Christmas Maltings and Clements Practice
- Patient List size: 17,166
- Launched: May 2019
- Model: Total Triage
Christmas Maltings and Clements Practice chose eConsult to tackle its long waiting times, complaints from patients and aid overworked staff. eConsult helped address all these issues, bringing the struggling practice back from the brink.
How eConsult helped turn around a Suffolk practice
Christmas Maltings and Clements Practice (CMCP) in Haverhill, Suffolk, was seeking new ways to improve its services and boost its reputation in the community after many years of practice troubles and unhappy patients.
In 2016 the existing GP partnership collapsed and the practice was taken over by the Suffolk GP Federation. They ran a ‘sit and wait’ model of care whereby patients had to attend the surgery to be seen that day and would be treated on a first-come, first-served basis. This method was impractical, often leading to patients having to queue out of the door as they waited to be seen by a clinician, leaving both staff and patients unhappy.
To try to counteract this, the practice moved to a ‘safe and sustainable’ triaging method, where staff were limited to a daily number of patient contacts and a cap on non-urgent appointments was implemented. Whilst this stabilised the workforce, it shifted work onto the duty doctor who was dealing with emergency contacts. Patients unable to book in advance were left with no option but to join long call queues, to the extent that the telephone system could not cope with the numbers of patients in the queue. Patients were angry and frustrated, resulting in a large number of complaints for the practice. Staff were also overworked and demoralised, leading to several clinicians leaving – they were trying their best to help patients but felt all they received was criticism.
In January 2019 the practice was put into special measures by the CQC following an inspection, with patient access one of the key issues identified. Community unhappiness and complaints saw local MP, Health Secretary Matt Hancock, also raise concerns.
“We were so occupied dealing with the problems of today we were unable to plan for the future and the long term needs of our patients. We knew that we needed to make changes as soon as possible to improve the care we provided. This meant we needed to take a leap of faith and find a solution fast.”Dr David Brandon, Clinical Lead GP
Embracing a new approach
Christmas Maltings and Clements Practice needed help, so in May 2019 the practice turned to West Suffolk Clinical Commissioning Group (CCG) to seek assistance towards funding an online triage tool. The CCG recommended eConsult as the platform was being commissioned by the Group and had already been implemented within some pilot practices. CMCP looked at eConsult and decided it was just what they needed.
The practice wanted to employ a ‘Total Triage’ model of care, where all patients would be encouraged to use eConsult as their first point of call. To do this, eConsult worked closely with CMCP’s Process Manager, guiding them through the process of implementation and collaborating to ensure the platform worked for the practice and patients in the best way possible. Some staff were less familiar with a triage-based model of care as they had previously been used to supply-led processes.
Staff were provided with the tools needed to learn and understand how to use eConsult. Clinicians and receptionists had access to a demo site, where they could use the platform themselves to get first-hand experience of how it worked, while the eConsult transformation team were on hand to provide any additional support when it was needed, including mapping internal processes and workflows for care navigators.
The final hurdle to overcome before launching eConsult was making patients aware that the platform was coming into place and how to use it. CMCP made a concerted effort to increase patient awareness. This included texting patients to let them know about eConsult before implementation, posting on local forums, designing and distributing leaflets and hosting public engagement events and sessions with parish councils to show patients how it works. The local PPG was also engaged with, who were very supportive of the eConsult service being brought to the practice and hosted training events in the local library to show fellow patients in the community how to use the platform.
“There was a lot of hesitation from patients when they heard about eConsult. People were worried that it would make it harder for them to access a doctor. We worked really hard to show patients how it could benefit the practice and themselves.”Dr Brandon, Clinical Lead GP
From hesitation to elation
Following the rapid roll-out, training and awareness period, Christmas Maltings and Clements Practice officially launched eConsult in December 2019. Thanks to the ‘Total Triage’ model and awareness campaign the practice implemented, use of the platform by patients quickly accelerated. Just one month after launching in January 2020 CMCP received 3,461 eConsults.
