Mary Hudson
Hello everybody and thank you very much for joining us. Welcome to the Transforming Primary Care podcast, talking about modern general practice today and particularly GP online access.
My name is Mary Hudson, I’m a Deputy Director in the National Primary Care Team – NHS England. And I’ve been involved for a number of years now in transformation in general practice and particularly digital transformation in general practice. I’m actually going to be moving on from NHS England relatively soon, but that’s put me in a frame of mind to reflect about the different things that I’ve been involved in across the years that I’ve been in NHS England. And there has been a lot of change. I think it’s always worth saying that, I mean, general practice actually at the forefront of digitisation of services ahead of the rest of the NHS for a long time now and continues to be. But we’ve seen a lot of change in the last 5, 10 years.
When I joined, there was a lot of work happening with patient online, GP online services. We then had the NHS App that came along behind that. A lot of practices starting to experiment with and begin to use online consultation systems. Then, of course, had the big shock that was COVID, which drove a lot of digitisation as part of the emergency response. There was quite an interesting uptake of video consultation in general practice as part of that emergency response then died away again, I thought was quite interesting. Since then, much more of a push on using online consultation tools as part of total triage, then modern general practice. We’ve had contract changes over that time as well to support, mandate, require digital change most recently with the requirement to have online consultation tools on throughout core hours.
We’ve also had a few years ago the push to get all practices onto cloud-based telephony. We’ve had the GP registration service, a lot of work around patient access to the GP record – essentially a lot of change. And I think really interesting how those changes have really landed in practices and with patients and how that has changed the relationship between patients and practices in terms of communication and how that access and relationship works. So really pleased to be having a conversation about that today with five general practice staff from across the region to talk about, you know, what that’s been like, the experience, what’s worked well, what’s worked less well, and plans and opportunities for the future.
So great to have all of you here. Thank you for joining me. To introduce the guests, we have:
Dr Robert Westgate, who is a GP and clinical director at Carlisle Healthcare Primary Care Network and is the chair of North Cumbria LMC – Local Medical Committee -welcome Robert.
We also have Jane Dalgleish, who is practice manager at Tennant Street Medical Practice in Teesside. Welcome Jane.
Then Rebecca Rowe, Practice Manager at the Ridings Medical Group in East Yorkshire. Welcome Bex.
Then Helena Ebbs who is a GP at Helmsley Medical Centre and Deputy Medical Director at Humber and North Yorkshire ICB. Welcome Helena.
And last, but by no means least, Lianne Jerome, who is at Yorkshire Health Partners where she is a Digital Transformation Lead and NHS App Ambassador. Welcome Lianne.
Thank you all for joining. So I wanted to kick off with – I’ve been talking lots of digital changes that have happened over the last few years. Interested in your reflections, what do you think that the change has been, supported by digital tools, that’s had the biggest impact for your practice? Robert, I wonder if I could come to you first and have your thoughts on that question.
Robert Westgate
Yeah, thank you, Mary. So yeah, it’s been quite a journey. I’ve been a GP for over 25 years now and seen lots of changes from the very early days of computers in general practice in the mid-1990s to where we are now and everything in between. The biggest change I think that I’ve seen has been the change around access and online consultations as an access tool. As a practice, we look after about 40,000 patients having gone through a merger process in Carlisle in 2016.
We had some major challenges with patient access, well, prior to the merger, but especially following the merger in terms of just telephone congestion and the people on hold for inordinate lengths of time with reception staff trying to understand what people were requesting. And that was hugely problematic and by the time people got through, patients were often frustrated. There were difficult conversations with our reception staff. If there was limited capacity, nothing to offer, it would be, ‘can you call back tomorrow?’, leading to even further frustration and duplication of effort and duplication of work. When we moved to total triage and online triage, some of the feedback we got from our front of house staff was, their conversations with patients had turned into, ‘I’m sorry, we can’t’, into ‘we can offer you.’ So we turned a defensive conversation into a positive offer of care and the next step. And our frontline staff had found that revolutionary. So rather than coming to work for a fightwith patients, they’re coming to work to offer people a service that would hopefully improve their outcome and their wellbeing.
