Appendices Demonstrator GP sites case studies The Practice Approach Benefits Barriers Conclusion Practice A1 – Transactional Services – Existing Implementation System InPS Vision (LAN) Practice Population • Approx. 4600 patients • Higher than average number of retired • Affluent area • Broadband readily available in the area Audit data Data collected January 2013 Objectives Reduce time spent on telephone for patients / staff. Improve communication between patients and practice Services offered Online appointments since June 2011. 10% of GP routine appointments are bookable on line. Online repeats December 2012, using in parallel with web based facility for repeat orders. Promotion. Services advertised on repeat scripts & practice website. No parental access. Patients can use online services from age 16. Actual So far benefits have not outweighed costs / effort of deployment. Limited benefits from online appointments only 48 booked / 13 cancelled in last 6 months = approx. £82 efficiency savings p.a. Web-site service for online repeats has improved practice efficiency and patient satisfaction – 1,000 requests every month. Too early to comment on VOS repeats. 4 online VOS repeats in last month. Expected In future online access to the record improve data quality. System issues. Many queries from patients due to password problems and log in failures (at least 2 per week), putting people off from using the service. 578 patients have signed up for VOS, but only 42% are active users. Patients using existing repeat order service on web. Patients say there are not enough appointments available online. Patients often book the wrong doctor when using online appointments Practice can’t use online booking for appointments as duration depends on the nature of the consultation. InPS Helpdesk lacked understanding of VOS. Tips re practice setup had not been shared with practice. . Lessons • Need to check patients ID on registration for VOS and hand credentials to applicant in person. System should have been robust before implementation There should have been a national approach with guideline. Active promoting is essential Next steps Release more appointments online for period Promote VOS in articles, website, dispensary bags Practice A2 - Transactional Services – Existing Implementation
village branch site • Approx. 10,400 patients, mixed demographic, higher than national average retired. IT literate population Audit data Data collected March 2013 Approach January 2013 Practice enabled “Patient Access” for repeat ordering and Medical Records Viewer. Appointments will not be enabled as practice is operating Doctors 1st triage system Medical Records Viewer offered to PPG patients and those recommended by GPs on clinical grounds only. Piloting repeats ordering with PPG before rolling-out to whole practice. Records Access All free text viewing disabled Patients must be over 16 to use transactional services and over 18 for Medical Records Viewer. No parental or carer access is permitted. Consent forms and leaflets adapted from PARTS examples. Improved patient safety. Correct medication is automatically selected for practice staff to process. Expected: Records Access Regarded by practice GPs as having potential to support patients with long term conditions. EMIS training support and documentation not sufficiently comprehensive. Risk of patient accessing 3rd party information / sensitive information. Online access could affect way clinicians keep records result in extra workload as patient queries increase. Repeat requesting does not force patients to specify which site they want to collect script from, doesn’t allow practice staff to sort online requests by site. process for patients is “clunky”. Use patient survey to evaluate progress and feedback with PPG members using Medical Records Viewer and repeats ordering. Update web-site to promote new online services, put message on repeat forms. May consider using online appointments for nurse appointments when functionality allows patient to selected reason for visit and book time accordingly. Practice B5 - Records Access and Transactional Services – New Implementation System EMIS PCS Practice Population • Operates across 2 urban sites. • Approx. 2,700 patients. Turnover less Objectives Improve practice efficiency Offer greater patient choice and convenience Help inform development of Records Access. Approach February 2013 Practice enabled “Patient Access” for appointment Actual Too early to say Expected: Transactional Services Reduce practice administrative burden and improve patient satisfaction. Expected: Records Access Improved patient trust and confidence. EMIS training support unaware that Patient Access could be used with EMIS PCS. Online repeats could not be viewed in workflow when practice enabled. EMIS took two weeks to resolve this “bug”. annual leave and bug with repeat requests viewing has Progress 2 patients signed up for Transactional Services. 2 patients enabled for Medical Records Viewing. Lessons Protected time needs to be made available for staff training and implementation (e.g. tailoring materials etc.).
Practice Population • Urban surgery • Approx. 4,700 patients, some socio-economic depravation Audit data Data collected January 2013 Improve practice efficiency Improve patient safety - processing scripts Approach January 2013 Practice enabled VOS (Vision Online Services) for repeat ordering and appointment booking for the first time. “Web-form” repeat requests have been offered to patients for some time. During 2012 over 3,000 requests were received this way. Patients can use this service to request any medication Patients must be over 18 to use transactional services. No parental / carer access is currently allowed. Promotion of service to patients via surgery web-site, posters in waiting room. When repeat requests via VOS go live note will be added to right hand side script Practice protocol, consent forms and leaflets have been adapted from PARTS examples. online which helps GP prepare for the consultation and saves time. Expected: Repeat Ordering Would like to be able to switch off web-site repeat order system. Practices processes approximately 400 scripts per week at a cost of approx. If 25% were received via VOS this could deliver approx. £4,800 in efficiencies. Before offering online appointments the practices was taking an average of 20 telephone calls for appointments per hour. Reducing these calls by 25% could achieve efficiency savings of approx. £6,000. Expected: Appointments Reduce DNAs where patients find it difficult to get through on telephone to cancel appointments. (Practice has approx. 4-6 DNAs) per week. They believe this has patient safety implications. Registration and authentication of patients has workload implications. Cost of annual VOS license. Further guidance is required about when it is appropriate to offer / withdraw parental access to transactional services. All routine GP appointments are offered online (except Bookable of the Day). Not live yet with repeat requesting via VOS. Plan is combine this with introduction of EPS2 and GP carrying out re-authorisation of repeats themselves. Lessons Online Appointments take time to gather pace. Next steps Switch on VOS repeats in April 2013 and switch off non-integrated service for ordering repeats May consider offering online appointments for booking telephone slots but would need to inform patients that there is no guarantee of actual time of call. Practice be willing to consider pilot of test result viewing, if results could be released after GP has viewed them. Currently the practice receives 6-8 calls an hour for test results, therefore potential for substantial efficiency savings for the practice, and better telephone access for all patients.
