Online consultations - why, what, how?

@robertvarnam #GPforwardview@robertvarnam #GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Dr Robert Varnam
Director of General Practice Development
@robertvarnam
england.onlineconsultation@nhs.net
Online consultations
Why? What? How?

@robertvarnam #GPforwardview
Pressure Opportunity

www.nhsalliance.org/making-time-in-general-practice/
bit.ly/time4caretool1

74%
7%
6%
4%
3%
3%
2%
2%
Potentially
avoidable GP
appointments
(audit by GPs)
Other in practice
Self care/Pharmacy
Outpatients
Sick notes / appeals
Care navigation
Continuity/preparation
Other
Data from 5,128 consultations
GPs judged 26%
of their consultations
to be potentially avoidable

74%
7%
6%
4%
3%
3%
2%
2%
Other in practice
Self care/Pharmacy
Outpatients
Care navigation
Other
GPs judged 26%
… 18% are about
how the practice
manages its workload
Potentially
avoidable GP
appointments
(audit by GPs)

20,861
1,889
1,550
1,015
818
789
564
564
Other in practice
Self care/Pharmacy
Outpatients
Care navigation
Other
GPs judged 26%
… 18% are about
how the practice
Average practice (6,700 patients)
Potentially
avoidable GP
appointments
(audit by GPs)

20,861
1,889
1,550
1,015
818
789
564
564
Other in practice
Self care/Pharmacy
Outpatients
Care navigation
Other
GPs judged 26%
… 18% are about
how the practice
Average practice (6,700 patients)
Potentially
avoidable GP
appointments
(audit by GPs)
Measure your opportunity…

GENERAL PRACTICE
FORWARD VIEW 10 High Impact Actions
Innovations from around England
that release time for GPs to do
more of what only they can do.
bit.ly/gpcapacityforum

Innovations from practices
throughout around England that
release time and improve care.
GENERAL PRACTICE

#GPforwardview
#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Online consultation systems
bit.ly/gpfvonlineconsultations

#GPforwardview
#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Better service for patients
Connects to the most
appropriate help
Gives patients more
control

#GPforwardview
#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Information about
symptoms and treatments
Find local services
Ask a query, send a
clinical consultation

#GPforwardview
#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
£45 million over three years
Available for every practice
Part of wider digital
transformation

#GPforwardview
#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
About Benefits Process Support

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
About Benefits Process Support

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
About Benefits Process SupportAboutAbout

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
About Benefits Process SupportAbout
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription,
check test results,
book appointment
What does it look like?

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
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
What does it look like?

#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)
System procured by the CCG, for bigger impact and value

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Software on the market
Rapid growth
• 2015: 2 systems widely available
• Jan 2018: national approved suppliers list = 6
• May 2018: national approved suppliers list = 20
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

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Benefits

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Improved access
More convenient access, connected to the most appropriate person first
time, signposted to self help ad community resources
• 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
More efficient use of GP time
Clerical queries addressed by clerical staff, some problems resolved without
face to face appointment, tests done before appointment
• 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
More effective consultations
GP can deal more effectively with the problem because details of the history and the
patient’s ideas, concerns and expectations known in advance
• one of the first things reported by many GPs
• it is hoped that future academic research will seek to quantify this
Benefits in practice

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Scenarios …
I’ve got this headache, and it’s been coming and going for the past month or
so. I’ve never had it this often before. I’ve tried my usual painkillers, but
they’re hardly helping. Some weeks I’m needing them virtually every day.
GP call back
History of tension type headache,
no previous prolonged or
recurrent episodes. Prescription
for Co-Codamol 8/500. No other
significant history.

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Scenarios …
My head’s killing me and I ache all over. It’s been going on for three day, and
I’m really bunged up. My throat’s red raw. Today I’ve got a cough as well and
I’m hot and cold.
Signpost to self help
information / minor ailments
service
Normally well young adult.

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Scenarios …
I tried that new tablet for the migraine and it helped SO much. I think I felt a
little tired after taking it, but nothing much. Is it OK to stick with this one?
Should I throw the Zomig away? I’ve still got a packet from earlier.
Message back to patient
“That’s good news. Yes, let’s put this on
your repeat medications now. Please let
us know if the headache changes or the
new Sumatriptan stops working.
Unopened packets of old tablets can be
returned to your pharmacy – thank you.”
Longstanding migraine. Analgesia
limited help. 4/12 ago Rx
Zolmitripan, no help. 1/12 ago Rx
Sumatriptan, asked to inform GP
of the result.

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Scenarios …
I tried increasing the Amitriptyline tablets but I’m just getting worse.
Headache every day and I’m just so tired. Even just standing up, I get dizzy
and nearly black out. Please do something to help me.
Book appointment with
nurse for blood tests
then follow-up with usual GP
Chronic tension type headache,
4/12 ago started Amitriptyline for
prophylaxis, titrated to max dose
1/12 ago, asked to inform GP of
results. Also menorrhagia and
previous anaemia.

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Scenarios …
This headache is killing me and no one’s doing anything. I was meant to
have a scan from the hospital but I’ve not heard anything.
Secretary to chase hospital
appointment / provide patient
with hospital contact details
Anxiety, depression and
headache, possibly migrainous.
No help from any medication.
Neurology appointment 3/12 ago,
ref’d for MR brain. No
correspondence since.

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Do patients use it?
YES …
1. 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.
Pote
eg Ry
eg Un

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Do patients use it?
YES …
1. If they know about it and are encouraged by staff
2. Use crosses the generations
Pote
eg Ry
eg Un
Potential shift to ‘click first’ for patients
• Rydal practice (suburban): 40% contacts online within 3
months
• Unity Health (suburban and student): 87% online
Data from

#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.
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%
Use crosses the generations:

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Is it ‘approved’?
Safety standards
• Detailed standards published by NHS England, October 2017, covering
legislation / standards for clinical safety, cybersecurity and information
governance.
• National approved suppliers established, January 2018, giving additional
assurance regarding essential functionality and financial stability.
Indemnity providers’ view
• Inform provider. No additional cost.
• Follow GMC and CQC requirements for good care, see in person if clinically appropriate,
don’t break confidentiality, check patient agreement with management plan
• Contact provider if…
• non-GPs are consulting (?additional cost)
• consulting with private patients (?additional cost)
• consulting without the record (?additional cost)
• consulting online with under 16s (may not be covered)

#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

#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Practice usage
• Staff need to be confident in describing new
channel to patients
• Response needs to be timely
• Need to direct work to the most appropriate person
New marketing
resources and
support
Technology
implementation
leads. New guides
for practices.
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:
Support for practices

#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
• 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

#GPforwardview#GPforwardview
GENERAL PRACTICE
FORWARD VIEW
Policy information:
Case studies:
bit.ly/GPcapacitynet2
england.onlineconsultation@nhs.net

Online consultations - why, what, how?

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