So, we introduced online consultations in the practice in around 2018 and that was partly in response to the telephone congestion and the difficulties of people getting through to the practice. We ran it as a parallel stream to telephone access rather than as an all or nothing. Introducing online access, it did what it said, people would use it, our telephone congestion would go down, and people were able to get through on the phones and that’s due to develop more and more over the years as online access has become more embedded in the way people access their GP practice.
We recognise that not everyone is digitally enabled, but if the majority of people contact us when they need us online, it means that those that are not able to contact us online are more readily able to get through on the telephone lines. And over these past few years, our activity has kind of plateaued at around 75, 76% of people contact us online by default and the remainder contact us over the phone or by walking into a front desk. But online access has been the most transformative aspect of digital impact over these past few years.
Mary Hudson
Thanks Robert, really interesting. Rebecca, I wonder if I can come to the same question with you.
Rebecca Rowe (Bex)
Definitely the access, the online triages had a big impact, but one of the nice things around that is all the new systems seem to be tying in with the NHS App and they’re embedded in the NHS App. And that is presenting lots of opportunities because we’ve now got lots of patients who have signed up for the app and a lot of the new systems, like the online triage are linking with the NHS App and allowing patients to use that app to then go into lots of different systems. One of the systems being the new online registration process for practices, which is nicely linked in through the app – it brings all the patients demographics up but there is also a web-based portal that patients can go into to register. Obviously the old way of doing it would be through the paper forms, which would mean we’d have to print forms out or have forms available. Patients would have to come in, take them home, fill them in for the whole family and then bring them back in and each form could take 5 to 10 minutes for an admin person to submit and put through the system. There might be errors, we might not be able to read the handwriting, and it might be a bit of too-ing and fro-ing back with the patient to find their information and their NHS number on the system to match them.
We are seeing a massive increase in people registering through the new online system within the practice.
And we get about 80 to 90 registrations a month now being done through that system. And when you think about that being maybe 5 to 10 minutes at the most for an admin person to enter that, we’re potentially saving about 14 hours a month, which is, you know, fantastic, which then frees up the time for our admin staff to then do the onboarding for these patients, get them registered straight away. Previously, it might have been twice a week that the admin people would register these patients, so it’s no longer taking three days to register a patient or, you know, a couple of days to register. It can be done within minutes of them sending that information over and they can then go straight on to accessing the triage service through their app because they get a message to say you’re now registered. Here’s the information of how you get an appointment and how you use our triage service. And they can also start ordering the medication, which is fantastic. It’s a really good service, in comparison to those delays that we, maybe, had in the previous system.
Mary Hudson
Thanks, Rebecca. Yeah, really great to hear how it’s not just each digital tool making an impact, but actually the integration between them as well. Jane, I wonder if I can come to you about perspective from your practice?
Jane Dalgleish
Yeah, hi. I think the one to me has been the self-booking links. I’m a bit of an IT geek anyway, but that to me has been absolutely phenomenal. I can remember when it first came out and I was explaining to our GP partners, there’s nine of them. So I did a demo when they all went, whoa, and I said, well, I did tell you it’s good. So, I find it absolutely amazing, it has stopped us having to make phone calls. You all know that’s like for admin because people are at work or they don’t answer the phone or you book them an appointment, they don’t come in anyway. So, this has absolutely transformed the way we work, certainly.
And a little bit of lateral thinking in terms of, I can remember a lady coming in to book a smear test, but she didn’t have a diary with her. So, the receptionist said, oh, I’ll just send you a link. She’s ‘oh great! I can get home, get my diary.’ And so that to me has been phenomenal. And the other one that has made a massive difference to the patients as well is the callback on the telephone system.
I think the frustrating part for me was, I think, like a lot of practices immediately after COVID, we were really struggling with access on the phones. So, we did a lot of work, changed the whole system round at the same time as we got the new telephone system in and then all the patients were saying, we love this telephone system. We’re like, it wasn’t just the telephones, we did some work as well (!) But yeah, any IT at all, I really jump on because I think it’s fantastic. And I think it’s transformed the practice, definitely. Again, probably like a lot of you guys with the online access, there was a little bit of twitchiness from the GPs, just that little bit of nerves. But we did it. We get a lot fewer complaints now and I think a lot of it is because the access is now so good. But we’ve worked hard to get there. But it’s been worth it.
