Tim Caroe
Hello everyone and welcome to our podcast. So you may not have heard my voice before. My name is Dr Tim Caroe. I’m the medical director for the South East of England for primary care and I’m a GP. So every Thursday and Friday I’m at the coalface understanding what online consultations are and using them.
So I have had the great privilege of being invited to come and talk to you with an amazing team of people about online consultations. And you’re thinking, why this accent? Why someone from the South East coming to North East and Yorkshire to talk about it?
Well, firstly, I think they’re playing a game of Top Trumps and trying to get every region represented. So SE tick…but secondly, I’ve been supporting the national team around this access, around this new requirement from the 1st of October around online consultations being open during core hours. And so I was kindly asked to come and share some experiences that I’ve had and to talk to the team about it.
And I have to say the amazing, talented, good looking team that I have in front of me that you won’t be able to see because this is a podcast and not a video.
I have Dr Tano Rebora, who’s a GP partner at Conisbrough Group Practice. Bill Graham, the Community and Innovation Lead for Modality AWC. I have Doctor Pippa Richardson, the GP Partner and Clinical Development and Performance Lead, also at Modality AWC.
I have Holly Burns, who’s the office manager at Thornton Medical Practice, and Doctor Aroop Sen, who’s the GP partner and access lead at the Ridings Medical Group. So everyone shout hello to everyone. Hello!
Hollie Burns
Hello!
Aroop Sen
Hello!
Pippa Richardson
Hello!
Tim Caroe
There you go. They are real. I am not making them up. So I think it’d be really useful – maybe just to say that let’s not assume what people actually understand by this subject. So should we just start off by saying what actually is an online consultation?
There has been, I have to say, when all these things come in, lots of debate around, well, is it e–mail? You know, what actually defines an online consultation? So is there someone here that can wave their hands and give that? Who feels they want to give it a stab – Aroop?
Aroop Sen
So online consultation is patients submitting themselves or via the care nav reception team, a clinical request. So that’s with the details about the symptoms, how long they’ve had it for, how long it’s been going on for –as much clinical information they can provide. Obviously different surgeries have different online triage platforms. We may have preset questionnaires.
Again, some patients don’t have online access – they can use the QR code at the surgery or the receptionist would fill it in for them and that all goes to the triage GP who then reviews the request, decides how soon they need to be seeing the clinical need, the importance, the urgency and then obviously they’re booked in accordingly on that advice.
Tim Caroe
Brilliant. You should have written the contract! There’s a definition in there, but yours was much better. So yeah, it specifically says it’s not e–mail, it’s something that you can go backwards and forwards with a patient who can have a conversation with you in electronic means. So as you say, many people will have different things and that’s part of how we might think of a tool to help with modern general practice, which is a term again that’s bandied around quite a lot.
And you know, for some people they’re like modern? you know, why? Why modern general practice? It’s a term – we have it, we’re stuck with it, but can anyone again help to define some of the principles of modern general practice again that this fits how you think about them? Pippa.
Pippa Richardson
I think for us it’s been about improving access and having a variety of access options for our patients and also ensuring equity in that access, so having online access but also still running the traditional methods of access like telephone consult and telephone access and in person access at reception alongside.
But we’ve taken decision to run it all through the same system so that we’re then handling all the enquiries through the same route and that really makes it feel like it’s fairer to patients and we’re not running the risk of it being a first come, first serve type system like we used to have.
Tim Caroe
I think that’s so key, isn’t it? That sense of equity, it doesn’t matter how you approach the practice, you know you are dealt with in the same way – that’s been so important because some people can’t access digital tools and some people also then can’t access the surgery, you know, maybe they’re housebound or you know they struggle on the phone. So that leveller of access is so important and there’s something else that that you mentioned there about fairness, about how you use resources rather than the first person off the mark gets everything.
And yeah, I think that element of modern general practice meaning the people who need the resource are the people who get it and that is kind of the fundamental heart of the ethics of what we’re doing. Tano?
