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How e-consultation helped us revolutionise our practice

18 May 2018

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As part of the General Practice Forward View, £45m has been invested to help practices purchase online consultation systems.
Practice manager Mark Thomas was looking for a better way to manage Chelston Hall Surgery in Torquay, South West England when he came across e-consultation.
The service, provided by e-consult, allowed Mr Thomas to revolutionise the traditional model under which general practice is run, allowing his practice to close consultations in a few minutes and save staff time.
Since Mr Thomas introduced e-consultation in his practice in January 2017, over 5,000 people used the service.
Mr Thomas tells Management in Practice’s reporter Valeria Fiore how he is leading the change in his practice.
What is e-consult?
E-consult is an online consultation system that was created by GPs to offer patients remote consultations and help clinical teams to triage their patients. It was set up to reduce the pressure on GPs by signposting patients to other services for minor conditions.
The problem
We have a nation-wide problem: there are not enough GPs to go around.
The majority of complaints about services in general practice are from patients who cannot get through to surgery because the lines are always busy. I have the most modern phone system in Britain, which was installed last year, but I often received complaints from patients saying that our lines are always busy.
How does it work?
By ticking the boxes in the programme, patients can have a first feedback on their problem. Any serious issue is indicated with a red flag, and the programme recommends our patients to seek urgent help.
If a patient gets no red flags, the consultation comes through to us. Our dedicated team that manages the e-consultation will look at the information the patient has provided and speak with the most appropriate clinician. For instance, if it is about a prescription query we’ll take it to the pharmacist. If it’s to do with asthma or COPD, we’ll take it to our specialist nurse. Eventually, if GPs need to get involved, we’ll take the issue to them.
Our aim is to challenge the traditional GP model, which is typically where a patient will call the practice and ask for a GP appointment and then gets seen by a doctor.
We can challenge that because the doctor now looks at the information the patient has completed through e-consult and decides what steps to take.  
E-consultations speed up the work we do at our surgery, as patients take time in their own home to fill in the information we need to make an informed choice.
Examples of change e-consult has made
We introduced e-consultations in January 2017, as a pilot site for NHS South Devon and Torbay CCG. As of January 2018, we had just over 5,000 e-consultations, of which only 1,000 required GP involvement. Of these, 30% were admin related.
Patients are getting an excellent service because they are being dealt with by the most appropriate clinician. They do not need to take several trips to our surgery as we can close the consultation in a matter of minutes.
Within two months since we implemented it, 90% of patients were recommending the service to others and 75% of those patients did not need to come back to the surgery within the next seven days.
Firstly, we had to overcome the GPs’ concern that their workload would increase, and we proved that very quickly. They don’t see it as an onerous job but as a more efficient way of working.
Secondly, we did a ‘soft launch’, so we did not advertise it on social media. People were finding our service online.
After acknowledging that the service was working for us, as we have on average 23-24 e-consultations a day, we now have a pre-recorded message on our voicemail asking patients why they did not e-consult.
We have sent out a lot of messages about e-consultation, we made our own video suggesting how to use the programme, we did training and education sessions for patients, and we will also offer some training to patients in the waiting room on how to use the digital platform.
How we changed the way we work
The service is no longer managed by the traditional reception team; it is now an admin function. So we have had to train people on how to manage e-consult.
The NHS has changed so much since 1948 and patients no longer need to use the traditional GP model: this is not an evolution; it is a revolution of service.
The future is bright! iPad cameras will collect our oxygen levels, pulse, and heart rate starting at some point this year at the same time when patients are using the e-consultation.    
Mark Thomas is a practice manager at Chelston Hall Surgery in Torquay, South West England.

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