Eden Court Medical Practice and Hodge Hill Family Practice, Birmingham
Watch a presentation from the Dr Richard Edwards, and a Q&A session with other practice leaders.
Questions from other practices:
- Is it challenging for the duty GP to handle triage as well as supervising other clinicians?
- Why not wait until all today’s appointments have been booked up, and then triage extras?
- Could this approach work in a smaller practice?
- Do you have the same GP on duty all day, or do you cover just one session each a day?
- Do you think this could work during winter, with higher demand?
- Doesn’t demand just expand infinitely if we ‘open the floodgates’?
- Doesn’t demand just expand infinitely if we ‘open the floodgates’?
What did the practice do?
The practices implemented a ‘total triage’ system with all patient-initiated contacts being directed through online contact using the AccuRx Total Triage tool.
Patients who are part of a longterm condition recall are booked directly with the clinician they need to see. All other patients are asked to use AccuRx Total Triage to send an online request to the practice. This has in-built translation. Patients who call reception but are unable to use a mobile phone have details of their need taken by the receptionist, who enters them into the Total Triage system, so that all patient contacts are processed in the same way.
All contacts are viewed first by a GP, who works together with a senior administrator much of the time. The GP triages the contact, redirecting admin queries to the admin team, asking the reception team to book appointments for some patients (including details of the most appropriate person and time), and dealing with some contacts directly – sometimes the triaging GP will call the patient for more information, but this is not always necessary, where enough information has been provided first time.
Currently there is one GP allocated to triage duties in each morning/afternoon session. The triage GP is also available to support trainees and ARRS staff, and answer queries from the clerical team.
What has happened as a result?
In spite of apprehension on the part of staff prior to implementing it, the new system has been well received by patients and staff and is delivering several benefits.
- Right access first time. More patients are being connected directly with the most appropriate member of the team, and clinically led decisions are made about the appropriate timescale.
- Continuity of care has improved.
- The stress of work for receptionists has been reduced.
- Patients are better able to communicate in their own language.
- The workload for the triaging GP has been found to be manageable.
- As a result of some contacts being dealt with remotely (in much less time than a typical appointment) and continuity having increased, the practice has released GP appointments. There are now unfilled appointment slots most days – the first time this has occured in the past 20 years.
- Contacts initiated through the online system provide rich detail about the patient’s need and their ideas, concerns and expectations. Knowing this before any clinical makes it easier for both the triaging GP and other clinicians to provide high quality care.
- As a training practice, it has been easier to ensure trainees have appropriate patients booked with them.
What would the practice say to others?
Communication to patients. Explaining the new system and the rationale behind it has been important in the early days. The practices have provided clear information in their website, their phone system and in reception. After about 6 weeks, the new system was being treated by most patients as ‘the usual system’.
Triage avoids treating all patients the same. Having an experienced GP involved at the start of the patient pathway has made it a lot easier for the practice to connect them with the right person or service at the right time and in the right way. More patients who need continuity are getting it, and a significant proportion of contacts are being dealt with in 3 or 4 minutes rather than needing a 10 minute appointment slot. It is now easier for clinicians and receptionists to spend more time with the patients who most need it.
A 24/7 system smoothes demand on the practice. Patients can use the online contact system 24/7. As a result there has been a gradual smoothing of demand, with less of the usual Monday morning peak. This makes it easier for the practices to meet patients’ needs appropriately without turning them away and asking them to call again.
Benefits can be rapid. The practices found that the benefits of the new system were noticeable within the first fortnight. After 6 weeks the system felt natural and neither clinicians, managers nor receptionists wish to return to the old system.
Learn and adapt. It had not been anticipated that the triaging GP would have as much availability to support other staff as they have. This creates new opportunities which are being explored. The practices are considering options for making it easier for the triaging GP to see patients in person as well as doing their triage work (which is currently performed in an admin room).
How could you use this?
Communication to patients. How would you let patients know in advance about the change to the access system? Options could include a newsletter, emails, text messages, information on the website and on posters, and on the phone system.
Preparing the reception team. How will you ensure the reception team are confident in explaining the new system and its rationale to patients, and in taking details from patients unable to use the AccuRx messaging system?
Choosing the pathway. What kind of pathway would you want to implement? These practices selected a GP-first approach, but it is also possible to have a receptionist-first pathway. There are pros and cons to each option, and it is worth considering what is likely to work best in your situation. An editable sample pathway is available here for you to work with in your own practice.
Updating the appointment book. What changes would you need to make to the clinical rota and the appointments to make the best use of this system? Whichever option you choose for the patient pathway, it will be essential to carve out time for clinical assessment of online patient contacts. You may also want to create some shorter and some longer appointment slots for the triaging GP to select, depending on the patient need (eg a 5 minute slot for a simple skin examination after the history has been taken, or a 15/20 slot for patients with complex needs).
Measuring impact. Consider in advance what you would measure to know if the changes are an improvement. This is likely to need to include assessing staff and patient experience, appointment availability and quality factors such as continuity.
Learn and adapt as you go. It is worth expecting that you will want to make some adjustments to your new system once it is in place – plan regular reviews which include clinicians, receptionists and managers.
Rethinking ongoing care. Ask your clinicians to note which follow-ups are booked in order to answer relatively simple questions about the patient’s progress. Experience is showing that many follow-ups could be handled safely and quickly by an online-first contact. A number of digital tools allow this to be scheduled, so follow-ups are not delayed.
View the patient pathway being used by these practices. Use the edit button (a pencil) to create your own version.