Case study summary
Thornfield Medical Group in Newcastle is made up of 8.5 whole time equivalent GPs and 4.5 whole time equivalent emergency care practitioners, comprising of Advanced Nurse Practitioner (ANP), mental health nurses and paramedic, serving a patient population of 21k. The practice participated in the Time for Care programme, which provided tailored support for the need of the practice during the pandemic, to look at ways it could reduce the number of face-to-face appointments it could deal with differently. Time for Care is delivered by NHS England and NHS Improvement.
A team under pressure
The vast majority of patients were coming into the practice for a face-to-face appointment, even if there was no clinical need to do so. This was putting huge pressure on staff who were increasingly finding the demand difficult to manage.
The team identified reasons why there were so many face-to-face appointments.
- Face-to-face appointments had become the norm for both staff and patients, with few appropriate alternatives offered.
- The practice had ambitions to make online consultations more widely available through eConsult but had not promoted enough.
- While signposting was happening it could be more effective.
By participating in the programme the practice team committed time and effort to tackling the above issues.
The team implemented a communications plan that helps it promote eConsult.
- There is more visible information on the practice website with embedded links e.g. information about sick note requests includes a link to eConsult where patients can make a request.
- The practice telephone message informs patients they can go online to book a consultation.
- The practice’s social media messages on Facebook promote the tool.
- Following telephone conversations with patients, care navigators send a follow-up text to patients that includes information about eConsult.
The push to promote eConsult has increased patient awareness and had a direct impact on patients taking up remote appointments.
A more effective way to signpost
The practice’s VTS (Vocational Training Scheme) registrar introduced staff to an excel tool they had previously used at another practice in Northumbria, which helps to signpost. It lists issues and queries patients contact the practice about and the appropriate patient pathway that should be followed e.g. book an appointment, refer to local pharmacy. This helps care navigators to direct the patient to the best person/service to help them.
The tool was tailored to local patient population needs by listing every request that came in to the duty team and the patient pathway it should follow. It is a live tool that is updated on an ongoing basis.
- A dedicated duty GP is at hand should the care navigators have any queries arise that are not on the tool, the GP can advise and then update the tool accordingly.
- The clinical governance GP who also works as part of the duty team will add information as new queries and issues emerge e.g. post-natal depression, diabetic hypo, arthritis pain
Patients benefit from going through a validated tool where they are directed to the most appropriate person or service. Any serious concerns are picked up and referred to 999 or 111 to speak to someone immediately.
Better understanding of patient needs
Care navigators now use eConsult Lite, where they ask patients questions about the medical condition and why they are ringing. This helps navigate the patient more effectively and have a record of the reason they contacted the practice and the advice given.
During the early stages of testing eConsult Lite care navigators were finding the tool unmanageable and too time consuming. As a result it was tweaked and a simpler version created which is quicker and easier to use.
- Over six months the practice has reduced the number of inappropriate appointments. Resulting in a decrease of face-to-face GP appointments by 22% per week and for the ANP by 37% per week.
- The number of eConsults per month have increased by 94%, giving patients a service than can be used easily. Thereby improving access for patients.
- Patient choice has increased, they no longer need to visit the practice for a face-to-face appointment if there is not a clinical need, saving them time and giving them more flexibility. Feedback from patients has been positive.
- Patients are receiving a more positive service. They are being directed to the most appropriate person or service to meeting their needs.
- GPs are working more efficiently, as most appointments are now done remotely it allows them to manage their workload more easily while also reducing footfall into the practice.
- The changes have given care navigators more confidence and improved their knowledge of how best to direct patients.
“It’s been hugely beneficial having someone to help and guide us, gain ideas from a quality improvement expert who has worked with other practices. We’ve significantly increased the number of online consultations giving patients more choice and flexibility, and staff a more manageable workload.”
Tracey Stuchlik, Business Manager, Thornfield Medical Group