Mary Hudson
Thanks, Jane. Really good to hear. I think you make such an important point about, you know, and I know we all know this, but it’s easy to think – or easy for some people to think, you just put the tech in, and it changed and then suddenly the benefit is there. But the patients maybe see that change, but the amount of work that’s gone into setting that up and getting it right so then patients can benefit from that, is huge. Helena, what would you say has been the biggest impact in your practice?
Helena Ebbs
So obviously, I’m a GP and practice as a GP, but I also in my ICB role support over 150 practices with the rest of the ICB team. And so, I’ve got one eye to what everybody else is doing and internally what we’re doing clinically. On a personal level, in my own practice, I think that the biggest shift has been the way in which I communicate directly with my patients. So first of all, in our consultations, we’re now talking about how you can then go home, read what I’ve written, in the notes, in the app, anything that’s not clear, just look back in your app. You’ll be able to see it all written down. The plan will also be there.
For other patients, we’re texting them the self-help information, the onward self-referral link, the text back response about ‘send us a photo’ or ‘send us this’, or we’re texting them their fit notes or other documentation that they might need. And that instantaneous way of communicating with people has completely changed how we interact.
I mean, for a start, we’re not using paper printing out and to anywhere near the same quantity that we did before. But there is also something about that relaying a message. And if you’re not sure, you don’t need to come back in and ask me. It’ll all be there written down in your app and encouraging that use of the app through every consultation, I think has been a big shift. What I see beyond the scope of my own practice, and you know, on practice visits that we do, is this real shift to creating really efficient access systems, a bit like Jane has just alluded to. So, a lot of practices, particularly bigger practices with multi-sites who have challenging operations to maintain, having that digital first approach to access, enabling really good clinical triage up front, maximising all of the different service offers. So, for example, really good effective use of Pharmacy First schemes because they’re able to signpost and triage really well through that digital first model.
Similarly, signposting to self-referral for podiatry or self-referral to physiotherapy or other services where people will not ordinarily know that those services exist if they’ve not used them before. And that digital triage really allowing that capacity in general practice to be preserved for what it’s needed for. And then as others have said, freeing up the phone lines then for those that really need it. So, some of our most digital-savvy practices using that self-booking link, what that’s doing is just letting the person that needs that one-to-one conversation with a receptionist to have a much less pressured conversation. And that’s really important. So, it’s not simply about having less of an admin burden. It’s also about the people who really need it having more time to be able to talk to people that they need at the front desk as well alongside that.
Mary Hudson
Thanks, Helena. And then, Lianne, I wonder if I can come to you on your perspective?
Lianne Jerome
Yes, I don’t sit in an actual practice because I lead primary care networks, but the biggest impact for us as a network was giving online access to all our care homes, to our single point of contact, which is an online consultation direct to our team. This meant that the care homes had 24-7 access to us. Although they were very well versed that nothing urgent comes through until a certain point, it meant that anybody on shift at two o’clock in the morning could request something from us and we would get it the next morning when we walked in. It meant that the handovers, the people that were handing over in the care homes over their shift didn’t get mixed messages for what they needed to submit to us – that person could submit it there and then. So, it was a real transformation for the care homes for us and the relationships you’ve been able to build for them as well as being fantastic. So that’s like, it’s obviously not an in-practice thing, but it has been really good for us as a PCN to have that.
Mary Hudson
Great. Thank you, Lianne. Jane?
Jane Dalgleish
Just to add, and we’ve had this in place for a good few years, so I’d forgotten about it, but we also use off-site printing as well, which is still tech, isn’t it? So, I still remember I had a member of staff who I used to call my ‘champion stuffer’ because she loves stuffing envelopes, but the amount of time it took. And now we don’t use that. And I also, just as a little amusing story, we had an apprentice one time and
we got him stuffing envelopes and there was something like 70 envelopes he had to stuff. And just before we put them through the franking machine, we checked them and he’d actually folded them so the practice address was in the window of the envelope. So, we had to undo it all. So, I’m glad to be out of that, but that’s worked really, really well. We did a bit of an exercise on the costing of it, and it is obviously slightly more expensive than posting. But having said that, it’s staff time you’re saving, paper you’re saving, envelopes you’re saving. So, we’ve used that and that’s been very, very successful as well.
