For Practice Business Manager Bex Cottey the positive outcomes of adopting the Modern General Practice (MGP) model in her South Yorkshire practice are summed up very simply:

“The positive patient feedback is phenomenal; every day there seems to be a new review left on the NHS website saying how easy it was to access our services.

“The queries that we now get on the phone lines are not about wanting appointments, they’re wanting referrals or other information.”

The MGP model focuses on improving patient experience and the general practice staff working environment by better aligning capacity with need.

For David Coleman, the GP Partner at the Conisbrough practice, which lies between Doncaster and Rotherham, one statistic says it all:

“We say enquiries will be addressed within three working days. The reality is that 99.5% at the very least, will be addressed on the day.”

The figures didn’t always look as healthy. Before the new single point of contact triage system was put in place, 30% fewer patients were having their needs met on day one. David, the practice lead for patient experience at the practice which serves around 12,000 patients, explains:

“There was always a queue. We had this huge spike between 8:00 and 9:00am.”

There was also a lot of time spent gathering information, with receptionists adding details to the triage list. Bex adds:

“We would explain to patients – this isn’t the consultation, we’re just gathering information to find out where to signpost you to next. That was the biggest waste of time.

“Now patients give all the necessary detail and it’s really clear.”

A catalyst for change

The introduction of the new system over two years ago wasn’t all plain sailing.

Bex recalls: “We had a temporary issue with our phone lines. Our online platform was already there for COVID-19 vaccines – we just hadn’t used the triage side of it.

“We had to communicate very quickly to patients that while we were doing all we could to fix the phone issue, this was, and still remains, an alternative. You don’t need to come in and register, you don’t need a password. The link is easy to find on our website.

“We had a lot of people then realise, wow, this is easy and it’s very efficient and quick…once the online enquiry has gone, I can sit back and wait for somebody to get back to me.”

David adds:

As we advertised it heavily on social media, we found that it ran fairly smoothly, straight away

“It lends itself quite well to a crisis really. You can control things….you can make decisions on the go.”

The new system was therefore surprisingly fast to bed in and patients gave it their full support given the greater access to their GP practice team.

The practice handles an average of 115 enquires each day. The online form informs patients these will be read by a member of the medical team and addressed within three working days.

“Our record is 220 enquiries. The majority will still be seen on the day unless they have a specific preference for a particular clinician” explains David

There are also safety-netting questions built into the software.

‘If they put crushing central chest pain or vomiting large amounts of blood, it will tell them this isn’t the way forward – there’s a better option.”

Facing fears

Despite the switch to the new single point of access triage system being fast-tracked, the practice still consulted with patient participation groups about the move.

They expressed concerns that less digitally literate would find it harder to access services. The practice team reassured them that while it was an option they could use, it was in addition to the traditional routes. Bex recounts:

“It was the fear of using the phone and what if they missed something or they don’t get a response?

“We explained that you can still come to the desk and talk to us face to face if you prefer.

“This system will make it easier for you because we have so many people using it – the phone lines aren’t as clogged up, the queues aren’t as long.”

The fear many clinicians have about adopting new ways of working in general practice proved unfounded at the practice, David explains:

‘I think the big fear everyone has is it will be a bottomless pit…

“We do see sometimes that people will send a message very early in an illness because they can. We manage it appropriately – recommend self-care at the pharmacy and send them information about when to worry about a cough that started that day, how to manage fever.  If you embed that kind of behaviour, it becomes less of a concern. “

Improving staff wellbeing

Staff behaviour has also changed – the use of digital tools has allowed the practice team to ensure clinicians have a balanced day and avoid the burnout that could come from seeing continuous complex cases.

David describes his role as on-call doctor, as ‘clinic creation’ and demonstrates how he uses his role as on-call doctor to make sure staff are not pushed to breaking point while being offered the opportunity to develop in their role.

He says: “You can gauge how much time things are going to take. And I think the system gives you enough information to know this a lot of the time.

“I’ll think that doctor had a really complex patient there – that mental health care wasn’t just a review… it was a crisis. You know that ended up taking an hour and they’re going to miss their debrief so I might pop a little catch up slot in there to check on wellbeing. The other part of having someone having oversight is that I can make these little interventions and make sure that my team don’t have a really horrible day.

“Another doctor might have come from an orthopaedic background, so they know all about shoulder or back pains. But I might think they’ve got a learning need so I’m going to book a gynaecology case with them.”

“it’s allowed us to do more” adds Bex

“Our online consultation service is always available, but we set safe limits for every clinician.