Tano Rebora
Hi all. It’s actually really encouraging listening to other people explain what they’re using and knowing that we’re doing the same thing here. So thank you for that. I think what we’ve all kind of touched on is this kind of idea of digital exclusion and the worry of some patients being that they can’t access practices that are using these online consultations, but like Aroop and Pippa were saying, we’re not saying that patients can’t come to the surgery or can’t ring, we’re just giving them another way of accessing the surgery.
What we’re finding is, I know we talk about modern general practice, we now live in a world where a lot of people are very digitally minded. By giving them a way of accessing the surgery by filling in a form as opposed to giving details over the phone or coming up to the reception desk like they would have done, it just allows them a better way of accessing services in a timely fashion.
Tim Caroe
Yeah, absolutely. And that timely fashion is also important. There’s been a lot of discussion about core hours and what that means and when’s the surgery have to be open. I think it’s worth saying at this point that from the 1st of October you need to have ‘you and your GP’ linked on your homepage, so for some places that might be a change as well as having the online consultation tool open between 8:00 and 6:30.
So hopefully people have had six months to think about this and to plan. And you know, this is really today just again helping people to think about it, helping to get it over the line. Bill, you’re the community and innovation lead, aren’t you? So what are your reflections around what we’ve just said?
Bill Graham
Yeah, yeah. Thanks for having me on the podcast. I do a lot of chatting to patients and getting them involved in these systems, but I also chat a lot to the staff. Now we’ve ran our digital front door as we call it now for two and a half years.
So we’ve now got two and a half years of data and feedback from running the system and just quickly for a bit of feedback from staff, particularly reception staff is because they now don’t do that triaging decision, you know what we used to call care navigation and we were all trying to turn our reception team into care navigators. The decisions are now made by the triaging health professionals or doctor team or pharmacists, and it takes a lot – has taken a lot of pressure off the reception team in that way and it’s made that job a much better job I think for the team there.
So I think that’s a really important thing to get out there. You know 5–6 years ago we were talking a lot about care navigation and our receptionists were care navigators and they would be having to make that decision what the patient was getting when they contacted the practice. Now that decision is made predominantly by the online triaging duty doctor. You know what we call the ‘DAD’. Maybe Pippa can help me there. Can’t quite remember what the DAD stands for?
Pippa Richardson
Digital Access Doctor.
Bill Graham
Access doctor! We’ll have a DAD in practice who’s kind of triaging the requests as they come in and it’s not a reception team member doing that anymore and that is – really the benefit to that in terms of staff morale over you know now we can see 21/2 years to where we were before we launched the system. It’s quite something to see, Tim.
Tim Caroe
Thanks, Bill. That’s really good. I’d love to hear what your dad jokes are within your surgery, but maybe that’s for another podcast. I would get the title wrong. It’s really interesting while you were saying that, Bill, that Holly, who is the office manager at Thornton Medical practice, was nodding away really vigorously, you know, what were your reflections on that?
Hollie Burns
Oh, I mean, it’s just night and day. The experience that we had as a reception team when we changed to a triage model, there was a lot of hard graft that went into it. We notified patients quite a while before we started in various different ways. So there was a lot of coercing people’s opinions about it, trying to make them aware of the situation, make them feel confident in it.
But as soon as we changed, just taking away that pressure – even though in our situation we didn’t really make the decisions for the doctors, I wouldn’t have said. But definitely once that decision has come from a clinician rather than a reception team member, the atmosphere is fantastic, the relationship between the patient and the reception team is a much more positive one and I think just overall the whole surgery felt a lot lighter once we’d actually made that change.
Tim Caroe
Yeah. So what I would reflect here is having done this across, seen this across the country, there are different levels of medical input that go into this trust. So some places will still say, Oh yes, our reception team deals with all of this and puts it all out with the help of sometimes AI or whatever and some people would say it’s our whole clinical team and you know, actually, you know, we’re not here to say which is the best model. From what I’ve experienced actually having that clinical oversight of all of these informations, for me, the more clinical the better.
And the other thing that people go was we can’t take doctors out from seeing patients because then we won’t have enough doctors to see patients like, well, I mean, personally, I deal with about 70 or 80, you know, sometimes up to 100 over the course of a day. And people are going, oh, you’re only supposed to see 25. That’s not safe. Well, actually, if I only saw 25, then those 75 would be going somewhere else – so what’s more safe?
