Let’s go back to early March, many GP Practices were closed to new patients and General Practice was in Crisis for many reasons including decreasing numbers of GPs, difficulty recruiting GPs to take up vacant GMS Contracts. Massive pressure on out of hours emergency services and general high demand on services, some of which related to the provision of free GP Care and Patient expectations had gotten 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 develop new ways of delivering care to our 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, staff and our patients safe. In the last few weeks and months, we have seen 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 weeks in advance with many GPs closing their Practice to new Patients. Another thing that was becoming common was a separate appointment column on the Practice Management Software for ‘Emergencies’. In one Practice where I was carrying out work, 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 informed me that on an average day, the list of appts for Dr Drop in (as I affectionately named it) was the same as the GPs regular appointment slots which meant that the GP was effectively double booked!!
Something was going to have to give. 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 electronic prescribing. General Practice went from establishing their own protocols in the first instance to following criteria for referring Patients for testing. Practices 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 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.
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. The evidence does not bear this out when you look at home-based tele-rehab solutions, for example. They do spectacularly well. 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. There is always the risk that as restrictions are being lifted that we could start to see a return to “normal”
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 due in part to convenience for both patient and provider. Having a structure around the timing of tele-health appointments makes it less likely for a virtual waiting room to back up in the same way as a real one. It provides a really good opportunity to fill in for some home visits for patients who are unable to leave their home where they have the assistance of a family member or carer
- Patient Convenience:
Patients appreciate not having to step away from colleagues at work to make a private phone call. Receiving clear reminders and communication around the appointment is also of benefit to patients. Surveys show 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. I have everything in my calendar but unless I set up a reminder, I would forget loads of appts. We all had so much going on in our lives prior to this Pandemic and everyone is being forced to take a step back.
“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 after another call to the Surgery 3 days later, the GP called and asked me to come in. My GP also offer 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 to our Patients. This can be done through SMS messaging, FB Page or through your website if you have one. How we communicate is key!
Here is an idea to consider.
- 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.
- Video consultation – Set this up after reviewing the triage information and it is deemed appropriate for a video consult.
- Face-to-face consultation – only if absolutely necessary, mainly where you need to do a physical examination.
This way of working has definite potential to open up capacity. Online triage has the potential to create a lot of efficiencies for both patients and clinicians. 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.
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.
If you would like to find out how I can help you to lay strong foundations for your Practice as well as a range of other services tailored for General Practice. Please do not hesitate to get in touch.