if they are unwell or have serious symptoms they now receive a better service from Bromley Connect. The system does not rely on reception triage or patients being turned away and told to call back the next day. There are still patients who want to see the GP for minor ailments and the PCN has engaged and carried out transformation work with the PPG and the practices.

Extended Access funding helps support the eHub

Bromley Connect PCN now uses extended access funding to pay for 3 sessions of the eHub. The other 7 sessions are shared between the 3 practices, with one GP covering 3 practices for 7 sessions.