Can I just reflect a little bit around that safety? We’ve heard about equality. You know, there’s lots of politics around this with many people saying we cannot do this –it’s just simply unsafe.
I’ve given some personal reflections on that. Is there anyone that wants to sort of stick their head up over that parapet and just reflect on that element of what safety looks like for you, as you’re doing this? And Pippa:
Pippa Richardson
I could perhaps talk through some of the things we’ve done to try and minimise risk. So I think one of the key things I think Holly mentioned as well was really carefully training and informing staff before we started.
So getting across to reception teams that they’re no longer the gatekeepers, they’re more of a patient advocate and information gatherer and also for the clinical teams, it was all about training and triage and clinical decision, rapid clinical decision making. And then also I guess as we went along, it was about doing refreshers and updated sort of top tips as we learned and in group discussions of what things people were finding were working and what things that weren’t working so well. We were careful to set up a place to store significant events reviews specifically relating to our online access so that we could pick up any problems early.
Designing the form is quite important as well, making sure that you’ve worked out exactly what workflows you’re using, how the online form helps to direct people to the right place at the right professional first time. And particularly with that we found one of the most important things was having really clear information about response times because early on we did find that people were sometimes using an inappropriate pathway that might have had a slower response time for something that needed something more urgent.
So we made sure all of the response times for the different pathways were really clear and we also started sending text messages to anyone who wasn’t going to receive a same–day response to let them know what was happening with their enquiry and how long it was likely to take so that if there was any issue they could get back to us sooner.
And I think one of the things you touched on different people doing things differently in terms of who does the triaging. I think for us we did feel that the safest way of managing risk at least to start with was to have a clinician triaging all our inquiries and we found that the patients, I think that’s one of the things about the system that the patients have responded well to.
Obviously it’s a big change for patients, but knowing that all their enquiries, all the clinical enquiries get triaged by a clinician has given them that assurance. If they’re not sure how urgent something is, that somebody’s had a look and if they’re then told it’s not urgent for today and we’ll give you an appointment in a week or two, then they feel much more reassured and are less likely to contact us again, which helps with workload if you’re not getting repeated contacts about the same problem.
Tim Caroe
Thanks, Pippa. That’s really good. And you know the other caveat within the contract is that it’s open for non–urgent things. If someone types in – I have a heart attack, you know I’ve got chest pains and they’re kind of sitting there waiting for a response…so really to be clear as a practice, as you said, what the routes are, what the response time can be.
Some people may want urgent things going that way because they’ve got someone reviewing everything as it comes in within seconds. Some people may say actually we leave that until later on, so it is only for non–urgent. So please make sure that you’re communicating via your websites, via newsletters, on your tool itself. Any bounce back that accepts saying we’ve received it has information on there about those response times. That’s been really important. Excellent.
So Bill – your reflections about that?
Bill Graham
Yeah, just to add to what Pippa was discussing there. Again you know we launched that system 2 1/2 years ago and we are we’re an 11 site 90,000 patient single practice in effect with 350 staff – we will get 50,000 online requests a month.
So amount of detail and you know because it’s online you can research it the amount of work you can do to plan capacity over the course of a year is fantastic I think for practices because you can really use that data to kind of extrapolate obviously patient demand and I just think you know that the way we design the workflows you know and the way we manage well when we introduced the new system we had weekly meetings as we tried to refine what we were doing because obviously it was a new thing we were doing and I think those first three months of launch when we launched the system, it was as much making sure the staff knew the system as well as the patients and it certainly was a I think we refer to as you know that.
There’s a visual that shows you the, you know, when you when you introduce a major change programme you know at the at the launch we all thought this will be fantastic and then within a few weeks we were in the ’trough of doom’ but then as we figured it all out as, I think we launched in April, by the time we got to July, August, we were starting to feel, yeah, this is starting to work. But I think for anyone embarking on this, you know, it’s a big change for patients. It’s a big change for the staff. Be prepared for, you know, all those growing pains as you bring that new system in. I think that’s absolutely vital, you know that.
