Let’s go back to early March 2020, many GP Practices were closed to new patients and General Practice was in crisis for many reasons including decreasing numbers of GPs, Pressure on OOH Services. There were challenges in retaining newly qualified GPs and difficulty recruiting GPs to take up vacant GMS posts. The OOH model was becoming unsustainable and there was a general high demand on services. Many GPs reported that patient expectations were spiraling out of control.
When the Corona Virus came into our lives in late February and early March many of us were a bit frozen in our tracks and feeling overwhelmed and anxious. However, I believe, that we have shown that in each of us is the ability to be resilient in these difficult and stressful times. We are already finding new ways to adapt and developing new ways of delivering care to Patients.
Apart from that first early reaction, which included fear, uncertainty, concern as well as a suite of other emotions, GPs and their staff had no choice but to respond and to consider how they were now going to operate and how they were going to keep themselves, their staff and patients safe. In the last few weeks and months, we have seen a rapid transformation in General Practice & Primary Care. In particular, a digital transformation.
We all know that over the last few years, many GP Practices were booking up to 2 or sometimes 3 weeks in advance with many GPs closing their lists to new Patients. It was not uncommon to see a separate appointment column on the Practice Management Software for ‘Emergencies’. In one Practice where I worked, I observed the receptionist coming under a lot of pressure from Patients looking for appts. I noted that the ‘Emergency’ appointment slot was becoming just as full as the already full appointment schedule for this GP. When I spoke to the Receptionist about this, she told me that on an average day, the list of appts for ‘Dr Drop in’ (as I affectionately named it this additional column) had the equivalent number of appts as the GPs regular appointment slots. This meant that the GP was effectively double booked!!
Something was going to have to give. Over the years, I have witnessed so much underlying stress and overwhelm in General Practice some of which could be managed and made easier, but in general for some Practices, it was becoming unsustainable. And along comes COVID_19.
It has been incredible to witness the digital transformation which has taken place over a very short period of time. From the COVID Screening form which was developed to cut down on telephone triage time to sending referrals via Healthlink and the fast-tracking of E-Prescribing. General Practice went from establishing their own protocols in the first instance to following HSE & ICGP criteria for referring patients for testing. These protocols were changing on an almost daily basis. Practices effectively went from full appointment lists to telephone triage and since that time, the digital transformation has continued.
We have seen how, almost overnight, clinicians roll-out a telemedicine service using off-the-shelf solutions such as Doxy-me and Eirecare (Nua Health) with other using Facetime, WhatsApp and Zoom. The long-term solution for ease of use will require having these platforms integrated into existing Electronic Healthcare Records and I know that this solution is already available on some Patient Management Systems. It will also be hugely important to ensure that the correct protocols are in place to protect both the HCP and the Patient.
There have been concerns that the biggest users of healthcare, the elderly, will be unable to use such services. I firmly disagree. Just look at any older person navigate an iPad after some brief instruction. I remember my Mum being a great example at the age of 91 as she navigated ‘The Facebook’. Elderly populations may need a little more assistance at the outset but once they have the basic concepts down, they do exceptionally well.”
There’s no software for the Patient to download, you can text or email them the link, they click on it, it opens a web browser, then they’re in your ‘waiting room’ and it’s as simple as that. DoxyMe can take photographs of clinical signs, you can share your desktop and show them images, you can even send them documents.
Patients do not place as much value on telephone consultations.
Many GPs are saying that a traditional telephone call is “a very useful alternative” but obviously you’re missing a lot of the information you’d like in terms of making a proper assessment of patients. There is also the challenge that Patients do not place as much value on telephone consultations.
With social distancing measures in place, Practices had to very quickly move to remote consultations; and we’re now in a position where only a small percentage of appointments are carried out face to face.
Adapting our Systems
- Video Appointments:
Tele-health is something we will all have to embrace at some point as social distancing continues and will remain part of service delivery after Covid-19. This will be due in part to convenience for both patient and HCPs but also recognising that working and consulting virtually has been on the sidelines for a long time already. Having a structure around the timing of tele-health appointments make it less likely for a ‘virtual waiting room’ to back up in the same way as ‘a physical waiting room’. Telehealth can provide a really good short term alternative for some home visits for patients who are unable to leave their home, particularly where they have the assistance of a family member or carer - Patient Convenience:
Not always having to travel to see your GP is a huge benefit for Patients. Receiving clear reminders and communication around the appointment is also of benefit. A recent survey showed that somewhere in the region of 30% of patients who missed health care appointments simply forgot and would have appreciated a reminder. That is the world we live in now. Personally, I have everything in my calendar but unless I set up a reminder, I would forget loads of appts.
“We now have a fabulous opportunity to re-educate our Patients on how future care will be delivered.”
I think we now have a fabulous opportunity to re-educate our patients on how future care will be delivered. I had my own personal experience recently and I am very lucky in that I rarely have to attend my GP. I had a telephone consultation and a prescription was sent to my local Pharmacy. Unfortunately, it didn’t have a lot of effect, and following a call to the GP 3 days later, I was asked to attend. My GP also offered video consults but because of the nature of my complaint, he felt it was more appropriate to see me in Person.
So how do we communicate all these changes to our Patients? This can be done through SMS messaging, Practice email, Telephone messaging , FB Page or through your website if you have one. How we communicate is key! In fact having a website is going to become so important, not only for patient information but also how we manage various patient requests.
Here is an idea to consider – Online Triage
- Online consultation first – if Patient wants to contact their GP, they will be asked to fill in an online triage form. In the case of a Patient who requires assistance they can bypass the form but instead contact the GP receptionist directly where they could be asked the same questions contained in the online form.
- Telephone consultation – if the patient’s query through the online triage form requires a response from their GP or GPN.
- Video consultation – Set this up after reviewing the triage information and it is deemed appropriate for a video consult.
- Face-to-face consultation – Where appropriate and necessary or where a physical examination is required.
This new way of working has definite potential to open up capacity. Online triage is a tool that has the potential to create a lot of efficiencies for both patients and clinicians but would require a lot of time in setting up. Practices would have the capacity to do more video consultations per day than they would face to face as the History would already be recorded on the chart from using an online or offline triage template.
Do you have a website?
If you have a website and it is just for information, consider upgrading it and maybe speak to your website developer/programmer to see if it can be upgraded to include online triage forms etc. Even if you do not use your website for this reason, it is a good idea to have a pathway for patients to establish what type of consult they need if any. If you don’t have a website, you can contact me at Best Practice for help or support with this. Websites can be a very powerful tool if used to their full potential.
Managing Patient Expectations
Before the current crisis, there was often the feeling that patients had been ‘short changed’ with a remote consultation. we would often hear and I probably held the opinion myself that “digital is impersonal and you remove the human factor” but now we are having lots of positive remote consultations which has proven the human connection can still happen through digital.
Moving forward, we have the opportunity to;
- Having a more structured approach to our working Day
- Reduce low value admin tasks:
- Reduce the time spent on low value back end administration such as phone calls, reminders and time spent by staff managing appointments.
- Enabling practices to use their staff and resources more effectively
In conclusion, now is the time to seize the opportunity to run our Practices in a way that suits us , rather than letting our Practice run us. We know the ‘old normal’ was not sustainable and we have now have the opportunity to become much more structured in how we are working. What will the ‘new normal’ look like for you and your Practice?
Director – Best Practice
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