Dr Arvind Madan WebGP Hurley Group Innovations

1. 18 General Practices
100,000 patients
10 Urgent Care sites
350,000 patients a year
Practitioner Health
School Health
Premises
Pharmacy
Turnaround of
Failing practices
Substance Misuse services
Refugee Care
Work
reducing
technology
Out of hours care
Nursing Homes
London focus
1M appts annually
Size of 2 hospitals
400 staff
Dr Arvind Madan
CEO Hurley Group
WebGP
Increased patient demand
Increased complexity
Reduced fundingIncreasing regulation
Higher performance targets
Reforms
Politically
sensitive
Recruitment crises

2. The Case for Change in General Practice
• 1 M appointments a day
• Increasing complexity
• Recruitment crisis
• Poor estate and infrastructure
• Increased regulation and targets
• Financial squeeze
• Low adoption of technology?
Technology has changed most industries…
BankingTravelLeisureShopping
Waiting for
the doctor
in 1907
Waiting for
the doctor
in 2014
But not general practice

3. Online Pilot
133K patients
20 practices
10 London
Boroughs
6 months
Online Transactions
Appointment booking
Repeat prescriptions
Viewing recordsSymptom Checkers
Self-help content
Written
Videos
Sign post
Pharmacy
Online CBT
Nurse call back 24/7 within 1 hour
E-consult
100 common symptoms,
conditions or scenarios
No work
for practice
Less Work
Patient
journey
into general
practice
COME
CALL
CLICK?
Existing model of general practice

4. Practice
specific
identifiers
boost patient
confidence
Commonest
conditions on
home page
Booking appts,
Repeats,
Self-help and
nurse call back
100 more
conditions
available
Simple flow
guide
Example
banner can be
linked to any
GP website
Patient visits your website

5. Patient select their condition

6. Patient
selects
option
Any locally
commissioned
offer can be
sign posted
They select from the various options presented
Why not just allow GP
open up their email
addresses to patients?
• GP cannot verify
identity
• Poor clinical
governance e.g. GP
response times
• Medicolegally risky
for GPs
• Too easy for
patients?
• Emails lead to
banter
• Risk of supply-led
demand
• Doesn’t optimise
data capture
• No closure of
communication loop

7. Personalised message
explaining:
• What happens next?
• When will I hear back?
• How will I be contacted?
• What can I do to help
myself in the meanwhile?
• What to do I do if I get
worse?
How does a patient e-consult?

8. GP report or e-consult
takes an average of
2.9 minutes
for GPs to process
Patient submits
completed
questionnaire to the
practice generic email
box as a GP summary
report.
Staff then workflow or
print e-consult for GP
to review
• 40% result in prescription
• 20% result in phone consult
• 40% still need to come in
Triangles highlight
positives, key negatives
and free text

9. Patient submits
questionnaire
from their
practice website
Admin print off
e-consult or
workflow it to
the GP
GP prescribes,
phones or
recommends an
appointment
Admin phone
patient to collect
prescription or
give appointment
By the end
of the next
working day

10. Pilot Results
36,000 visits in 6 months
27,000 unique visits
9,000 used self-help
18% self-managed
avoiding an appt.
80% 111 calls closed
60% e-consults closed
Over 2,000 e-consults
400 GP hours saved
Cystitis (female)
Depression
Contraception (restarts)
Knee pain
Earache
Asthma
Sore Throat
Rectal Bleed
Shoulder pain
Cough
95% patients said
website was
good or excellent
83% FFT recommend
2/3rd < 45
1/3rd > 45
57% women
25% BME
28% English
Second language
11% unemployed
000204060810121416182022
Templates by
hour of day 100% GP confidence
83% GPs said good for patients
78% GP want in own practice
E-consults took 2.9 minutes
on average
Did patients use it? Who used it? Top 10 symptoms or conditions
What did GPs think?
Did patients like it?
When did they use it?

11. Very detailed -
clear and
concise, very
good!
It allowed me to avoid
spending time on the
phone or traveling to
the practice, while still
having my condition
looked at.
This site is
fantastic! Finally a
GP that has
caught up with
using decent
technology!
Got the
required
prescription
that I
requested.
Resolved my issue
quickly without
needing a face-to-
face appointment
and wasting time
(either mine or that
of the doctor).
It was perfect. Fast and
efficient. I didn't have to
take time off work to go
& see my GP in person.
very quick follow up
Efficient, this
service works for
working
individuals that
don't have time
to be put on hold
over the phone or
arrange an
appointment
during work
hours

12. For every e-
consult
5 patients use self-help
2 patients use pharmacy advice
1 patient requests a nurse call back
1 patient uses the symptom checkers
For every 3
e-consults
(= 1 appointment)
15 patients use self-help
6 patients use pharmacy advice
3 patient requests a nurse call back
3 patient uses the symptom checkers
Up to 10 patients
benefit
Up to 30 patients
benefit
Amplification Effect
Supply-led Demand?
We asked patients: What would you have done if the service hadn’t existed?
Request of face to face appointment 79%
Request a telephone appointment 4%
Gone to walk in centre or A&E 14%
Nothing, wait and see 3%

13. Summary
There is much talk about how general practice is unsustainable, but very few provide solutions…
WebGP provides:
Better access
• 24/7 self-help content
• Sign posting alternate offers
• Symptom checking
• Nurse call back
• e-consult from their own GP by the end of the next working day
Better outcomes
• Comprehensive history gathering
• Robust clinical governance
• Earlier intervention in illnesses
• Digital disinhibition for mental health issues
Better use of practice resources
• Reduced demand by empowering patients to self-care
• Triages patient need and steers practice use of appointment capacity
• Efficient e-consult process
Commissioner savings
• Reduces use of urgent care services
• Reduces morbidity through earlier intervention
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