You know, you don’t expect it to be a smooth ride. There’s things you can do to mitigate that, to make it smoother. We’ll hopefully share some of them in a bit, Tim. But yeah, just wanted to add that into Pippa’s discussion around, you know, minimising risk.
Tim Caroe
Absolutely. So if you feel that you’re in the ‘trough of doom’ or as educators might go, the ‘conscious, incompetence quadrant’, you know, that is OK. We have all been there. There are things to help and we will before we finish, you know, cover those things that are out there to help. So Tano, you were wanting to come in there?
Tano Rebora
Yeah, just reflecting on what Bill was saying. So we we’ve been using our online consultation model for about since COVID and actually came about because our telephone system went down for a couple of weeks. So we had to start engaging with that.
So what we’ve what we’ve done is we’ve got five years of data now. So we can look over the past five years and go actually November is the hot spot for our surgery. So we know that that is the busiest time of year. So that therefore, you know as partners we’re looking at our time out of practice, you know annual leave – try and avoid that month because we know it’s going to be the most busy, but the information you can get from a day–to–day input level.
What we’ve noticed is that Monday always is the busiest day of the week, whereas you know previously we all knew that OK, but what actually. we find is that Monday is the busiest, Tuesday tends to be quite busy too and then it drops off really quite steeply. So from a workforce planning point of view, we know we need to front load the front of the week and it’s just allowed us to find ways in which we can manage that demand.as well as we possibly can with that extra data, so it can be really helpful from a planning point of view.
Tim Caroe
Absolutely. So can I just give a reflection here, which is that data is fundamentally important and when you say to people, what’s your practice like? They go, oh, it’s busy. I go, well, what do you mean busy? They go, oh, so many people. Well, how many? Oh, so many. You can’t run a multi–million pound business, which is what most of us are running, on thinking that your customers are kind of lots of them.
So understanding your data is always the first step in this and the tools that allow you to do that, the digital telephony and all those sorts of things, including our online consultations will enable you to understand your data. And I just wanted to mythbust something else as well, you know, everyone’s neck is going to be sore once I say this, is that demand is eminently predictable and demand is limited. So I tried to do this for years in my practice and there were a couple of partners who went. We cannot do this because demand is infinite.
If you open up gates, you will get an infinite demand that will never stop because people will just come on in. And that is absolutely not true. So everyone on this podcast will tell you, I know how many people are going to contact me tomorrow because it’s the same number that contacted me last week on this day and the week before and every Wednesday for the last five years!
So if you’re feeling that when you open this tool, you get overwhelmed, there is a backlog. So there’s a number of people who’ve been unable to get in. And Bill’s trough of despair is all of those people as patients who’ve been wanting to contact you and haven’t been able to. So you do get this kind of an initial spike. And then when you meet that unmet demand, it does come down to a predictable amount. And ask your next door practice how many they get every day, how many per thousand. That’s roughly what yours is likely to be when you get that out. So hopefully that will be good.
Now I hope by this point in the podcast a) people are either kind of switched off and you know, not interested or they’ve gone, yes, but tell me what help can we get? So folks, talk to us. What help is there out there? What help did you use and what can the person wanting to do this more, what help can they get? Have we got any takers? Otherwise I’ll point to Aroop because you haven’t heard his lovely voice a lot. You’ve heard everyone else today.
Aroop Sen
I think with our ICB they looked at different online consultation providers. We were already using one data from COVID because you used to use a lot of video consultations.
So we obviously went with that platform. There was a lot of training involved, which I think everyone has gone through. The data was very important because again, it’s giving you that snapshot of the week in, week out of data of access, providing the access provision, making sure you have enough appointments – Mondays, yes, I always thought Fridays would be busy, but it was always the Mondays with the peak and then it tails off and Friday happened to be the more quieter day of the week, which when you see the data that I was surprised for that initially. I think, yeah, it’s trying to find the online consultation which works for you.
We’ve had good relationship with our provider, we fed back, they’re quick to respond, they’ve adapted to our needs, we’ve adapted their platform, sending out multiples of self–booking links again for the quick like the UTIs and the skins like quick messages or midwives. We’ve got all preset messages which you can just send out to the patient. You’re saving that time.
