The team at MyHealth Group in York, North Yorkshire, first made changes in April 21 in response to feedback from their patients. They have since restructured their staffing based on the insight they received from their digital systems.

Practice Manager Lucy Murdoch recalls,
“we had to offer contact via online consultation and our existing platform wasn’t good enough. It was quite clunky in terms of how patients used it and also in how it fed information back into the system.  Nothing was coded.”

The practice, like many across England, was also experiencing surges of demand first thing each day – the 8am rush. Lucy continues,

“Patients were calling us and we were having to tell them ‘unfortunately we’ve got nowhere to put you right now’ so we knew that we needed to do something urgently.”

The team decided to introduce a new, improved and combined online consultation and triage system. The next step was to consult with the practice’s patient participation group (PPG)

“Having this a panel of advisors on board, which includes a retired nurse, was key,” says Lucy

“We spent a lot of time looking at it from a patient perspective. We also did as much data analysis as we could – we already had cloud-based telephony at that point. It was really useful to be able to understand our call patterns.”

The telephony data revealed the practice, which has a list size of just under 19,000, was frequently experiencing an influx of calls, and a lot of repeat calls from the same people. This suggested that not only did the practice not have the right staffing levels to manage the demand at this time, but people were also calling back as their needs were not met.

“A lot of people were calling us at certain times and then calling back again which indicated they were not able to get through or get an appointment,” Lucy continues.

“Once we put this problem to our patient group, we got their buy-in and we set up several groups to move the project forward.”

Implementing a new system in a month

The practice had just one month to get the new system up and running because the contract for the previous system was due to expire. Lucy describes how everyone had to work together to ensure the implementation of the new services were as smooth as possible as follows:

“Each of our GP partners has a lead area that they look after, and all of these leads were involved. Some of the staff that would be working actively with these systems also took responsibility.”

The team felt the looming deadline really spurred them on to makes the change and do things quickly but knew that taking patients with them was vital to their success.

“Patient engagement was absolutely essential,” Lucy continues

“We updated patients through text, social media, putting things on our website. Our care navigators and social prescribers ran a couple of sessions in the local village halls to help patients who were maybe not as IT literate to understand the concept.”

As well as sending regular update emails to staff and also producing step-by-step guidance.  the project team also held training events using a test environment so the staff could safely run through common scenarios.

Lucy remembers “One person would be the call handler taking information from a patient and having to put it through the system, then other people in another room were picking that up so they could  follow the process and understand how it all joins up.”

When it came to the go live date for the new system the practice were well supported. Their online system provider was on site to help with any initial teething issues and they also kept patients informed.

Lucy continues, “We put messages on the phone line, to say that our new system is going live.”

“We tried to manage patient expectation. When we didn’t get it 100% right patients were happy to feed that back and we answered any complaint or concern.”

Refining the system

Once the new system was up and running, the practice made further changes to make sure it worked for both staff and patients.

Charles Sinclair-Lack, a GP partner at the practice, says the practice quickly came to realise the importance of setting parameters, saying:

“You go from having this demand that is capped because you don’t know where to put anybody and you’re turning people away, to having a continual conduit for patient contact.”

“People contacted us at 2.00am with quite worrying things. There was no one here at that time to react to them and it didn’t matter how many warnings we put on the system; people just clicked past them.”

The practice switched their online system from being on all the time to mirroring their opening hours.  They have also streamlined the options available for patients to choose when filling in the online form.

“it was getting so complicated for us to manage and for the patient to understand which applied to them.” says Lucy

“We narrowed it down to ‘do you have a routine problem’, ‘do you have an urgent problem’ and then a few very specific queries like follow up appointments, contraception, admin requests… “

Charlie adds, “… each of those categories that a patient can select goes to a different team.

“The admin ones go straight to the admin team; the GPs don’t need to worry about them. Any of the actual clinical cases do go to a GP because then they can be triaged appropriately.”

At My Health Group a team of 9 GPs are responsible for the triage of patient requests.