Mary Hudson
Great, and so what is that service exactly, the off-site printing? You can send it and someone else will print and send it to the patient.
Jane Dalgleish
Yeah, literally the printer comes up in your printer list. So, you just press print just the same as you would and it just goes off site.
Mary Hudson
Great. So, for those few, well – reduced number of patients that do need a paper letter, that’s dealt with efficiently. Great. Thank you, Jane. Bex.
Rebecca Rowe (Bex)
Yeah, on the back of sort of the technology that’s come about, the text messaging services really picked up during COVID. We had a massive push, I think every practice did, to try and have a means to contact patients, preferably via e-mail or text message being the most favourable and that did reduce our printing and letters going out. But the biggest thing that that’s then brought about is all these systems as they’ve come on board, NHS App, whatever you use for your messaging, for your triage and whatever messaging you use, whether it’s through your clinical system or it’s an add-on system that you use, for getting messages for booking links and things like that to patients. Because we’ve now got text message consent for all these patients, you’ve got a consistent platform and method to communicate en masse to patients. And all of these systems that we’re all looking to change, whether it’s bringing in AI, whether it’s bringing in new triage tools, or switching from an existing triage tool to a very different one, we’ve now got contact with all these patients that we can send those messages out en masse.
Things like new services being available, like the online registration and different things that we’re wanting to do. And if we make changes to how we’re going to review patients, because we now want to bring them in in the birth month and we’re not bringing them in when they want to come in in the year. It’s all those sorts of messages. You’ve now got a way to get this message to everybody. And whilst you’re not going to be able to get everybody on text message, you can get a big proportion of your population and they’re hopefully then going out and spreading those messages.
The other thing that I found, like Lianne was saying about care homes being involved, they can act on patients’ behalf to do a lot of this, as can carers or anybody who’s sort of at distance from patients, they’re not near where their relatives are in care homes, they can contact us and say they’ve got concerns through the triage service and can we look into mum or just give them some update on how somebody’s doing and they can help and support people who are housebound and maybe would otherwise have difficulties coming into the surgery, they’d be on the phones for a long time waiting in call queues. And this is now meant that for some of these services, they’re available 24-7, particularly through the NHS App.
Maybe you turn your triage off just to your core hours, but you might leave your routine requests open. But some of these other services, like ordering prescriptions through the NHS App, is all available throughout. And at times when people who are busy and working during the day, working mums and doing it for the full family, they can go on an evening and do this. And that wasn’t possible before.
Mary Hudson
Yeah, thank you so much. Really interesting. I wonder if we could move on a little bit. We talked a little quite a bit about impact on patients, which is great. And we said a bit about the impact on practices, but I wonder if we can talk a little bit more about how the practice has changed, what people’s staff roles are in the practice. Helena, you talked a little bit about, you know, how you interact as a clinician with patients and how that’s changed as a result of some of this technology that’s been introduced. I wonder if we can dig into that a little bit more. How have you felt that what the practice does and how it works has changed over the last few years?
Helena Ebbs
I think we’ve seen a real difference in the way we gather clinical information to do things that are quite high frequency volume. So, a really good example might be menopause health checks. Most women who are taking HRT know what they want, know an awful lot about it, are really well informed. They’ve already been through a process to get their HRT and actually they just want to have a health check that’s as simple as possible, most of whom do not need to come into the surgery. But from a clinical perspective, you still want to know that that’s the right drug for the right woman, that they’ve got up to date information, that they know who to contact, if they’ve got any concerns, that you know, some of the safety checks are made and up to date information is conveyed to that patient. A lot of practices now routinely do a lot of those reviews online.
And I think what’s really important about digital consultation, and Bex has picked up on this already, is many of those women are working women who do not have the time to be able to come into the practice to have a routine consultation for something for which they want to just continue and have no particular concern. And that frees up the face-to-face time and the energy to see people who are having problems, who have got complexity, who need much more of your attention. So, it’s quick and it’s easy and it’s safe. It’s better for people who don’t need to lose time from work or, you know, rearrange somebody to pick up their children or whatever it is to get there. And that’s a big shift in the way that we do things. So, as you go from practice to practice now, you know, what you find is people are beginning to go, oh, well, that is also high volume, that’s also something we do a lot of, that’s also something we could have a different approach to.
