Slides for a workshop with GP practices introducing online consultations and the GP Forward View fund

1. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultation systems
• About online consultations and the fund
• Benefits and lessons so far
• Process for planning and procurement
• Support for patients and practices
• Dr Robert Varnam
• Director of General Practice Development
bit.ly/gpfvonlineconsultations

2. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultations – why?
bit.ly/gpfvonlineconsultations
About Benefits Process Support
Improve access and manage workload
Right
Access
Right
time
Right
place
Right
person
Right
care

3. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
What does it look like?
• The practice has a licence for a system operating via web portal +/- app
(ie no software to install / maintain on-site)
• A link is put on the practice website
• Patients use it as their first port of call
• information about symptoms, conditions and treatments
• ask a question / initiate a consultation with practice
bit.ly/gpfvonlineconsultations
About Benefits Process Support

4. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultations
bit.ly/gpfvonlineconsultations
About Benefits Process Support
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription,
check test results,
book appointment

5. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultations
bit.ly/gpfvonlineconsultations
About Benefits Process Support
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription,
check test results,
book appointment

6. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultations
bit.ly/gpfvonlineconsultations
About Benefits Process Support
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription,
check test results,
book appointment
Type details of the problem or
question here…
Send

7. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Systems available
bit.ly/gpfvonlineconsultations
About Benefits Process Support
• Rapid growth
• 2015: 2 systems widely available
• January 2018: likely >10 on national approved suppliers list
• Functionality currently more targeted at first contact than ongoing care
(but rapid evolution occurring)
• Interoperability currently limited - but rapid development…
• closer integration with clinical systems
• links with 111 Online
• links with NHS.uk
• Citizen ID
• links with apps & wearables

8. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
The GPFV fund
£45m over 3 years … equivalent to £0.80/pt average
Available for every practice
To pay towards costs of purchasing & using solution to
enable patients to consult their practice through an app/web
portal
• not about private providers
• other features not essential (eg video calls)
• join-up with other services not essential (but note pilots)
bit.ly/gpfvonlineconsultations
About Benefits Process Support
System procured by the CCG, for bigger impact and value

9. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Future development
Active development is underway to provide a more seamless digital
experience for patients across a range of NHS services. Pilots are
underway to test approaches that link general practice access with
111 or NHS Choices. There is still much to do, but the pace of
change is rapid.
bit.ly/gpfvonlineconsultations
About Benefits Process Support
Self care and prevention
• NHS Choices
• Apps & wearables
Primary care
• GP
• Pharmacy
• Dental
Urgent and emergency care
• NHS 111
Enabling technological capabilities
• Citizen ID
• Patient health records
• Directory of services
• Regional interoperability hubs

10. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Benefits: evidence in early adopters
bit.ly/gpfvonlineconsultations
Improved access
eg Unity Health, York: GP wait reduced from 2-3 weeks to 1 day, DNAs from 10% to 3 - 5%
eg Larwood surgery, Workshop: named GP wait reduced from 1-5 weeks to a few hours
Connecting patient to most appropriate source of help
Making Time in General Practice study: GPs judge 7% of consultations should have gone to
someone else in the team, 8% of consultations could be handled by clerical team, 6% more
appropriate for self care
eg Docklands Medical Centre: 90% of users did not proceed to request support from practice
Some problems addressed more quickly by GP
eg Docklands Medical Centre: 40% of contacts resolved without patient needing to come in, mean
2.9 minutes’ GP time
eg Unity Health, York: 66% handled remotely, take <10 min for clinician
Improved information prior to face-to-face consultations
Patient’s history, ideas, concerns and expectations provided in advance
Opportunity to obtain more information before definitive consultation (eg specific symptom score,
patient diary, blood tests, etc)
About Benefits Process Support

11. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Case studies:
bit.ly/GPcapacitynet2

12. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Do patients use it?
Yes – if they know about it and are encouraged by staff
• Where patients are not engaged by the practice, the service is hard to find on
the website or staff are not confident in describing the benefits, patient uptake
can be very low.
• This is not surprising, but it is sometimes overlooked by practices. Recent
academic publications confirm this.
bit.ly/gpfvonlineconsultations
Potential shift to ‘click first’ for patients
• Rydal practice (suburban): 40% contacts online within 3
months
• Unity Health (suburban and student): 87% online
Potential shift to ‘click first’ for patients:
eg Rydal practice (N London): 40% contacts online within 3 months
eg Unity Health (York): 87%
About Benefits Process Support
Use crosses the generations:

13. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Is it safe / approved?
Safety standards (cybersecurity, information governance, ESCROW, etc)
• Detailed standards published by NHS England October 2017. National
approved suppliers list gives assurance that specifications meet all relevant
current legislation and best practice standards.
Medicolegal view?
• Same as for phone consultations / patient letter (see in person if clinically
appropriate, follow GMC and CQC requirements for good care)
• contact provider if non-GPs are consulting
Cautions
• Consider confidentiality, potential need for face to face conversation /
examination, checking patient agreement with management plans.
• Consulting without the record is less safe. Inform provider, likely to pay extra
• Patients under 16 – generally not
• Private patients – must inform provider, likely to pay extra
bit.ly/gpfvonlineconsultations
About Benefits Process Support

14. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Publication of full requirements
and planning guidance
Launch process
CCG plan
Plan approved by NHS England
Funding allocated to CCG
CCG procures systems for practices
Practices go live
30 Oct 17
November
and
December
January
onwards
National webinars for practices
and CCGs
Planning support for CCGs
from NHS England regional
team and national commercial
and procurement Hub
Procurement advice and
support from Hub
Ongoing programme of
showcases (through General
Practice Development Programme)
Marketing materials and
support to engage with patients
bit.ly/gpfvonlineconsultations
About Benefits Process Support

15. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Support – for procurement
National Commercial and Procurement Hub will create an approved suppliers
list to be used in a dynamic purchasing system (DPS). Requirements:
• relevant functionality
• meet all appropriate standards (inc IG and cybersecurity)
• organisational capacity to meet demand
• financial stability standards
The Hub will keep the DPS updated with new features, standards and suppliers
CCGs can then run mini competitions using the list
• assurance re standards and state-of-the-art solutions
• fast procurement (min 15 working days)
• best value for money
DPS
launch
in Jan 18
About Benefits Process Support
bit.ly/gpfvonlineconsultations

16. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Support – for practices
Experience to date yields important lessons about maximising the benefits …
‘Having the system doesn’t give benefits – using it does’
Practice Manager, South of England
Practice usage
• Staff need to be confident in describing new
channel to patients
• Response needs to be timely
• Staff need to make the most of opportunities to
direct work to the most appropriate person
New marketing
resources and
support
New practice
resources
Support from
regional Patient
Online teams
Patient usage
• Patients need to know about the system and be
confident in the benefits
• It needs to be easy to find on the practice website
Support being provided:
About Benefits Process Support
bit.ly/gpfvonlineconsultations

17. @robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Monitoring and learning
Monitoring
Management information will be gathered quarterly as part of the General Practice
Forward View monitoring system.
• Uptake by practices
• Systems being used
• Performance of the Dynamic Purchasing System
• Alignment with other digital services (as they come on stream)
• Patient usage statistics (number and type of contacts, demographics)
Deeper learning
A sample of practices and localities will be invited to participate in providing much
more detailed data. This will generate more insights into the impact and critical
success factors. Lines of enquiry will include:
• Patient utilisation (eg clerical / clinical query, new / existing problem)
• Outcomes (immediate disposal, reconsultation rates, time taken)
• Patient and staff experience
About Benefits Process Support
bit.ly/gpfvonlineconsultations

18. @robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
bit.ly/gpfvonlineconsultations