Slight understatement – we’ve got a bit of a challenge at the moment, we all know its tough in #teamGP in general practice right now. Most know its due to imbalance between funding allocation, capacity and demand and there are a number of great blogs out there; this one, We were never closed from Dr Abbie Brooks @DrAbbieSBrooks prompted me to offer my thoughts.
At Redmoor Health we try to help practices with digital change. We try to help embed tech and digital ways of working to make practice’s lives easier. We also try to explain why this benefits patients and practice teams, helping those that can, to self serve, whilst releasing time to support more vulnerable and in need. We are commissioned by NHS organisations to do this, as they try to implement policy directive, whilst offering support and balancing the need to ensure value for money at the same time – no mean feat. And all of this is happening at a time where patients have been ill with a novel virus, some have lost family members to covid, are in fear of getting covid, or have been vaccinated to reduce the effects, on top on their pre-existing (possibly deteriorating) conditions and any new health concerns. No wonder everyone is tired and fraught, and I hope our offer of help comes with the understanding that we know how challenging it is out there right now.
Access and online consultations….
Some say, that enabling online services mean that ‘the floodgate is open’, in fact one GP actually said that they’d hold me personally responsible if they switched on Online Consulting (OC) and then couldn’t meet the demand. And perhaps some (in my opinion) wrongly blame the tech for this surge in demand. Others are more honest and know that previous methods of access to general practice were unfair and not based on any sense of clinical need or priority. The ‘sorry, everything is booked, please ring back at 8am tomorrow’ never worked or landed well. Perhaps a small minority of GPs were actually unaware of their access problems as the ‘good old Reception gatekeeper’ managed to shield them to an extent. Most know the main reason is lack of GPs and staff leaving due to increased pressure.
Good practices have been triaging for almost 10 years so moving from Telephone to Online Triage wasn’t a huge step forward. But patients are individuals with their own problems, each one is important to them and not in any way relational to the next, ‘more ill’ patient. So, many people have no concept of clinical prioritisation or indeed the pressure in the system, at the time that they become unwell. They do what they’ve always done, either ring the GP or look on the website. What’s the first thing that many see? ‘Consult with your GP now’.
Online Consulting and your website…..
Job one for practices, look at the placement of your offer. Unless you have a wonderful system that offers self care as part of the triage process, make sure that your site offers self care first. Then explain what to do and where to look for information when you are closed, and then show the online consultation banner.
Patient and practice expectations…
Also, the change in culture of 24/7 access to everything and ‘need it now’ convenience is driving the demand, supported by some influential but irresponsible mainstream media headlines. At the end of the day, I am one patient, I might use all modes of access, but not all at the same time. Why wouldn’t a patient expect to use these methods? They do for every other aspect of daily lives. This last year, I’ve used online consulting, had telephone triage calls, been seen and referred when needed and sent images via text solutions to help the process along. Each time, I’ve understood when and how a reply may arrive, but that’s because I work in the system, not necessarily because that information is available either on a website or via other methods of communications. We know that many practices still struggle to blend the multiple routes of access, planning this into their workflow and so try and restrict to fewer options for patients. This is perhaps what seems to increase the OC demand, because GPs are now seeing stuff come via OC that previously other members of the team would have dealt with, if the enquiry had come in by phone or in person.
Practices ask for ‘one system/thing that does it all’ to help with this. Believe me, training teams on multiple platforms with similar names and functionality isn’t easy so I understand this request – but there isn’t one supplier that currently offers it all – there is a blend of online services, online and video consulting and use of messaging systems from suppliers and a ‘marketplace of offers’ of functionality that is mind blowing; no wonder we can’t choose the right product to meet everyone’s expectations.
Education and awareness
Our biggest challenge is how to educate people, on what’s available, what to try first, and how to seek help when needed; making this information inclusive and easily accessible and known about, even when patients are not ill. NHS.uk have worked hard at improving their website resources, and a number of website suppliers have improved their site templates well, but many practices have yet to benefit from this.
Within practices, the challenge is how to create this information and disseminate it to local populations, but we should be doing this collectively and not as separate individual practices. Many seem to struggle to articulate this ‘why, when, what, who, how’ approach into patient communications, most likely due to workload pressures or even time to think about it from the patients view.
PCNs – the digital opportunity…..
So, primary care networks (PCNs) offer this opportunity and the covid vaccine program has enabled great collaboration, supported by some super tech, software and motivated teams to work differently. We need to keep this way of working and think wider than collaboration for just vaccines. Let’s use the PCN structures and new team members to think about consistency of communications, education of the right route of access for the problem, what to check first and where to look before contacting your GP. And let’s use the power of community networks and social media to share this information.
How many PCNs have digital communications on their regular agenda or are building networks of digital champions both in their workforce or communities? And if you’re in a commissioning role and haven’t already done this, please get chatting about blending Digital First, Primary Care & Workforce commissioning together, because one enables the others and your pooled resources will go much further.
Get in touch firstname.lastname@example.org if you want to explore further, we’re all here to help each other.