It’s one of those things where you start and then you adapt and you evolve. I think that’s the key message which with anyone starting off with a triage system has to remember.
Tim Caroe
Yeah, absolutely. So you can get help from the provider themselves who can help you through this. There are other sources of help as well before I list them off. Have other people had that sort of external support and help? Holly –
Hollie Burns
We had a GPIP facilitator, so we had somebody who actually came in. I think I could. Don’t quote me on this. I think it might have been around 6 to 9 sessions. I can’t exactly remember, but we had allocated time each Tuesday afternoon where we came together, myself, the practice manager, sometimes a clinician and we did the whole plan together.
We looked at all of our communications that we’d send to patients, looked at our trends, looked at appointment type, frequency of types, amount of calls. So that was invaluable for us. I don’t think if we hadn’t have had that time allocated each week and somebody to actually sit down with us and outside perspective – she was also from a practice.
But yeah, that that was invaluable to us. That’s what really got us confident and ready to go.
Tim Caroe
Yeah, absolutely. That GPIP program is, it has been really transformative for many, many people. Aroop, did you have that?
Aroop Sen
Just on that note, which Holly said, like we do that for our local practices. So they’ve been visiting our practice or I would go to them and we would sit with them, go through our platform, what we’ve done, we’re trying to map their patient journey to see how it works for them because what works for us may not work for them. So again, staff skill set and everything is important.
So I’ve done numerous sessions myself with neighbourhood practices on similar to what Holly mentioned. So that is that’s very helpful for practices who want to start off total triage is looking at what your neighbouring practices are doing. Even when I started off because I’m in in hull east and went across the bridge and looked at a few practices to see what they were doing and then adapting what works for us.
Tim Caroe
Aroop, I think that that is both geographically and sort of metaphorically important, isn’t it? Going across the bridge? Because I think actually there are two camps. Let’s be honest, there are people who go, this is the most amazing thing I’ve ever done and it saved my practice. And I’m evangelist and I’m telling everyone.
And then you’ve got the other people going, this is the death now of general practice because it’s just not the right thing to do. And sometimes you have to build a bridge, sometimes you have to have conversations and you have to talk about it, so.
You know, there are practices in my area who went, well, what are you doing? You’re making the problem, you’re part of the problem, not part of the solution. And now they’re ringing the doorbell going, oh, can I just you know, would it be alright if we just popped in and saw what you’re up to? And so those bridges of building relationships are so important and people coming in informally are like you said and you’re going there, there are peer ambassadors as well. So you know there are people there to help and support.
There’s also loads of national online stuff, so they’ve released a whole toolkit maturity index. You know, hopefully the link will come in these podcasts. So you know if you’re not convinced by, you know, the help of your supplier, by your peers, by your peer ambassadors, by the national staff. You know, it’s like, what have the Romans ever done for us? I’m sorry if now that’s a Monty Python quote that ages me as 51. There’ll be the young GPs listening to this going, what is he on?
So I’m just going to say now we’ve talked a little bit around processes and contracts and what you do. What’s the feedback been like from the people who’ve used the system, the people that we like sometimes as a profession to call patients, but who are fundamentally our public, the people that we are there to serve, how have you managed, you know, what their feedback is and your participation groups and how have you brought them along on the journey with you? Pippa:
Pippa Richardson
So yeah, it’s been really interesting. We before we when we were in the planning phase, one thing that was really helpful was we got a group of patient volunteers who were willing to try and help us test and refine the online form and that would that helped to get the people in our community starting to think about it. And we did a couple of Facebook Live events where we invited all the patients to come and hear a bit about it and just really starting to get people thinking.
We also encouraged our staff to just mention it at every opportunity so that they kind of it was getting into people’s minds that this was coming and I think that that that made quite a big difference. More recently we’ve involved our PPG trying to improve some of our communication because some of the feedback we’ve had has been about it being too wordy or too complicated or we’ve not done well enough on the plain English.
