ProActiveGP Virtual Clinic

Dr Muhammed Akunjee, West Green Surgery, London

The problem

In 2014 we changed our practice’s way of managing blood results and moved to a proactive SMS with EMIS driven and Outlook templates to facilitate. This was in response to a local CCG dashboard showing an increased level of A&E activity. We undertook a demand capacity audit and wanted to focus on efficiencies around appointment usage. We noted that a large number of patients were booking appointments for follow up with the GP for simple discussions around blood results or scan results, with a large majority wanting simple reassurance for normal results.

We set up an outlook signature template for a range of common conditions that had messages that could be sent via the nhs.net network to inform patients their results. However, the method to do so was slightly laborious and difficult to transfer or educate other clinicians to uptake. We felt that this could be streamlined further and decided to create a software that could both expand the number of templates and offer a system that was easily transferable. 

Additionally, in November 2017 we noted that our NDA (National Diabetic Audit) achievement was only 37 percent and that 28 percent of our hypertensives remained poorly controlled with a blood pressure greater than 150/90. We felt that the classic system of patient recall through post or telephoning in a non-prioritised alphabetical way was wasting valuable administration and clinician time along with practice resources on letters, stamps and printing costs.

The Bright Idea

We set ourselves the task of identifying areas that would reduce face-to-face GP appointments through pre-emptive SMS contacts, freeing them up for those who had more pressing clinical needs. We wanted to create a solution that could make our contacting of patients more efficient, automated, and safer, while also covering a wider range of conditions and scans. We also wanted the patient to be given an SMS that described their condition, explaining what it was, the red flags and the outcomes in terms of further referral or repeat scan, as well as the need to take a script that had been organised. 

We created a software that performed 3 functions running alongside EMIS and using the existing NHSmail infrastructure, that would allow us to:

  1. Send clinical template driven SMS messages to patients covering abnormal blood and scan results; 
  2. Send password protected blood test request forms to patients via email whilst simultaneously texting them the password; 
  3. Allow us to add a password to an e-Referral appointment file (or any .docx, .xlx, .jpg, .tiff) and send this to the patient via email whilst texting them the password to ensure that a 2 step protection prevents unsolicited access. 

The move to this system also assisted in e-referrals, which previously had an overly complicated system wherein patients had to either wait in the waiting area for referrals to be written out or return on another day to pick them up. This sometimes led to a loss of the referral letter, which further increased the wait time to access care.

The impact:

  • Patients: The system allows patients to stay informed of their results scan or blood tests earlier than they would have previously. Patients are advised about what to do and outcomes expected. Patients no longer need to book further appointments solely to find out their results or what the next steps would be saving practice time. 
    Patients are being informed more quickly about abnormal results than previously.
  • Staff: Helped doctors give clear information and advice to the patients.
  • The system made it easier and quicker for the admin staff to send patients their results via email without worrying about breaching patient confidentiality. It has helped saved time by negating the need to call patients Reduced the number of patients attending simply to pick up letters and appointment details Now, if a patient attends for GP follow-up, all the relevant tests have been completed, ensuring best use of the GP time
  • Practice: Freed up at least 40 appointments weekly. 
    Saving of £20,000 per year of clinical appointments, increasing access and has kept waiting times down. 
    Drop in the number of patients attending for follow-up results simply to be given a script or told to repeat blood tests. 
 

 

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