North Surgery, Annan
- Patient List size: 7,500 patients
- Location: Rural practice, Annan, South West Scotland
- Launched with eConsult: April 2020
- Model: Routine / On the day
North Surgery was one of the first practices in West Scotland to implement eConsult and to understand how online consultation could improve practice efficiency and patient safety, especially during COVID-19. In the space of two weeks, both of the practices in Annan rolled-out eConsult to their patients, in order to keep the community and the practice staff safe. Patients have appreciated the ability to seek help from their practice during lockdown and now use it as the principal access route for help and advice.
North Surgery is a semi-rural practice in Annan, South West Scotland. The practice has 7,500 patients and 7 GPs with varying shift patterns, each with outside interests. As a training practice with a 40-year history of new students, new developments and improvements, they are used to dealing with changing environments.
In the autumn of 2019 Dumfries and Galloway Health Board and its Clinical Lead initiated an evaluation into different online consultation suppliers, with eConsult most closely fitting the needs identified across South West Scotland. However, when COVID-19 arrived in the spring of 2020, there was an urgent need to radically change service delivery across the area.
The practice had gone from two weeks’ wait for an appointment to dealing with all patient queries on the day, without face to face consultations. Relying on telephone and video appointments, they decided this was a good opportunity to explore new ways to allow patients to seek help and to implement eConsult as their online consultation solution.
Thinking about their patients, who probably needed help but were unsure what to do about it during ‘lockdown’, both of the practices in Annan (North Surgery and Greencroft South Medical Group) rapidly procured and implemented eConsult over a two week period. The practices wanted to send a clear and united message to all patients in their community about the best ways to access healthcare during COVID-19. Working together also meant they could share ideas and best practice – giving them collective responsibility to make it work for their patients.
Over this two week period, the practices worked hard to carry out eConsult’s online training, attend training and best practice webinars, map out processes, workflows and to devise scripts for staff members to follow, reinforcing the reasons for implementing a new way to access services from these surgeries.
“Our implementation process was rapid because we knew that COVID-19 had created a state of flux – it felt like the perfect opportunity to adopt a different approach that could still allow us to help our patients. There was a lot of appetite for change among practice staff, and having the training fresh in our minds when we started was incredibly helpful.”Dr Neil Kelly, GP Partner
The practice focused on informing patients in advance by way of a local press release and by sending out regular text messages and emails in the lead up to their live date. They needed to let patients know that as face to face appointments weren’t possible there was a new way to interact with the practice. By sending out a link to the practice website, patients were able to explore the eConsult platform and the practice has found patients very receptive to this change. The message on the practice’s website was also adjusted to reinforce eConsult as the main access route into the practice. As eConsult had built-in messages and information about COVID-19, including Government advice, the practice did not need to add too much information to their own website.
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“We’ve gone from not doing online consultations to doing them seriously in the space of less than two months, and it’s gone really well. For us, COVID-19 has been an opportunity to introduce the service and reduce the number of patients coming into the practice. Most of the requests that come to us don’t require a face to face – but introducing a new system like this would have been a much harder sell pre-COVID.”Dr Neil Kelly, GP Partner
There has been positive pick up from patients since day one and it is now used as the principal entry source for routine or on the day appointments. The practice works hard to ensure that eConsult reports received are responded to as quickly as possible, usually within a few hours, and most of them on the same day as the patient submitted them. The practice has found this to be a good way to encourage use: when patients see a response and a good level of detail it helps them to know whether they are being asked to make further contact or if they can help themselves through self-help information sent to them.
Now patients are getting used to the idea, some still need support and the practice is providing encouragement and advice regularly. The practice will use a clinical system initiated ‘eConsult Lite’ templates that were developed to support reception staff to gather comprehensive histories over the phone. They are also maximising their usage of long term condition and chronic disease questionnaires, using them to gather information and patient expectations of their conditions, such as asthma or mental health. This allows the practice to have brief but focussed remote consultations with patients, instead of their usual face to face appointments.
eConsult practices in Scotland have formed a network to share best practice and to facilitate feedback and idea generation with members of the eConsult team.
“It’s been great to see some of our suggestions for how eConsult can be improved and implemented already. The team works actively to improve condition questionnaires, listening and developing with clients. I’ve been impressed by the agility and speed of response, positive attitude and approach from the team, with all interactions feeling constructive.”Dr Neil Kelly, GP Partner