The project team focused on a set of operational challenges that the new technical solution needed to address and worked with their clinical system suppliers and the national and regional NHS England teams to create the right technical solution to solve them.

Challenge 1: Developing a more seamless way of managing online consultations

The PCN wanted to move away from a traditional ‘refer in’ model for eHubs where local GP practices either forwarded online consultations into a PCN hub federated delivery model via email or fed them manually into a cross-organisational appointment booking system. Instead, it worked with EMIS to develop a way of getting online consultations to flow directly into the PCN-level clinical service enabling the centralised hub-level processing of online consultations.

This involved setting up a new MESH inbox within the hub and then reconfiguring each practice level online consultation service so that all patients’ triage forms were automatically re-routed into the new inbox. In addition, the team used the eConsult Smart Inbox tool to efficiently process online consultations between the hub and their constituent practices, significantly improving workflow and communication.

Challenge 2: Designing a more effective way of updating the patient’s coded care record 

While care record sharing agreements between the clinical systems at the patient’s registered practices and the hub had been available for some time, there was a gap in coded care record management which meant that the patient’s GP practice would have to either access hub-based activity via a shared care record, or manually code relevant entries from a hub-based consultation into the patient’s GP record.

Folkestone, Hythe and Rural was one of two PCNs that piloted a new ‘consultation write-back’ functionality with EMIS that allows consultation entries added to the hub record to be coded back into the patient’s registered GP record automatically. This has been done via a technical sharing agreement and means that local GP practice staff no longer need to manually update their records after handling each online consultation thereby saving time for practice.

One of the technical issues that arose during the pilot was that consultation write-back functionality allowed consultations to be sent between practices in certain scenarios as well as from hub to practice. EMIS will shortly release an enhancement that will allow this to be switched on and off according to the client’s preference. In the meantime, any PCN looking to exclude practice-to-practice write back can contact EMIS to request one-to-one consultation write-back agreements.

A second issue was that all third-party products that created consultation entries in the EMIS Clinical Service were not written back to the host GP practice using consultation write-back. Again, EMIS are due to develop an enhancement to resolve this issue. More details on the temporary workarounds put in place to manage this issue can be found in our EMIS PCN hub clinical system functionality issues log.

Challenge 3: Creating a more efficient way of managing prescribing processes

There were also practical barriers that prevented prescribing from the hub. After consulting with a patient, a hub-based clinician could raise a prescription on their behalf but was not able to issue it. This led to additional work for the practice which needed to reconcile any prescriptions raised before issuing them.

Following discussions with NHS Kent and Medway ICB, the PCN established a new prescribing cost centre, which has been configured into the Electronic Prescription Service (EPS) module in the hub clinical system. This has allowed hub-based services to raise and issue non-repeat prescriptions directly. It also aggregates data on PCN-level prescribing for PCN audit and monitoring purposes.

Challenge 4: Supporting different referral methods 

The project team also worked with their clinical system suppliers to develop a series of technical solutions and workarounds to support the different ways in which a patient could be referred into the hub by one of the constituent practices. The next section of this guide provides more detailed descriptions of how each referral method works in practice.

Challenge 5: Managing workflow using the eConsult Smart Inbox tool

The PCN uses the eConsult Smart Inbox tool to help hub and practice-based teams to process and triage online consultation requests in a collaborative way. The tool helps to build resilience and supports business continuity if the capacity of the hub becomes over-utilised, or if there is insufficient hub staff to manage demand, by allowing the seamless flow of online consultation requests between practice and hub. This also encourages multidisciplinary working and supports the “right care, right person and right time” approach based on clinical need.

Next section: Supporting referral processes