Advisory Board Benefits workshop Stakeholders: PATIENTS GENERAL PUBLIC CLINICIANS GP PRACTICES PUBLIC HEALTH WIDER NHS Key questions to consider: Why is patient access important? Better understanding of condition/health. Proactive partner in care. Share record with those caring for them. More accessible services. Patient empowerment. Increased confidence. Greater transparency. Improved trust & confidence in NHS / clinicians. Access to information to improve clinical Improved with patient. More informed conversation with patient. Improved compliance with treatment / care Cost and efficiency savings; admin and clinician time more effectively. Improved data quality. Enables health advice /messages to deliver directly to patients. Improves health literacy. Reduces inequalities? Improved health literacy. Integrate with other NHS services. NHS sustainability strategy. Improved transparency What would you do differently if the service was available? Be more prepared at appointments. Carers able to care better if armed with knowledge. Less DNAs, less appointments. Make better decisions. Ask more questions. Check information recorded is correct. Help co-ordinate care. Share information with other health / social care providers Take greater responsibility for own health. Help support family and friends who are receiving care / treatment. Make better lifestyle choices. Write notes with patient in mind. Prescribe “access” to patients to help improve their understanding / adherence to care plan. Encourage patients to to record to support day to day decision-making. . Offer patients a choice re accessing services and information. Deployed freed up resources to improve other patient contacts. Use access as a mechanism to to communicate with patients / public. Encourage public to access records and take proactive interest in their health. Encourage patients to share records directly with other care providers Better coordination of care between providers. .
How would success be measured? Increased patient satisfaction. Fewer DNAs Fewer inappropriate / unnecessary consultations phone calls / requests just to access information Less need for patients to repeat information. Public confidence increases. Public awareness of health options increases Improved compliance. Increase in the number of patients accessing their record. Patient better able to contribute to discussions re care. Decrease in the number of appointments. Fewer subject access requests. Fewer complaints about contacting the practice. DNAs Fewer phone calls. Fewer requests to print information. Better data quality Improvements in health literacy. Greater awareness of health / care and treatment options / consequences. Improved lifestyle choices. Decrease in the number of investigations / unnecessary procedures. More appropriate care delivered / quicker. Reduction in adverse events / litigation. High patient / public levels of satisfaction.
Debra Little Practice Manager Preston Park Practice Nicky Macdougald Practice Manager Westgate Surgery Dr Christopher Markwick Clinical Lead Highcliffe Med. Practice Advisory Board Member Tad Matus Chief Information Officer NHS of England Senior Responsible Officer / Advisory Board Member Sol Mead Patient Representative Patient Reference Member Valerie Middleton Patient Representative Patient Reference Group Member Ray Morgan Patient Representative Sandgate Practice Folkestone Demonstrator Site Ray Morgan Patient Representative Sandgate Medical Practice Anne Morrison Public Health Programme Lead NHS of England Advisory Board Member Joanne Palmer Regional Account Manager EMIS Nin Panjit Project Director London Connect Henry Pares Head of Informatics Planning Department of Health Dr Mike Medical Secretary Kent LMC Advisory Member Scott Pashby Regional Business Manager InPS Gill Peters Trainer InPS Dr Inram Rafi of the Clinical Innovation and Research Centre RGCP Dr Venkat Reddy GP Mocketts Wood Surgery Demonstrator site Neil Reynolds Associate Trainer KCMS Margaret Shorland Patient Representative Sandgate Medical Practice Barbara Change and Benefits Realisation Manager NHS North West Caroline Smith Product Development Manager InPS Chontelle Smith Admin Team Leader Sheppy Community Hospital Demonstrator site Christine Smith Implementation Manager Eastern & Coastal Kent PCT Lynn Smith Benefits Lead NHS South of England Advisory Board Member Julia Taylor Practice Manager The Cedars Surgery Demonstrator site Thomas Practice Manager Bird-in-Eye Surgery Demonstrator site Alison Turner IM&T Manager West Byfleet Healthcentre Advisory Board Member Dave Wellbelove Patient Representative Patient Reference Group Member