From the 29th March 2021, all contacts with the practice are moving to an on line service called eConsult. The aim of this paper is to explain why the practice has made the decision to move to this system and answer some of the queries you will have about how this will work.
Why are we making these changes?
The Covid pandemic has changed the way general practice works and there will be no going back to the way that appointments were booked before the pandemic started.
· The Department of Health and NHS England now require practices to work in a “100% Total Triage” way. This means that for every encounter, the receptionist is required to establish the reason for the request, then direct it to the appropriate clinician, which may not be a GP and may not even be within the practice.
· Over 80% of patient requests can be dealt with, without physically seeing the patient face to face. Alternative methods include text messaging, telephone and video contact. The requirement is that we see face to face, only those patients where there is a “clinical need” to see them.
· The GP workforce has changed significantly in recent years – previously patients were seen almost exclusively by a GP. Then advanced nurse practitioners were added. Now, there are a whole range of different clinicians that can deal with issues, GP’s, GP Registrars, physicians associates, prescribing pharmacists, advanced nurse practitioners etc. Following triage, the matter is sent to the most appropriate Clinician to deal with.
· Wait times on the telephones have grown recently, due to excessive demand and pressure on the telephone system with lines being taken by outgoing clinical calls, meaning that patients have had to queue longer. This has been exacerbated in the last 3 months by the volume of outgoing calls to book covid vaccinations. Extra lines have been procured, but have made little difference due to the demands on the system. This is not sustainable (for any party) going forwards.
What are the benefits to patients of these changes?
· We know that for many years, there has been a scramble at 0830 each day to get an appointment. The number of contacts we can deal with is obviously limited, which has meant that there have been some days (not every day by any means) where the demand has been greater than the number of appointments we can offer. The length of time of people queueing has grown. By using eConsult, the practice is available 24 hours a day, 7 days a week. EConsults are triaged from the answers the patient provides and if necessary, the patient is redirected elsewhere, for example if they need urgent treatment they will be directed to A & E (General practice has never been an emergency service). Each eConsult is triaged by a Clinician (clinical) or an administrator (admin) depending on type. They will then be dealt with in priority order, normally by the end of the following working day. Responses may come by various means, telephone, text, video etc.
· The telephone lines will be freed up, for those patients who can’t use eConsult. Staff will take their details and submit an eConsult on the patient’s behalf. Everyone will therefore be treated in an equitable manner.
· Those patients who historically have been seen annually for chronic disease checks, are often working population. For those (and many other patients) having to telephone at 0830 is a problem, as is taking time off from work to attend in person. Under eConsult, when called for their annual check up, the paperwork for the check is provided up front and completed by the patient and returned. It is then reviewed, with the patient only being contacted as necessary, to either complete the checks remotely, or if they need to be seen to make the necessary arrangements. This will be much more convenient for patients.
Frequently asked questions.
1. Will the change disadvantage the elderly or those without computer access? No it won’t. Because the bulk of patient contact will have moved away from the telephone, these patients will be able to get through to reception and be dealt with more efficiently.
2. What if you don’t have internet/computer access? Phone the practice, staff will submit the eConsult on your behalf.
3. Are there any patients who cannot use the system? If so – how do they access the practice services? Yes – those with no internet/computer, those where English may not be available, those with learning disabilities, children under 6 months of age, children under 16 calling by themselves. Those patients will need to contact the practice in the normal way and will be dealt with.
4. When will the practice return to a booking system as it had before the pandemic? It won’t – for the reasons stated earlier. The requirements for 100% triage are here to stay. All practices will move to the sort of system now being introduced in due course, the practice is simply moving to these methods as an early adopter.