Business Manager Gareth Thomas explains why such systems can create unrealistic patient expectations and why telephone triage has worked better for their needs

A key priority for general practice is ensuring patients have timely access to the services we provide. After all, it’s an important aspect of quality care. The pandemic saw a rapid adoption of telephone and digital-first systems across UK practices to reduce contact and minimise the risk of infection spreading, as well as be able to quickly expand access to primary care.

The emergence of digital triage systems became another solution for practices, and in some areas were fully funded by local NHS organisations as a response to Covid.

In our area – Cardiff and Vale University Health Board – all practices were offered a fully funded platform for online consultation and triage that collects medical or administrative requests, and sends them directly through to the practice for internal workflow.

Practices didn’t have much time to assess the long-term financial aspects or how it would affect patient demand, so many agreed to implement these systems to ease short-term pressures and widen access to services during a national health emergency.

However, we turned down the offer from our health board. Why?

Partly because of previous experience using a similar platform piloted in 2018. But it was also because of an award-winning Patient Access Quality Improvement (QI) project we had launched back in January 2019. This had given us a better understanding of our practice’s real needs and priorities, and how to respond to those. And, for us, that didn’t involve digital triage.

The QI project involved a model for testing change called the Plan-Do-Study-Act (PDSA) cycle. Particularly important was what we discovered about our reception, telephone system and digital access. Based on the project’s results, we decided to move to a full telephone triage system that helps us manage patient appointment demand more efficiently.  This involved:

1. Enhancing reception staff skills and reception services

We had run interactive and fun sessions with the reception team to find out their ideas on how services could be improved for patients. The aim was to give staff the headspace to come up with frontline solutions. These solutions included care navigation training, co-location of GPs with the reception team, updating the website to allow for more digital access, understanding the reasons patients most often called in, and improving ways to cancel an appointment.

2.Simplifying telephone systems

Since it was clear our system was out of date and not user friendly, we asked our patient participation group (PPG) for feedback. They told us they wanted a simple auto-attendant without complicated options, and the ability to leave a voicemail if they couldn’t attend their appointment.

3. Making the website work harder to streamline processes and help patients get access faster and easier

We overhauled our practice website and replaced it with a more digital friendly system. We included our PPG in the design process. Patients can now request appointments via online forms and we have introduced an administrative services section.

Data from other surgeries already using online platforms revealed there is high demand for administrative requests. Our new website gives us more control about how we manage this and allows us to come up with a more bespoke approach. For example, we can create appointment request forms during the annual flu season to free up phone lines and ensure other patients can more easily get through to make an appointment (reducing any frustration).

This year, to further improve the patient experience and reduce telephone demand, we have moved across to a hosted telephony platform provided by EVAD that offers greater flexibility and scalability, including the ability for patients to request call-backs so they don’t need to wait on the phone line in a queue. We have an average of 500 call-back requests per week.

We have also made available the  Surgery App, which more than 5,000 patients have registered with.

Since the launch of these two new services, data has shown an overall reduction in connected call volumes to the practice of 21%. We know that our maximum connected call volumes per week will be 1619 with a minimum of 1232 – data that is really useful for our reception team.

We are currently testing a ‘live chat’ facility within the app that uses a form bot to manage questions commonly asked by patients, directing them to the relevant page on our website.

Practices aren’t online retailers

When it comes to online consultation and triage platforms, the concern for us is that it can raise patient expectations, making it seem like practices are like online retailers, able to deliver an on-demand service.

We know that patients don’t always understand that’s not how general practice can work.  As a result, some practices may be finding that these platforms are more of a hinderance than a help, and are unable to turn off the ‘demand tap’ as they try and get back to more normal routines and appointment systems, as well as face-to-face consultations.

Good advice for any practice looking to improve access is to think about the needs of the practice and balance these against the needs of patients. Think about what improvements you can make to patient access that also raise staff engagement, particularly as workload in general practice is rising.

Moreover, don’t forget to include patients as equal partners in the co-design of services, use ideas on how to improve from your front-line staff and test any small changes first. It will all ensure the quality aspect isn’t forgotten about.

Gareth Thomas MSc is Business Manager at West Quay Medical Centre in South Wales and Associate Director of the Institute of General Practice Management