“It’s about allowing them to say ‘I’m starting work and I’m finishing work at a sensible hour. I have breathing space in the day to be able to actually talk to my colleagues.’ We can compare notes. We can talk about cases.”

When asked what happens on the extremely rare occasions when the limit is reached, Bex is confident patients still can access the care they need.

“We have the Saturday hub, we have same day Health Centre which is commissioned for GPs if we need an overflow. We have our health bus that is often in our area and available to treat minor illness and we have first contact physio “

Learning from the data

Information from the system has helped the practice manage staffing levels, both on a day-to-day basis and looking at yearly trends:

Bex explains:

“Last year we could see we experienced winter pressures in November. Our demand was absolutely soaring…but as November’s not typically a month where people have holidays, we had capacity to handle it.”

It also helped them get a true picture of pressure at the practice.

“Sometimes you get this feeling it’s been a particularly tough day,” Bex continues.

“We can look at what’s going on and work out if it’s just perception. Is it that the staff who are managing that day need more support, or is it because demand versus staff capacity was higher?

“It helps us budget better and work out exactly how many staff we need.”

Moving away from the 8am rush

Patient choice and convenience is something that has motivated the practice throughout the change process. The 8am rush has flattened because patients can now choose the time and place that suits them.

When showing the data behind the enquiries. David says:

“You tend to get that little spike after school.

“That little cough has now turned into a more serious cough and a fever, or a rash.

“Because we have managed all our enquiries earlier in the day, I have appointments still available to meet that demand.”

The practice also wanted to make sure all enquiries were treated equally regardless of how the patient chose to get in touch. Bex explains:

“The quality of the information we get from the patient helps us work more efficiently and because we are triaging, every patient gets to see the most appropriate clinic.

“ It doesn’t matter which way your query goes in – online, phone or in-person it gets funnelled in the same direction to the same people, our GP partners doing the triage. It’s a really simple template for our staff to use”

Using the multi-disciplinary team

The practice’s six GP partners have the option of triaging patients to a wide range of allied health professionals. Patients can also book themselves in using the online system.

The Primary Care Network has access to 2 1/2 full time equivalent physiotherapists working out of the practice building two days a week. This means patients can often access physio services same or next day.

David continues

“We used to have a lot of requests for pain relieving drugs, and now because people are seeing physios first for acute musculoskeletal things they’ve dropped significantly. They’re getting sent down the pathway of movement and exercises and empowering them to do something about it themselves.”

Tips for successful implementation

When asked what adopting the MGP model has meant to them. Bex states:

“It’s about providing patients with the service they need at the time at which they need it.

“Something that would have been a face-to-face automatically previously can be a phone call or a text message now. You are getting three patients seen and dealt with in that time… that’s not harder work. That’s smarter work.”

It’s not one size fits all, David warns his fellow GP partners:

““It’s not an off the shelf solution that you just drop into your practice system and it will work. You have to tweak it and make it fit your culture and how your practice runs. The evolution of our systems probably took three to six months.

How it works will depend on what system the practice uses currently and what patients are used to, David continues:

“If you’ve done triage before, it will be different compared to a practice where reception booked everything. If its new to you, introduce it really gently – use it for a specific cohort of patients or try capping it for a day.

The early weeks are also critical to implementation success. The team experienced initial issues due to some variations in triage techniques but worked together to resolve it.

David recalls:

“The pace of change and development in the first fortnight was really fast. We had daily lunchtime chats about the new way of working as it evolved from one day to the next. You need buy in from everyone, so you need everyone to be involved in the discussions.”

“People are still coming through on the phones at the point of implementation, your queue is going to get longer before it gets shorter,” adds Bex

“Slow down and talk to the patient. Don’t feel rushed. Take them through the process step by step, hold their hand through the very first time so they can see how easy it is – they can do it themselves on their own next time.”

The power of positive change

The team realise the changes they have made have created a positive impact on their day-to-day lives:

Bex explains with heart-felt emphasis,

“Now we can reply to that ‘I need to see a doctor’ call on the phone and say “We do have appointments. Can you just give me a little information so we can get you in with the right person?”

David says with similar emotion:

“I can look back… It’s quite easy when you’re on that hamster wheel and you don’t have that control and oversight to lose track of the fact that someone ringing at 5:45 is calling because they’re desperately worried.

“Before we introduced this system, the first day back from holiday I felt like all that well-being and rest had gone by lunchtime. And I don’t feel like that now. I recognise the volume of work is higher, but the way we’re managing it, is making it somehow feel like it’s less.

If your practice would benefit from peer-led support from another practice in the region, please get in touch with the primary care transformation team at england.ney.pctransformation@nhs.net