Skin lesions is a really obvious thing. Anyone phoning up now with a problem with their skins, provided it’s not in a particularly sensitive area where you wouldn’t be taking photographs, then actually the default is to message that person to say, before a clinician contacts you, can you send us some photographs? And the vast majority of people can, just like the vast majority of people can use a banking app. Yes, there are a few people who can’t do that. But if the majority of people who do, do that, they result in really quick, efficient consultations that again, clears that capacity so that people with really complex needs get more face-to-face time and more of that traditional general practice they would always have had.
Mary Hudson
Thanks, Helena. Jane?
Jane Dalgleish
Yeah, just really to add to what Helena was saying about the HRT, certainly using the remote booking or the online booking, the first year we used it, I think it’s going back two years, we front-loaded on smear tests and we’d actually hit target on both of the smear tests by June of that year, which was absolutely brilliant because then it freed up time to do all the other work that needs doing.
Mary Hudson
Do you remember what month you’d got to the target the year before?
Jane Dalgleish
Probably near to April, I would think. Scrabbling at the last minute (!) It’s always difficult to get people in and I think like Helena is saying, because most women who have smear tests are working, but if they get this booking link, then they’re at work when they’ve got the diary in front of them and they can see when they can fit it in. We’re ahead of the game with smear tests all the time now.
Mary Hudson
Yeah, excellent. Robert?
Robert Westgate
Thank you. I think modern general practice is by definition very transactional. Is it very transactional? Some of the strengths of general practice and the benefits of general practice are relational care. It’s that continuity of care. And I think one of the things that we’ve seen over the years of implementing modern general practice access is how to deliver some of the benefits of continuity of care by getting people in front of the right clinician for the right nature or cluster of problems. So, it maybe feels like a bit of an oxymoron to say that modern general practice access can support relational continuity of care. But by that sort of front end of clinical triage when someone contacts the practice, we can respond with simple stuff in a simple way, position people with their clinician of choice or the most appropriate clinician for the nature of their problems and build and rebuild those relationships in general practice that are so important to list-based care that are the strength of UK general practice and what add value to the NHS. And we should all know that continuity of care improves patient outcomes, it reduces mortality, it reduces utilisation of out of hours of A&E of unplanned care etc and improves patient and professional satisfaction and used in the right way, modern GP access can really support delivery of continuity of care.
Mary Hudson
That’s great to hear, Robert, because I’m sure all of us and everyone in general practice is not wanting access at the expense of continuity but getting access right so that continuity can also be supported and therefore those care outcomes. Perhaps we can dig into that a little bit more in a moment, because it is a challenging area. But Bex, first of all, do please come in.
Rebecca Rowe (Bex)
Just building upon what Helena was saying about some of the patient pathways that have developed as a result of having text messages and ways of monitoring patients. So, we’ve done the HRT, we’ve done pill checks that are now all done through our online messaging system,and depending on the questionnaire responses that we get back, some of those will get a review with the ACP (Advanced Care Practitioner). Some of them will be okay and they’re then reviewed and the medication can continue. And the other big area we’ve managed to develop through the text messaging service and questionnaires is our BP pathway. We used to have hundreds of patients coming in for BPs every month with healthcare assistance for hypertension monitoring, new identification of hypertension and that would be them coming in repeatedly for blood pressure checks.
They can now do that all at home and we offer machines to be lent out to the patients to do four-day monitoring and then they can send their results in on this other questionnaire that will be sent out to them. And we’ve now got a pathway for identification of new patients with hypertension without them coming in, whereas previously that would have been lots and lots of appointments with the healthcare assistants, which then frees up the healthcare assistants to do the bloods that we need to take, the things that they need to do like B12 injections, ECGs and that has generated masses of capacity within the practice and been an absolute game changer for us.
Mary Hudson
Thank you so much, really interesting. And I think from a central perspective on modern general practice, as I was mentioning a minute ago, the idea or the underpinning philosophy is if that some of the more transactional or lower acuity demand from patients can be dealt with more efficiently and that does create capacity to then deal with other issues and support patients in a way that supports continuity and supports longer term outcomes. I suppose though there is also very high demand in general practice and being able to balance that is not always straightforward. So I’d be interested if any of you want to reflect on, you know, whether that has genuinely created capacity to be able to deliver outcomes in the way you would want, or whether because demand is so high, actually, you know, by using these tools that allows more demand to come through, but that also soaks up the capacity that’s there because there is too much demand. But Robert, what’s your perspective?