Charlie continues: “It doesn’t matter whether patient fills in the routine or the urgent form. It still goes to a doctor, that page review. But what it tells us is how worried the patient is about their symptoms and how urgently they think they need to be seen, which is really useful information.”

New ways of working

The new ways of working have reduced pressure and improved working for the team.

“They’ve given us a much better understanding of the requests we get through and a bit more autonomy over how we manage them,” explains Lucy

“We can determine where those requests go… and because there’s a lot more data analysis behind it, it’s easier to do that. You can give people specific areas of responsibility…”

The practice are confident that their systems are set up to make sure that the patient cases are dealt with by the most appropriate people – and in the quickest and safest way.

Lucy continues: “Some of it’s just directing patients to services like Pharmacy First directly. The other is the data side of things. It means we can monitor when we actually can’t see any more patients and we can do that at the front of the line as the patients are coming in.”

The practice has six allied health professionals the team can refer to, including a physiotherapist and a mental healthcare worker.

Charles adds: “you can just directly send patients to places where they get the care straight away they need. Physios are perfect example…that’s relieved a lot of pressure on the GP system. Patients are getting more specialised care and are also being given coping mechanisms to be able to deal with the problem then and there.”

Challenges with expectations

Some of the challenges have been around managing patient expectations around the wider GP team but the practice say this is improving over time as patients appreciate the speed with which they can be seen and treated.

Charles says:
“Our feedback has gone from being about getting appointments – I don’t want to have to wait this long to being seen, to being more about the member of the team they are seeing – I still need to be seen by a GP.

“But that’s just the nature of it. The especially good feedback we get is because we can react incredibly quickly…with certain rashes and things like that they can send us a picture that morning and we can have them on treatment within hours. They don’t need it that quick by any means. But we can do that and the patients love that instant response”

Lucy adds “Our compliments far outweigh any complaints or grumbles – it’s it usually things like I put in an online form this morning 15 minutes later the GP had called me and I had a prescription because it can be instant.”

The practice team also appreciate there is more to look at in the future in relation to the managing the impact of modern triage techniques on GP workload. Charles says:

“there’s a lot more computer work for GPs because someone has to look at these forms and that’s not necessarily what colleagues want to do. So that’s a challenge.

“triage is probably the hardest part of our job. It’s very difficult. You’re making quick decisions or limited information”

Restructure

The changes have enabled a substantial reduction of workload for the administrative members of the team. In January 2024 the team restructured based on the information received from the new system, creating new patient services and records teams.

Lucy explains “We had backlogs of work, not enough people to be able to manage it. And when people were sick, there wasn’t enough cover – it was affecting our access, it was affecting staff morale.

The team recognised they needed to do something to improve services for patients, to protect staff and to improve staff retention.

“We threw everything up in the air. We looked at exactly what we had coming in for every single area that these non-clinical teams have to deal with and worked out how long it would take.” Lucy continues.

As a result they stripped things back to create two new teams.

The patient services team deal with all first points of contact – phone calls, reception and appointment booking. They also manage the planning system,

The record team deal with the patient record including registrations, deductions, data quality, the coding of documents, and referrals.

“We’ve already seen vast improvement in terms of workload management, things been more evenly distributed,” Lucy adds.

Reaping the rewards of change

The positive impact of the changes made are showing in the data and the team have said a final farewell to the 8am rush. The practice now receives around 5-6k enquiries a month through the online single point of contact system, with the majority of calls being received between 9 and 11am. Around half of patient enquiries are submitted online.

Lucy concludes:

“Between 8:00 and 9:00, the calls aren’t as busy as they used to be…we have a phone message asking patients to be mindful of keeping our phone lines available for more vulnerable people and encouraging them to try online.”

“We also look at patient feedback. Each month we assess how patients have rated the online triage system from excellent to poor. Generally, it’s excellent and good by a vast majority and that gives us the confidence to say that modern general practice is working for us.”

For more information about Modern General Practice visit NHS England » Modern general practice model