So we’ve tried to get the PPG involved with reviewing all of our messaging and that sort of thing to see if we can improve it. And I think I just wanted to add, it’s sort of on this theme from what Aroop said about adapting things. It’s really important that when people are thinking about this, they think about it being an adaptive process, you’re never going to get it right first time at the beginning.
You’re never going to find the perfect way of doing things. But if you use your patients and your staff as a real resource, you’ll find very quickly you can refine it quite well with suggestions from staff or feedback from patients. Little changes can make quite a big difference to how well the system works.
Tim Caroe
Absolutely right. Just having that partnership and not seeing it as something that we’re doing as a practice. It’s just we’re doing this as a community. And what about feedback? Has anyone got feedback? Have you done patient surveys? Bill.
Bill Graham
Just to add in there to what Pippa was saying, we’ve you know we’ve monitor feedback very carefully and you know just comments from patients keep an eye on social media. I think when we launched the system you know there was a real mix in social media.
People loved the new system or some people hated the fact they were asked to be doing something different. Again, I think that’s something you’ve just got to push through when you’re introducing the new system. 2 1/2 years in now, you know the vast majority of patients are happy using the system and you know did very little negative feedback. In fact, some of the people who are probably most against the system when we brought it in, people that I know and are some of the patients that we know and we talk to are now actually, you know, really happy with the fact that they get quite a quick response.
They don’t have to wait in a phone queue. If they’ve got an urgent issue, they’re seen on the day they’ll be communicated with and given options of appointments to book into. So they, you know, they see the benefits of the new system. Now I think, like I say, the process of change can be really painful. It can be painful for the staff team, it can be painful for the patients.
But you know, as we sit here today, you would never go back to what we had before. Just thinking about what Holly said just, you know, earlier in the conversation, the whole environment and the practice is so much more positive than it possibly was, you know, three years ago, when we were drowning with the phone calls and we were really struggling with the demand and that, you know, that previous way of operating just really wasn’t a model that was working for patients or staff.
So I think, you know, you look back, you just look back at what we had before and you would never go back to that. So we’re in a much better place with what we’ve got.
Tim Caroe
No, it was unsafe, wasn’t it, Bill, in the sense that you have just phoning, phoning, phoning and the 27th person who needs help doesn’t get it because your 25 appointments are gone. So that’s important. Just interestingly, I used to hear lots of things at the front desk going, why can’t I just book an appointment?!
Actually having a QR code that people could have a look at and go straight to the practice website that explained why they couldn’t just have an appointment was really useful. So think about those conversations that are going to happen at your front desk or on the phone with people just going, I just want an appointment with Dr Caroe. So that that was quite a journey for us as well, just to kind of take people along. Did you have that as well, Pippa?
Pippa Richardson
Yeah, I think that’s a really good point because whilst all the people who have willingly used the online system have been generally very happy with it, the people who need to still use the traditional methods, particularly telephone.
They’ve had an adjustment to make because it’s not quite the same experience as it was before where they would just ring up and ask for an appointment if they got through and then if they if they were lucky enough that there was one, they’d be given it and that was the end of it. So now we’re asking them quite a few more questions and we’re filling in the form for them and then they have to wait until someone comes back to them with what the plan will be.
So it’s a different experience and I think it’s it takes some people a bit of time to get used to that but the thing that probably has helped to get people on board has been that explanation about the equity side of it and the fairness and the fact that we’re trying to make sure it that appointments are allocated based on need rather than on who gets through on the line first.
Tim Caroe
Yes, Aroop?
Aroop Sen
Just on that point, it’s also like word of mouth. Once the patients use the service and they’ve had a positive experience, they sort of spread the word amongst themselves. So that’s also a positive experience is always shared by other patients. We did our patient survey at our practice and we had 81% rated triage/online consultation as very good or fairly good.
And one thing which we which helped a lot was during the launch we used to have regular sort of ‘mythbusters’ every day just promoting the service as what we’re doing and again, lots of patients would log on saying ‘what a wonderful experience, we got a call back within a few minutes and seen that day. So all those positive comments were looked at and obviously everyone reflected back on that and the service kind of came as it is right now and has developed, but then again, that word of mouth does help a lot.