Robert Westgate
Yeah, thanks, Mary. I think you raised some really interesting points. I think it’s important for any organisation, be it GP practice or anyone delivering care, to strip out waste and inefficiencies in what they do. And using digital, as we’ve heard from different examples, can really help with that. We know from data, about 2% of the entire England population contact their general practice on any working day. We know the population is now about 10% greater now than it was about 10 years ago. And we know that GP whole time covered numbers are maybe about 5% less than they were 10 years ago, even though there’s a bit of an upturn there at the moment.
A now retired colleague of mine who saw through the introduction of modern GP access and online consultation says, well, this is definitely better for patients. This access is excellent. But what do we do when we’re full? And these are very real issues. So yeah, strip out the inefficiency, get people in the right place with the right clinician, with the right bit of the service, the right pathway as best as you can. But fundamentally, there are some very real capacity issues and the attention around how to meet demand whilst still working safely. And that’s a bit about workforce, a bit about national contracting and all that sort of stuff, a bit about shoulder times and some of the safety around that as well. And these are all very real issues and all need to be worked through to enable the benefits of digital, the benefits of online, but there are some fundamental sort of tenants in there about having the right workforce, the right resources for that workforce, the most efficient way of working to enable all these things to happen safely.
Mary Hudson
Yeah. Thank you, Helena?
Helena Ebbs
Sometimes it’s easier to use patient stories to demonstrate how we work differently now. And it’s very difficult to use sort of broad metrics around access to understand whether or not these things are more efficient or not. But on an individual basis, I think we see the efficiency there all of the time with these models. So, I’ll give you an example. A couple of weeks ago, I had a letter from a hospital specialist about a patient of mine who’s in their 90s. Now, he’s not a usual person in his 90s. You know, he’s pretty sharp and pretty active and pretty spectacular.
Nevertheless, needs additional support from friends, family, carers to get by these days. And I was concerned that the letter from the specialist that he’d received was really quite complex language and that it might need debunking a bit to just make sure that we were all on the same page because there was an awful lot of things to digest. And so, I wanted to speak to him to check and called him and he didn’t answer. Quite rightly, he was busy doing other things and not sitting by the phone waiting for his doctor to ring. Now I only work, you know, a few days a week in general practice. And so, my ability to check and make sure that things were okay, and, you know, I obviously had a sufficient level of concern to want to do that, meant that I needed to think about how I could do that in the absence of him answering the phone ad hoc.
Now, in old world, I’d have booked an appointment for us to have reviewed things or got somebody else to have a telephone appointment or face-to-face appointment at some point to just go through it. In the new world, I texted him and said, this is what I’m thinking. Can I check you’ve read it? Can you let our reception team know if you want to talk this through more fully? And this is how you book an appointment if you needed to. And later that afternoon, I get a text back to say, all good, I’m happy with everything, not to worry, see you soon. Right? Now that would have been an appointment in the old world for sure. And I suppose I want to raise that case for a couple of reasons.
One, because that person was in their 90s and was texting their doctor freely and was perfectly capable and happy to do so. And the other, I suppose, is just to illustrate that we are not using follow up appointments in the way that we used to. And yes, demand can feel really endless in lots of ways. But if you use this in the right way, actually you enhance continuity and you enhance that relationship with your patient. It’s not detracting from it at all.
Mary Hudson
Fantastic, Helena. Thank you. It’s a great example. Jane?
Jane Dalgleish
Yeah, I just wanted to go back to a slightly earlier point about the demand, which we all know is now phenomenal. And I think sadly, the demand has soaked up the efficiency savings. So, you know, we’re not seeing maybe the benefits that we perhaps could have done. However, our staff, our admin staff hours have dropped year on year. Sadly, that hasn’t created any savings because the costs are going up all the time. So, but I actually wonder that without these efficiency savings, how many general practices would have actually gone to the wall because they couldn’t maintain the number of staff that they had. And I did an exercise, I think it was last year, and I was really pleased that our admin staff, the hours were going down. But as I say, sadly, it hasn’t saved us any money really. I mean, it obviously has, but it doesn’t feel like it has because the costs are going up, you know, exponentially. It’s an interesting question as to if it weren’t for the technology, where would we be now?
