Organisation introduces a tool that allows GPs to remotely triage and signpost patients to appropriate care pathways, reducing the time needed to review patient cases and saving costs

Challenges

 Primary care is struggling to cope with unprecedented demand and more complex patient needs. Pressure on services is exacerbated by unnecessary attendees (who should be seen elsewhere) and others unable to make appointments. Our solution uses a digital platform, improving patient access to healthcare, directing them to the most appropriate care, reducing the need for appointments and increasing efficiency for clinicians and administrators. Patient contacts their own GP, answering a set of questions relevant to their symptoms. GP (who has access to electronic-medical record) triages patient remotely, offering the most appropriate care (prescription, follow-up call, face-to-face appointment or general advice). Please refer to attached pdf for more information.

Actions

 Involvement

The platform was developed in 2014 by NHS GP partners to address issues of access weighed against demand within their group of practices. The product has been constantly evolving with the input from key stakeholders:

•NHS clinicians

o7 GPs and 2 Senior Nurses in core team

oGovernance by 30 UK GPs including GPwSIs, trainers, academics and leaders in general practice

oClose partnership with NHS Choices (self-help)

oExpert Group meetings every 6 months with 10-12 clinicians and senior NHS managers

oDesign workshop for primary and urgent care

oSurveys/ interviews with customers (including practice managers, GPs, nurses)

•NHS administration team

oDesign workshops for primary and urgent care platform involving multiple stakeholders

oSurveys/interviews with customers

oFeedback from CCGs and Federations

oNHS Choices

•Patients

oPatient Participation Groups, Patient Councils and Patient workshops

oOngoing patient survey with >20k responders

oDesign workshop for primary and urgent care platform involving multiple stakeholders

•Development technology experts. A group of senior GPs and academics, software programmers, website user experience experts and input from Design Council, Patient Participation Groups and NHS Choices.

oCurrent in-house development team of eight experts in product creation, product management and user experience/interface

oDesign workshop for primary and urgent care platform involving multiple stakeholders

Cost

Since 2013 we have invested £1.2m to get us to this stage, covering both technical development and significant clinical (GP) input into the content of the platform.

Value

•Improved patient service: Patient can consult with GP from home, 24/7 with response within 48h (access + convenience).

•Improved efficiency: signposting to most appropriate channel of care, prioritisation of appointments, remote closure (reduced time needed to review patient’s case), self-help system and financial savings (~£13 per patient).

•Improved efficiency/flexibility of admin team: lower number of calls to the practice allows administration team to better manage their time.

•Wider range of services offered to patient: As GP is able to access the patients’ medical history it is possible to manage more complex, chronic and complicated patients. This means eConsult allows the GP to deal safely with medical administration tasks, refer patient to secondary care, deal with mental health and other clinical areas.

•Product is safe: eConsultations are reviewed by GPs and system offers red flags to immediately redirect patient to most appropriate channel.

•eConsult is user-friendly: used by diverse age group, with easy navigation and high satisfaction rate (>80%)

•Data is secure: sent via NHS server

Results

1.eConsult grown from 0 - 402 practices (UK) within 4 years (~5% market share)

2.~68% of eConsultations solved remotely, enabling savings of ~£13/patient

3.eConsult resulted in estimated ~£850k saving in 2016, expected ~£1.5m in 2017

4.eConsult improves access to healthcare offering 24/7 care and 48h response (cf. average 2-week appointment wait-time)

5.>90% of practices would recommend eConsult, claiming it benefited patients (improved access and convenience), admin team (increased efficiency & flexibility) and clinical team (increased headspace, reduced time needed to review patients’ cases and costs)

6.~80% of patients satisfied with service, will return to and recommend it

Please refer to links with case studies and patient testimonials

Spread

 eConsult has spread from only Hurley Group practices to currently 402 practices across UK (England, Wales, Scotland) meaning that over 3m patients can use it.

We aim for eConsult to move into Urgent Care Centres allowing for enablement of a rapid and effective see and treat model using:

•online registration

•pre-history collection

•automated BP/pulse/temperature/O2 sats

•intelligent clinical risk stratification

Currently, eConsult is cooperating with Bexley Urgent Care Centre and local general practice to develop an integrated platform for urgent care. eConsult is developing partnership with Evergreen Life to add personal account management tools (online booking, access to records) via one platform.