Tim Caroe
Yeah, and just let’s bring it down to actually something concrete clinical. I mean, in the old days someone would phone up and they’d say I’ve got this worrying thing and I want a doctor to look at and they may get an appointment. They may not. Then if they don’t, they have to phone back the next day. Maybe they phone 4/5/6/7 times. They finally get a 15 minute slot with Dr Rebora, who’s there, they walk in and they say I’m worried about this and he goes, that’s a seborrheic keratosis, don’t worry. And then they walk out again. So how much effort has that taken them to get that appointment? How many contacts have they had with the practice to get that appointment?
In Dr Rebora’s practice now, they’ll go online, they’ll send a picture, he will look it up and he’ll go. That’s a seborrheic keratosis. Here’s a link to the website which shows you what it is and what to worry about, and it probably takes you to know maybe 10 seconds to do, and then you move on to the next one.
The element of benefit efficiency that you can bring and you can also say the other way round, this is going to take forever. And you know they’ve got this and this and this and this and this, a 10–minute appointment, it’s not going to cut it. Actually I’m going to, I’m going to do a couple for this. And I’m sorry, I’ve used your name in in vain, Tano. So do you want to come back and go that that doesn’t reflect well where are you at?
Tano Rebora
Yeah, no, sorry, good example. I think the other side of it is that there has to be a change in the mentality about the idea of a doctor needs to see this, or a doctor needs to get this sorted. One of the things that’s really helped our surgery is getting the right patient to the right kind of clinician or service. So sometimes it doesn’t need to be a GP.
Yes, GPs can do an awful lot, but actually we’ve got a variety of people in our clinical team. We’ve got ANPs, we’ve got ECPs, we’ve got a physicians’ associate, we’ve got local pharmacists, we’ve got clinical pharmacists, we’ve got such an array of people in our team now, it doesn’t always have to be I want to see a GP. So sometimes things will come through on the online platform and actually we’ve got a really good service locally with Pharmacy First.
So actually it could be a case of well actually yes, it might be a UTI and it is a lady under the age of 65 and this is the first time she’s having that – actually Pharmacy First can see that person today and get that sorted and potentially give appropriate antibiotics without it needing to come into the surgery that freed up appointment means that I can see something else so I can deal with someone else or I now have another appointment for someone else.
So one of the things it’s allowed us to do is properly triage what needs to come into the surgery and what can be directed elsewhere. We also have things like Evolucio, which is an eye service locally we’ve got from our ICB, we’ve got access to direct physiotherapists, so there are lots of different avenues we can use rather than everything having to be seen by a GP like it used to be.
Tim Caroe
Yeah. And thank you so much for saying that because that is fundamentally important. One of our sites called EBC and I’d love to have an ECG by one of your ECPs at EBC and then we could see how much confusion that brings!
The important point you make is that yes, there are, there are lots of different people within our team. So it doesn’t have to be a GP within our practice team, nor does it actually have to be our practice team at all. So something that would have taken an appointment sitting there talking about, well, he doesn’t want to go to school and can you write – actually you’ve got a school nurse.
So these appointments that used to be long and difficult actually aren’t needed at all in many cases and that’s what can happen. And we talked about the level of clinical input needed. They may not be happy hearing that from a reception team, but actually if it’s from Dr Sen or from Dr Richardson, that’s quite a different matter. And so that element of that senior clinical decision making and helping people know where the best place to go can be really important.
Now my confession is that we could talk about this probably for the rest of the day. Because each of your individual journeys to get here has not lasted for 55 minutes on a recording. In many cases it’s been years and the richness that you have brought to your teams has been really important.
And I think in terms of wrapping up, if I may just pull a pull a thread out of this, I think Bill’s trough of despair is a good place to just reflect that it if you’re listening to this podcast, you may have already – are you going to listen to it if you if you’re already down the end? Maybe not. You’re probably in that point of going, ‘Oh my goodness, we’re going to have to do this. I’ve got no idea.’ So we just acknowledge that that is an OK place to be and that there is support out there and there’s a journey and there is a step and there’s one more step.