Mary Hudson
Yeah, interesting. Bex?
Rebecca Rowe (Bex)
Sort of saying the same as Jane. We have seen a reduction in the work for some of our admin, which has naturally meant that we’ve reduced rather than increasing, but that has just kept up with the cost of living and the expenses of running a practice. But one of the things about demand, I mean, we’ve done total triage for two years now, and we’re a large practice working across five sites, 48 and a half thousand patients – the efficiencies we’ve had have been massive in centralising triage, just having two GPs doing the triage for all five sites instead of having duty doctors at each of these sites. One thing it has done is brought visibility of the demand so we can actually see what the demand is, whereas before, when we were saying we haven’t got appointments, please ring back tomorrow or later on in the week, we now have to have all of that demand and we have to do something with it. So that then allows us to look at our access, look at our planning for the clinicians we need. So it might be that you need to employ more ACPs, it might be that you need more pharmacists.
So more than ever we have got visibility of the skill mix that we need and it does allow triage because we have got clinicians who are doing it – GPs – and it allows them to direct to the most appropriate person but it also provides equity of appointments amongst patients that it’s not the first person to go online after midnight, because that’s when appointments become available and when their need might not be – you know, they need an appointment, but it might not be today. It might be something that can wait a bit longer. And because the GPs are triaging it, the patients in the main will accept that that’s been triaged fairly. And if there is some more information that they need to give us, they will give us that information.
but it’s all about appropriate signposting, hopefully a bit more equitable with the appointments and a bit safer because how many patients were trying to access the service and were maybe really unwell and going elsewhere because they just weren’t able to come through to us.
So, I think what’s difficult at the minute is we’re not able to cap demand, we’ve got to be open until half past six with all this triage coming through. And obviously with the funding, that means more GPs, doesn’t it? And that funding needs to come and unfortunately, it’s not necessarily going to come quick enough for us, I don’t think (!)
Mary Hudson
Interesting. Thanks, Bex. I think we could go on with this conversation for a long time, but time is ticking. So, I wonder, you know, what’s next for your practice, your PCN and where you’re working in terms of, you know, what you’d like to see or what you’d like to introduce in terms of changes over the next year, couple of years? What’s next for you? So, Lianne, is there anything that’s kind of on your to-do list that you think will have a big impact?
Lianne Jerome
In terms of impact, I think the biggest impact coming down is AI as your receptionist. That’s going to have a massive shift in demand coming through to your practice. And that looks really interesting, actually. A couple of our practices have started that process. It doesn’t come without its hiccups, but to have that picking up that demand coming through that front door that way is quite an interesting thing. But the features the NHS App is bringing at the moment, they’re just coming thick and fast and it’s really great for the patients. It’s having that time or that group of people that can sit with those patients to talk them through the NHS App to teach them how to use it.
Everybody seems to be so scared of it if they’ve had an issue with it in the beginning. But once you sit and talk them through how to access it, where everything is, how easy it is to see your blood results, how easy it is to access repeat prescriptions, it’s so lovely to see that they go, ‘well, it wasn’t as hard as I thought it was going to be.‘ And that just reduces demand on the practices, doesn’t it? Because they’re then not ringing the practice. They’re actually going on their NHS App. That’s been fantastic and I just want it to get better and better. So yeah, I’m all for these new things that are coming on the roadmap for the NHS App.
Mary Hudson
Excellent. Thank you, Lianne. Jane, anything that you’re planning that you think will be interesting?
Jane Dalgleish
Yes, I’m retiring on July 5th (!)
Mary Hudson
Well, congratulations!
Jane Dalgleish
To be fair, I agree. I can see the NHS App moving in leaps and bounds. I think the problem we’ve got at the moment is all the restructures that are going on with NHS England and ICB.Certainly in this area, there’s times when you literally don’t know who to go to as a practice. So, a bit of a scary time, but I also just out of interest. I think for this practice, it’s a good time for me to retire and we’ve got somebody in place already. So when all the changes come in, she’ll be in at the beginning instead of coming into a structure that’s already established. So, I think it works well.
