Michael Penston, digital transformation lead for Southampton North PCN, shares examples of how a programmer can ease the workload in general practices by streamlining processes – including the estimated cost and length of time it takes to set up.
Automating systems and processes in primary care can have a positive impact on both patients and staff. It has the potential to improve the patient experience and boost job satisfaction because it eases the workload burden by streamlining flow. To get it right, a dialogue between programmer and GP is required. A GP might not know what can be automated, and a technician might not know what needs to be automated.
In addition, much of the work is more than software and automation, so it needs leadership involvement. It is implementing new ways of working, updating workflows, encouraging remote working, and making sure people are making the most of existing tools.
The benefits of GP leaders and a programmer working together are many, as demonstrated by some of the projects I have worked on.
Registering patients
As a student practice, registrations have always presented a very high workload. By streamlining the process, we have turned that around, and registrations now tend to blend in with day-to-day activities.
Old process: Patients would come to the practice and fill in a paper registration form. Staff then checked that it had been completed correctly, ascertaining that the address was in the catchment area and looking for the patient on the Personal Demographics Service (PDS), sometimes known as the spine. A member of staff would then manually input the patient’s information from the form into the clinical system. It was a lengthy and labour-intensive task.
New process: The online registration form undergoes automatic checks for catchment area and validity of data such as NHS numbers and addresses and looks up patients on the PDS. It also gathers data on the first language and whether a translator is required. If the match is approved by a member of staff, the patient is automatically registered.
Once registered, the system can send automated emails to patients, eliminating the need to call or write to each person. It also automates receipt and confirmation emails.
Set-up time: It takes six weeks to develop, and then a few days to train staff to use it. Communication of changes is an ongoing task.
Time saved: Previously, processing each registration would take at least five minutes. Now, staff usually only need a few seconds to check over registrations.
Cost: Six weeks of time costs around £5,000. There’s also the ongoing hosting charge, which is less than £10 per month.
Contraceptive Pill checks
Automating the checks for those on the contraceptive pill led to saving GP time, faster issuing of repeat prescriptions, better data quality and more efficient use of resources within the practice.
Old process: Patients had to come in for an appointment. Later, this was simplified with an online questionnaire which was then reviewed by a GP who would manually enter the data into the clinical system.
New process: Patients fill in an online questionnaire and the responses are checked against set criteria. These are then robotically entered into the patient record. If the patient meets all the criteria, the GP does a final check, and the medication is reissued. If not, the patient is sent back to the GP for manual review. Time is still saved by having the responses already coded into the record.
Set-up time: As it has a very similar architecture to the registration system, training time was reduced to a brief chat.
Time saved: This task used to take GPs around 40 minutes a day. It now takes less than 10 minutes.
Cost: We hit more technical snags than expected with this project but because a lot of the architecture was recycled from the registration system, it was probably in the region of £1,500 to develop. However, if the time savings are true, then it will pay itself back within a month.
Vaccinations
When we had a major influx of students requiring flu/HPV vaccines in Oct 2022, we developed a system to streamline the process. As a result, a mass vaccination programme was mobilised in two weeks with minimal impact on the surgery.
The online booking system processed around 3,500 patients in 18 months and the check-in system has processed 50,000.
Old process: The patient would phone, wait in a queue, and ask for a vaccination.
New process: The online booking system asks pre-screening questions, patients are matched through the Patient Demographics Service and it automatically formats and generates a separate Patient Specific Direction. The vaccine is still recorded by the administering clinician as usual.
We developed a check-in system whereby patients are given a ‘ticket’ by giving their date of birth when they check in at the front desk. The vaccinator can then scan the QR code on the ticket to pull up the patient’s details. This meant we could monitor the number of patients coming through the building, wait times, and identify slowdowns in the process through analysis of collected data.
Time saved: We significantly freed up phone lines. Each booking took two minutes of staff time plus an additional two minutes as the patients waited for their call to be answered.
Set-up time: Practice staff do not tend to get involved with this system. When I left the vaccination programme, the next person picked it up very quickly, which is a sign of well-designed software.
Cost: Around £1,000-£1,500 to develop.
The vaccination booking system worked so well that we then adapted it to improve collaboration with the university wellbeing service. By using the same architecture, we could streamline processes so that university wellbeing staff can book an appointment with a mental health nurse. It only took around four days of development time and cost under £500.
It avoids the need for referral forms and calls or emails back and forth between the wellbeing team and reception staff. It has also facilitated a partnership between the NHS and university support teams, which has since expanded to include closer working on case consultations and group sessions.
Processing documents
We receive hundreds of emails a week, many of which need to be attached to patients’ records. This could be laborious and frustrating. The new system automatically adds them to EMIS, which frees up staff and the length of time it takes to process documents. It’s also improved accuracy.
Old process: Staff would need to manually export and attach the document to the patient record. If emails contained images or attachments, this could take a lot of time, as formatting and merging PDFs often proved problematic.
New process: Emails have a structured and standardised underlying format, so they can be processed programmatically. We have software that reads emails from the inbox, renders attachments, and sends them directly into the clinical system through MESH.
This system was originally set up by an ex-GP partner, but it had to be rewritten when changes were made to NHSMail, which was a good opportunity to make improvements.
Time saved: Probably at least an hour a day.
Set-up time: Two weeks to re-write the programme. No time required for training staff.
Cost: Around £1500. It easily paid for itself within six months.
These examples give a taste of how a programmer can help streamline processes and workflow in primary care. Other projects that I’ve been involved in include automatic PDF compilation and text recognition from scanned records, automation of bank staff timesheets/payroll and automated data collection of audits.
And there are plenty more to work on. Next on our list are the automation long-term condition and medication monitoring recalls and more automation of data entry, such as blood pressure.
Michael Penston is a student at the University of Southampton, where he studies Computer Science. Read his article on how a practice or PCN can work with a computer programmer here.
A version of this article first appeared on our sister publication Pulse PCN.