And maybe just tomorrow you could text one person on your list for the next day going. I see you’re coming to see me. I just wonder whether I could you know, save you a trip. What’s up? And maybe 10 seconds later you may have managed that consultation and you might have a gap in the afternoon. What’s the smallest step you can do to build confidence with your teams?
There is help out there. And the aim of this fundamentally is to support people, not to come down with a tonne of bricks, you know, the day after and go, you are not compliant and bad things are going to happen to you. The aim is to support you. There is nothing special about anyone on this call other than they’re like you and they’re like me and my journey to this has been ups and downs as well and your journey is going to be ups and downs.
But I just hope listening to this you have had some hope that this is possible.
You’ve got some expectations of help that you can help to get there, and we’re real. And if we did another podcast with all the mistakes that we’ve made, that would probably also last the same amount of time. So none of us are perfect, expect to make mistakes.
But hear that this is a way that you can help your teams and your population to deliver safe quality care. Are there any last words that anyone else wants to throw in that we haven’t said at the end, I’m sure Bill, you’ve got a fist- Yes, I knew you’d have a fistful. Come on.
Bill Graham
I’m not exaggerating when I’m saying I’m 800% sure that making this switch will not be a bad decision.
Tim Caroe
Brilliant. Brilliant. So that’s one word. Let’s say in a sentence, let’s go around just kind of one, one or two sentences that you would say to your colleagues who are going not sure. I’m going to pick in an order – Holly.
Hollie Burns
It’ll be difficult, but building the confidence in your staff, in your patients, having everybody on board is the massive key thing you can do, and it’s not actually as bad as you think it’s going to be.
Tim Caroe
I love that. And now everyone else has had a chance to think as well. So thank you for going first in that. So Aroop, what would you say?
Aroop Sen
I think initially it’s it won’t run to plan. So as I said before that adapt, evolve and see how it goes. Again the team needs support. So whether you’re even as your lead GP is supporting your reception team or you’re supporting your colleagues during the three, just be there available for everyone so that peer support.
That reflection that even at the end of the day, at the end of the week coming, looking at what could have gone better or what mistakes have happened, what can we do to make any changes, just taking all that feedback and putting it together.
Tim Caroe
Loving it. I’m loving it. Tano, what about you?
Tano Rebora
So I would say that this isn’t going to fix all the problems that we all face in primary care, but what it will do is give you a tool to help you manage that demand in a safe way.
Tim Caroe
Thank you, Tano. Pippa.
Pippa Richardson
I was thinking about what I feared most before we started this journey and I think it was that fear of unfettered demands just landing on us and us being on it able to cope and I guess.
If the one thing I can say is the reassurance that 2 1/2 years down the line our demand hasn’t changed. As you said, it’s set very much similar to how it was at the start apart from that blip as you said right at the very start.
And the things that you gain from understanding your whole demand and your needs in terms of capacity are huge. And that then opens all sorts of doors in terms of other things you can think about in terms of improvements because once you understand your demand.
And what types of demand you have and what sort of staff you need to meet that demand, you can really start to look at the clinical things you want to improve on. So that’s the exciting thing for me I think.
Tim Caroe
Brilliant. And my one sentence is going to be about continuity and that many people might say, oh, it breaks continuity. Actually, this model can help you support continuity because I might go only Dr Richardson is going to be able to deal with this. I know they want to talk to someone else, but that’s precisely why Dr Richardson is the right person to talk about this. So having that sort of input can actually support the continuity elements.
Well, I feel like we’ve been like Avengers Assembling, tackling, you know, this, this thorny topic and you know, it is really humbling to hear about all your journeys. I hope that whoever listens to this podcast you know, comes away equally as energised as I feel about this.
And North East and Yorkshire. Wow, I knew you guys were great. You know, if anyone wants to come down to the Southeast, come and work with me, you know, feel free. But you’ve been absolutely amazing today. I’ve really appreciated this conversation. I hope you’ve understood my accent being from so far away and I suppose I should say tune in next time when I’m sure the North East Yorkshire team are going to have something truly awesome for you. They are really good.
So thank you to all the team at the North East Yorkshire region for having help put this together and we will join you on a podcast next time. Goodbye.
End