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22 February 2019
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Stratford Village Surgery in East London, which cares for around 10,000 patients, used to struggle to meet demand and its patients were sometimes waiting for over two weeks to be seen.
However, after introducing a new online triage system, the surgery managed to reduce average waiting times for appointments from two weeks to two days.
GP and medical director at Stratford Village Surgery Dr Bhupinder Kohli tells Management in Practice how they achieved this.
For some years, we had been telling patients to call in the morning to get an appointment but the average waiting time for routine appointments was two weeks.
It was really unhelpful for them and this problem was affecting our reputation.
We heard about online triage and chose Egton’s online triage system, which is part of Emis Group.
People are now asked to fill in an online form, which is accessed via a web page. They write down what problem they’ve got – for example, headache, earache, or vomiting – and the form gives them advice, suggesting whether they should call 999 or 111.
Once the form has been completed by the patient, it comes to us electronically. We read their answers within 24 hours of receiving them and we also call most patients within 24 hours.
We call patients that we think are more vulnerable – including children, the elderly, and patients with symptoms such as chest pain – to come into the surgery.
Usually, only one in four patients needs to be seen face-to-face. This means we have more appointments available and that more people can get an appointment within two to three days.
We had a soft launch in August 2018 but oficially launched the system in October. We have now fully embedded it and can guarantee our patients a call back within 24 hours.
Our average waiting time for appointments has dropped from two weeks to two to three days and all of our urgent care cases are now seen on the same day.
Since introducing the system in August last year, we have also seen a 20% reduction in incoming phone calls and a 33% reduction in daily face-to-face consultations.
We have implemented this system across our three sites, with each taking around 400 forms a week. I would say that half of our work is now coming in through the forms but our capacity has gone up, because the forms take six minutes to deal with while a face-to-face consultation takes ten minutes.
This system is also safer because patients don’t have to wait to see a doctor to know whether or not they need to ring NHS 111 or go to A&E. Through the form, they can put their symptoms in and it will tell them what to do and where [to go]. It also contains lots of information and self-help advice.
The system has also helped us with our workforce issues. We haven’t had to hire extra staff and we have still been able to cut our [appointment] waiting times.
The phone traffic is also down as people are no longer crazily booking appointments because they know that they can submit as many forms as they like 24 hours a day – we will deal with all of them.
It was at first challenging to introduce this new way of working.
Initially, people who live nearby were still physically coming to the practice to get an appointment while others were calling.
However, the receptionists couldn’t see what the appointment was for because the patients would say ‘it’s private’ or ‘it’s headache’ and that wouldn’t help the doctors decide whether it was urgent or not.
Patients who call in are still triaged on the phone, those deemed vulnerable or in need of urgent care can get an appointment but everyone else is directed to the website to complete the online form.
Through it, patients are asked to be more specific about their [condition], which supports us in helping them with the care they need.
It’s a big change in terms of process, because it affects the doctors, the receptionists, and the [practice] managers but once we got there, we could see the benefits.
The main change for receptionists is to retrain patients, referring them to the online triage system.
Staff also had to be trained to show patients how to access the forms. Sometimes, patients ring saying that they can’t find the form. While they are on the phone with the patient, the receptionist sends them a text with a link to the form and verbally guides patients through how to use it.