I have to say personally, I’ve loved working in general practice, but right at the moment, I think it’s a very nice time to leave as well, because it’s hard work. Big changes ahead – I’m still not convinced about these neighbourhood schemes because we don’t really know what they look like.
Mary Hudson
Yeah, well, congratulations to you personally, Jane. Glad that someone else is coming in behind you, who I’m sure we’ll continue that innovation. I mean, we’ll see with neighbourhoods. I think it will be interesting. But yeah, lots of questions still about how that’s going to play out. Helena, Bex, Robert, any final words from you about, you know, new things that you’re hoping to introduce that you think will make a difference? Helena?
Helena Ebbs
Picking up the neighbourhoods point really, I think there’s an opportunity for us to show and support other providers across neighbourhoods how we can use these digital tools really well. Primary care is a really innovative and strong place for maintaining connexion and continuity with its population and using these digital tools, whether it’s by a revolution or an evolution in how you do things, is a real position of strength that the rest of the neighbourhood can depend upon. And I think when we think about population health management and how we survey our population, how we understand how to deliver services better. Using digital tools is a really good way of getting feedback, you know, helping to understand about how your service feels as somebody who’s using it. You know, all sorts of different ways of using it, not simply by the consultations that we’ve talked about. Bex has referred to that already. You know, if you’re launching a new service, you can promote that really well, but you can also ask your population what it is that they feel that they need, why they’re not accessing the services, what they think needs to improve. And being able to use digital tools in that way, I think, will really help us with neighbourhood health.
Mary Hudson
Great, thank you, Helena. Robert?
Robert Westgate
Thanks, Mary. Another colleague was just reflecting the other day on an artificial intelligence and just thinking about empathy and was concerned that an AI bot may have greater empathic skills than themselves as a health professional and is that a worry?(!) I don’t know, could be a worry, I think (!), I mean the whole landscape of the NHS is just really, really busy at the moment and there’s lots of change. And I guess, thinking about the digital agenda and the personalised care agenda and how we organise ourselves to narrow the gap, to improve people’s life chances through health and be fair and accessible and all that sort of stuff. There’s a key thing about authenticity in general practice. I guess my wish of the system is that general practice is valued as a building block of the NHS that we hold so dear and that we don’t lose sight of the value of general practice in amongst all of the modernity and the reorganisation and that general practice has the ability and the opportunity to step up and lead this journey of modernisation rather than necessarily being led. And I think from the examples we’ve heard this afternoon, there’s loads of innovation, loads of lean working, very much person-centred. We live and work within the populations that we serve and that’s really, really important. And most GPs that I speak to, myself included, just want it to be the best that it can, and I think stepping up to lead the changes to support and protect the NHS, building on the foundations of general practice is going to be really important and harnessing digital along the way.
Mary Hudson
Fantastic. Thanks, Robert. Bex?
Rebecca Rowe (Bex)
Yeah, just leaning on from what Robert said then, general practice is definitely in a good position to lead on these neighbourhood health partnerships and I think we are definitely going to be the drivers behind it. Digital tools that we’ve got are just going to enable us more to, you know, get patient feedback, navigate things with these patients and communicate en masse to these patients, which other organisations just don’t have that information. Their clinical records are so up to date in general practice, whereas they’re not in other entities. Building upon the NHS App and trying to get as many patients signed up to that as possible is going to be key because all of these new tools are linking in there.
And therefore, It would be great if other agencies and services started to work with us to improve the communication to patients and do the things that we’ve done over the last 10 years to improve patient experience for patients and the people who care for them and care homes and everyone else involved in care and it would hopefully make it a better place.
Mary Hudson
Thank you so much. Thank you so much all of you for your time. It’s been a really fantastic, fascinating discussion.
Clearly so much innovation going on in your practices, really pushing for that efficiency in order to create capacity to support patients to do what’s right for them. I think there’s a lot that the rest of the NHS could learn from general practice. It is the most efficient part of the service, I would definitely say the most important part of the service and hopefully fantastic future ahead, leading changes and continuing to deliver fantastically for patients.
Thank you all for your time and have a great rest of the day.