Thinking of moving to a ‘total triage’ model? Get in touch with our team
Initially concerned patients quickly embraced eConsult and saw immediate benefits to its use. They realised that the platform meant that they could receive advice and care from clinicians much quicker than before, receiving a response in just 24 hours rather than having to queue on the phone or outside the practice in the hope of getting an appointment. For those patients who were unable to use eConsult, the practice developed a ‘VIP list’ of patients with specific, complex conditions that were better dealt with directly over the telephone. This also ensured that these patients felt the effect of the improved telephone access resulting from other patients going online. Soon the complaints were turning into compliments. Feedback from patients has been positive, with over 60% saying they would use the service again instead of a face-to-face appointment. Comments on the service include:
- “[eConsult is] convenient because I can fill it out whilst getting on with other tasks during the day instead of queuing in the surgery or waiting on hold for ages.
- “I’m very satisfied because I’m getting almost immediate action. I find it very reassuring that a doctor or pharmacist can communicate with me only hours after my initial request. If I needed 1:1 attention I’d seek it but most of the time I don’t. eConsult saves so much time.”
- “I think it is a great time-saving tool for patients and GPs. I also hope that it is avoiding people cancelling appointments as I know that is a huge cost to the NHS, so I fully support this service. Our local doctors are notoriously difficult for getting through to reception, let alone trying to get an appointment, so this is an excellent improvement. It was quick and simple to do.”
It’s not just patients who have benefitted but staff as well. Clinicians, like patients, were initially hesitant about the introduction of eConsult to the practice. However, following its implementation, they saw an immediate improvement in their ability to provide care to patients, work-life balance and morale.
“Staff were initially worried that there would be a flood of demand from patients once eConsult was in place and didn’t want to undo the cap on consultations that was previously in place.
Once we had the platform up and running, the benefits were immediately realised by the team. Now we can predict our demand and it is stable, so we can plan and resource ahead of time, as before we were unable to analyse our data and consider our processes. Patients were happier with the service provided so clinicians received fewer complaints. At the same time, the efficiency gains made from staff not having to be on the phones or hold face-to-face consultations for every patient meant they were able to better manage their workloads. Before eConsult, most days staff would be working late into the evening, now we’re able to finish our work on time.”Dr Brandon, Clinical Lead GP
Staff morale also improved thanks to CMCP’s new communal working policy. Clinicians converted the practice’s meeting room into a hotdesking office where they could all manage and work through eConsults together. By sharing advice and expertise with one another, this created a greater sense of comradery and togetherness within the team. It also allowed staff to more quickly pick up nuances and best practice that come with experience in remotely closing asynchronous online consultations.
eConsult has also proved a valuable tool for CMCP during the COVID-19 pandemic. With the platform already in place, when the pandemic hit the practice had eConsult to hand to allow clinicians to do more consultations remotely. This helped to keep people safe and prevent infection while still allowing staff to provide care to those that needed it. With patients being told to stay home where possible, it encouraged many to use eConsult to contact the practice, leading to further uptake and embracing of the platform across the community.
CMCP’s turnaround since implementing eConsult, as well as the development of its long term strategy, has even seen the practice taken off special measures by the CQC following an interim inspection, a testament to the hard work carried out by staff to improve its service to the community. Dr Brandon also presented on the practice’s achievements at a meeting with representatives of the Town Council and local MP Matt Hancock, who expressed how impressed he was with the work being done.
Dr Brandon, Clinical Lead GP
“eConsult has been an integral part of our recovery and has provided us with a solution to a problem that has proved unsolvable here for the best part of a decade. By helping the majority of patients through the platform, we are able to spend more time where it is most needed. We can better help more vulnerable patients who are now no longer competing with very congested telephone lines. eConsult helps us deliver compassionate, connected and personalised healthcare.”