Hurley Group – eHub – How structured data is essential to an effective eHub
Hurley Group – GP Partnership
Key benefits:
- eConsults structured data is critical to their eHub. It offers a safety capability they simply do not have with traditional models
- 10 times recruitment from the offer of flexible remote working
Introduction:
Dr Ross Dyer-Smith and his colleagues at the Hurley Group first created the idea of a digital eHub in 2017. The idea was born out of the realisation that they had inconsistency in the processing of eConsults across their sites and a workforce that had a lack of familiarity with this way of working.
Their eHub model was designed to have a team of highly skilled clinicians and a management structure that could help manage online consultation demand and therefore maximise efficiency. In 2017 the Hurley Group were also an early adopter of online consultation via eConsult, which allowed for remote access, remote prescribing and shared hospital records. All of this was set up to enable safe and effective remote care.
“We created the eHub concept in 2017 because of a realisation that we had inconsistency in the processing of eConsults across our sites and a workforce that had a lack of familiarity with this way of working. We felt an eHub would create a team of highly skilled clinicians and a management structure that could help manage demand and therefore maximise efficiency. We also at that time had a collection of tools available (eConsult, remote access, remote prescribing and shared hospital records) that enabled safe and effective remote care”
Dr Ross Dyer-Smith
A diverse team allows for flexible and efficient working
The Hurley Group eHub is staffed by a team of over 60+ staff that has consisted of an admin team, GPs, pharmacists, PA, ANPs. This team then works in the eHub in a flexible way (remotely, at different times and in a high remote management mindset) to create capacity by providing the equivalent of 8 whole-time staff sessions. This gives the capacity back to the practices within the eHub to continue to run normal services, creating a much larger capacity for patient access to care.
70% of all eConsults are processed by the eHub.
After being submitted by a patient all eConsults now arrive directly into the eHub first, this is known as a Primary eHub. Approximately 60-70% of these eConsults are processed by the eHub with the remainder either triaged out to local service providers (i.e. pharmacy) or passed back to ehub practice sites where the patients are registered at. In the early days, 100% of eConsults were processed by the eHub centrally, but the team found it did result in some deskilling and lack of knowledge on the clinicians not working in the eHub. This has been a major development for the eHub as it has evolved since 2017.
eConsult’s structured history allows a safe and fast triage process
Dr Ross Dyer-Smith believes that the structured information that is collected by eConsult is absolutely critical to the safe triage process. 100% of eConsults are triaged by a clinician. Once up and running, a clinician is able to process eConsults at a rate of up to 120/hr which is made possible by the flagging and detailed history. This means true triage can take place without the medical record, at high speed.
“It’s absolutely critical. We could not function the eHub without it. It offers a safety capability we simply did not have with traditional models”
Dr Ross Dyer-Smith
An effective triage process has meant a vast improvement in speed of triage for patients. They have noticed that patient satisfaction is closely linked to speed of response and getting patients to the right place fast, so overall patient satisfaction has improved.
Bucking the trend in GP recruitment
Following trends in other industries the Hurley Group eHub has been able to offer very flexible working to staff. This has meant that pre-pandemic recruitment levels were 10 times that of normal general practice, and the team has been able to get the best teams in for the roles.
The eHub is staffed by eHubbers (that’s what they call themselves) from all over the country from Yorkshire to Cornwall and also internationally with NHS staff working from 13 different countries. This has been game changing to recruitment, meaning the eHub can now look nationally and internationally instead of being restricted to local only.
Unlike other Primary Care offerings, the Hurley Group is able to offer some real benefits to its staff, which has meant hiring has been far easier than the national average.
Flexibility is key to being able to handle Primary Care
Having a mature eHub meant the Hurley Group had the perfect pandemic-proof system! They had a seamless transition and put this down to having an eHub up and running prior to the pandemic. They actually managed to increase their overall capacity during that time.
This has also allowed the Hurley team to have “ surge” capacity in times of need. With such a large team, even a small contribution from each individual makes a big impact on the wider capacity when there is a challenge at the practice sites.
The way the eHub has been built allows for flexibility, which has been key over the past few years. The team has been able to change the model quickly, easily and must have done this at least 10+ times during the last few years (pandemic, high demand days, bank holidays, skill mix changes). It’s an easy service to evolve and refine quickly.
During the pandemic as the number of F2F consultations dropped immediately, the eHub were able to take on more online consultations to deal with more patients remotely. Over time, the eHub has been able to increase the number of patients it processes by closing more consultations remotely.
The Smart Inbox gives oversight of health issues in the triage queue.
The Smart Inbox helps with triage and overall visibility of all eConsults. The triage process in the eHub means the team has got so good at predicting demand that they are normally only a few eConsults out on their prediction each week.
Since the Hurley Group eHub started we have done 1/2 million eConsults from 80,000 patients through the eHub with a 90% remote closure rate.
30% of all eConsults are now diverted to other roles or services with 5% diverted from any clinical service. This has both promoted far better use of all resources, and helped to balance workload pressures out across the teams.
What next for eHubs?
Dr Ross Dyer Smith: ‘I see eHubs working across the country helping out areas of need, who may have low numbers of GPs. I see us retaining many more staff that would have left the profession because of the flexibility of remote working.
eHubs can work for secondary care helping manage demand in EDs and outpatients. the possibilities are huge.”
I see eHubs working across the country helping out areas of need, that may have low numbers of GPs. I see us retaining many more staff that would have left the profession because of the flexibility of remote working. eHubs can work for secondary care helping manage demand in EDs and outpatients. The possibilities are huge.