Folkestone, Hythe and Rural PCN – eHub Case Study
eHub Case Study
- Kent and Medway Integrated Care Board
- 7 practices semi-rural location
- 49,336 combined list size
- eHub setup October 2022
Key benefits:
- Primary eHub for processing online consultation requests utilising PCN staff and services
- Appropriate eConsults triaged and filtered into PCN Hub Minor Illness service, PCN level services and Community Pharmacy Consultation Service where applicable.
- Collaborative working between PCN Hub and member practices using Right Care, Right Time, Right Place principles.
What we will cover:
Introduction:
Folkestone, Hythe and Rural (FH&R) PCN was founded in 2019 and consists of 7 member practices of varying size in a semi-rural location on the South Kent Coast area. The patient demographic varies from pockets of deprivation around Folkestone to more rural elderly population with multiple co-morbidities. The former South Kent Coast CCG locality has experienced a GP workforce shortage with many GPs retiring and too few replacements resulting in a growing locum workforce over permanent GP staff. Consequently, some of the practices have experienced around 2500-3000 patients per whole time equivalent GP with rising demand and pressure on appointments.
In late 2021, Folkestone, Hythe and Rural PCN set out a plan to design and implement an eHub to help support the practices that were challenged by the rising demand for online consultation.
FH&R PCN eHub is now processing over 4500 eConsults per month and the processing of eConsults by the eHub is now substantially quicker than the individual practices prior to the implementation of the eHub. The digital infrastructure of the PCN Hub and eConsult Smart Inbox was pivotal in deploying a quick and scalable solution to meet the rising demand of winter pressures.
eConsult was procured as the online consultation system of choice across Kent and Medway with an accelerated rollout just prior to the COVID-19 pandemic. During the pandemic, many of the practices shifted to remote consultations to safely manage their patient population and consequently, there was a growth in online consultation utilisation. Some of the practices implemented a ‘total triage’ approach to help manage the rising demand during these challenging times.
In late 2021, Folkestone, Hythe and Rural PCN set out a plan to design and implement an eHub to help support the practices that were challenged by the rising demand for online consultation. A series of transformation workshops were arranged, the practice baseline positions were presented and options for a potential solution were discussed. It was evident that each of the practices had varying utilisation of online consultations adjusted to list size with some heavily dependent on eConsult as part of their triage process whilst others had minimal usage and slow traction in embedding online consultation within their operating model. Each of the practices had different methods of processing online consultations and different response times to inbound requests.
The data below shows the baseline position and total monthly eConsults across the PCN prior to the implementation of the eHub:
Designing a solution:
Based on practice feedback during the initial workshop sessions, the following pre-requisites formed the requirements for the design of FH&R eHub:
- Seamless and equitable access for all PCN patients
- Central processing and triage of all inbound clinical requests via eConsult by the PCN Hub
- Maximal utilisation of PCN services where applicable to complete the eConsults with the remaining clinical eConsults to be completed by practices.
- eConsults from patients with complex clinical needs and where appropriate preserving continuity of care to be processed by practices
- Administrative requests initially to be processed by practices
- Ensure a financially sustainable model is created using PCN resources and financed within existing PCN contracts
Proposed operating model and technical solution:
The final solution selected by the practices led to a hub consisting of three advanced nurse practitioners and two care-coordinators.
The hub consisted of three elements:
- Centralised processing of all eConsults from the member practices
- Provision of an ANP-led minor illness service with a combination of telephone and face-to-face appointments.
- Provision of appointments to support the Enhanced Access Contract introduced in 2022 across 6:30 pm – 8 pm Monday to Friday and 9 am – 5 pm on Saturday.
In order for the proposed solution to be implemented a programme of digital transformation occurred supported by the PCN Digital Transformation Manager to create the necessary infrastructure to support this collaborative approach.
All PCN practices utilised EMIS Web, therefore an EMIS Clinical Service was commissioned with a full data sharing agreement, PCN level cost centre for prescribing, spine services configured and a dedicated MESH inbox to receive inbound eConsults intro a central location. Folkestone, Hythe and Rural PCN were part of an NHSE South-East Region pilot of consultation write back with EMIS so that all consultation entries made in the PCN clinical system were automatically written back into the registered GP practice.
Initial testing successfully received all inbound eConsults into the clinical service and consultations were written back to practices having been processed. However, there were substantial limitations in efficiently processing all eConsults at this scale within the EMIS Clinical Service in isolation. Subsequently, the PCN reached out to eConsult to implement the eConsult Smart Inbox for our eHub. This tool was a key an essential component to ensure seamless and collaborative working across PCN Teams and the practice teams in a highly efficient process.
The eConsult Smart Inbox enabled the PCN Hub team to efficiently triage all inbound clinical requests in a centralised queue and select all eConsults that were relevant to the following PCN level services:
- Minor Illness Hub
- First Contact Physiotherapy Service
- Mental Health Service
- PCN Pharmacist
- Social Prescribing Link Worker
- Community Pharmacy Consultation Service
The user-interface within the Smart Inbox was intuitive to be able to filter appropriate eConsults, signpost to PCN staff and add comments to support multi-disciplinary working across teams. Conversely, practices were able to visualise hub activity as well as their own work and continued to process administrative requests as before.
Outcomes:
Since the implementation of the eHub, the monthly throughput of online consultations has increased and some of the practices that had underutilised eConsult were seeing growth. FH&R PCN eHub is now processing over 4500 eConsults per month in comparison to around 1500 per month towards the end of 2021. Initially, the eHub team were selecting around 18% of inbound clinical activity into the minor illness hub or PCN level service. This has now increased to around 35% of inbound eConsult requests being processed by the hub. Since the introduction of the Capacity and Access Support payments and contractual changes for 2023/24, FH&R PCN is revisiting the scope and capacity of the hub to further increase capacity and access.
The processing of eConsults by the eHub was substantially quicker than the individual practices prior to the implementation of the eHub. This was due to a dedicated PCN team who were now able to process the eConsults centrally. Practices reported the freeing up of admin overhead and they were able to focus their efforts on any residual activity that was signposted to the practices and focus on patients with more urgent and complex needs.
Prior to the implementation of the eHub, many of the practices struggled with the demand on Monday mornings due to weekend submission with some of the practices restricting non-core hours access to eConsult. Due to the efficiency of processing eConsults by the PCN team and the hub operating during the extended hours of the enhanced access contract including Saturdays, practices reported a reduction in admin and clinical time processing eConsults, particularly on Monday mornings. The practices also
For those patients triaged into the minor illness hub, the vast majority were offered a telephone or face-to-face appointment the same day. We were able to implement a PCN level Community Pharmacy Consultation Service (CPCS) utilising the efficiency of the smart inbox to select appropriate cases that met the inclusion criteria for the service.
With regards to winter access funding and acute respiratory infection cases during the winter of 2022, the eHub played a key role of triaging appropriate cases into the additional appointment capacity that was created through the winter access funds. The digital infrastructure of the PCN Hub and eConsult Smart Inbox was pivotal in deploying a quick and scalable solution to meet the rising demand of winter pressures.
FH&R PCN were the first to pilot the CPCS module directly within the EMIS Clinical Service enabling PCN hub staff to signpost patients to CPCS. It is still early days for the PCN CPCS service as more data is being gathered. The initial activity was low mainly due to the anticipation of a prescription required. However, the model has been reformed to include a dedicated PCN line for pharmacists to directly request a prescription via the PCN Hub following a CPCS consultation.
A provisional survey demonstrated overwhelming positive feedback on the PCN Hub service and this was presented to the PCN PPG.
