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The Future NHS Plans: Delivering Transformation and Sustainability
1. Transforming Communications
Between GPs and Consultants
(Keeping it Simple)
Roger Tweedale
18 May 2017
Consultant Connect, Oxford Centre For Innovation, New Road, Oxford OX1 1BY T: 01865 261467 E: info@consultantconnect.org.uk
2. Ensuring Patients get the Right Care at the Right Time
the NHS will take decisive steps to break down
the barriers in how care is provided between
family doctors and hospitals
NHS 5 Year Forward View
STPs are a way of bringing together GPs,
hospitals, mental health services and social care
to keep people healthier for longer and
integrate services around the patients who need
it most.
NHS Next Steps
3. The Issue – Communication Complications
GPs
Consultants
Hospital
Switchboard
E-Referral
(Choose&Book)
GP Practice
Switchboard
Referral
Management Email
Voicemail
& Call-backs
4. The Issue – GPs Getting Specialist Advice
How does a GP currently get
advice from a specialist
?
5. The Issue – Advice Option 1 - Written
Written Advice
LetterEmail E-Referral
Written requests (take time to write)
Written responses (take time to write)
Often involve clarification questions
Significant impact on pathway timing
Generally good for complex or non time-sensitive advice
6. The Issue – Advice Option 2 - Telephone
Telephone Advice
No medico-legal record
Difficult for Hospital Trusts to track activity
Different number
for each specialty
Limited / variable hours
of availability
Long waits; PA / Sec /
Voicemail message
Consultant call-back
via GP switchboard
Direct and fast
Do you have a ‘friend’?
Will they answer a call?
Specialty hotlinesCall via hospital
switchboard
‘Phone a friend’
via mobile
7. The Solution – How It Works
GP Phone
Local Consultant
Team Mobiles
Option 1 (Cardiology)
Option 2 (Diabetes)
Option 3
(Gynaecology)
Option 4 (Paediatrics)
Etc.
1. Single dial-in number for each practice
2. NHS # input
3. Calls linked to groups of consultants
4. Calls digitally recorded
5. GPs rank call outcomes
6. Activity/outcome reporting for CCGs/hospitals
Accesses advice on all specialties on offer
(only one number for a practice to remember)
For medico-legal tracking only
At end of call by selecting from keypad options
Rather than to just one consultant
(improves answering rates)
Fully encrypted medico-legal record
(makes it paperless/admin free for consultants)
Tracks the quantum of advice provided by hospital teams and its impact
(supports putting sustainable reward structures in place)
(enables easy payback assessment)
8. Top CC Specialties Nationally
1. GP calls (landline or app), chooses
specialty, inputs patient NHS no.
2. Call loops through “rota” of available
local consultants, GP put through to first
consultant to answer
Conversation is recorded and call data
tracked. Outcome of the call is ranked by
GP / consultant
How It Works Performance Feedback
70%-80%call pick-up rate
0:53av. connection time
4:06av. call duration
Volume and Coverage
10,900,000 patients covered
38 CCG areas contracted
1500 GP practices
25 specialties offered
>90%
of consultant and GP users believe that
Consultant Connect is good for healthcare in
their area
"I rang about a patient who was
severely autistic and would have
been very difficult to admit or
even get to a hospital appt. Was
able to manage at home."
"Consultant opinion saved a
referral and helped quickly put
my patient at ease with a clear
management plan."
“Excellent initiative – back to the old days
when speaking person to person made
much more sense.”
“It provides a learning opportunity - how
to manage patients better on a case by
case basis”
Rollout
6 weeks average implementation time
Elective
• Cardiology
• Diabetes / Endocrine
• Elderly Care
• Gastroenterology
• Gynaecology
• Haematology
• Paediatrics
• Urology
Urgent
• Acute Medicine
• Acute Surgery
• Ambulatory Care
• GP Liaison
20-30%
of calls to urgent specialties avoid an
unnecessary admission to A&E or direct to ward
67%
of calls to elective specialties avoid an
unnecessary referral or admission
Experience So Far
“It is a no brainer. Most GPs and Consultants
wish the same thing - efficient way to sort out a
clinical issue. Nice to have a quick chat.”
50,000+ calls p.a.
10. Jean Hamilton, 77, from Romiley in Stockport. Mrs Hamilton had been
suffering from low blood pressure which had led to two visits to A&E,
including an incident where she collapsed and hit her head.
Usually a patient like Mrs Hamilton would have been referred to the
hospital, which would have led to a letter and an appointment 3-4
weeks later.
Instead, Dr Woodworth used Consultant Connect and within 25
seconds he was through to consultant endocrinologist, Dr Richard
Bell.
Between the two of them they agreed that Mrs Hamilton’s medication would be adjusted and blood
tests would be carried out, with a plan for Dr Woodworth to call Dr Bell again if needed after getting the
test results.
Dr Woodworth commented that in this case, and others, the greatest value of Consultant Connect was
the speed with which he was able to give patients more tailored advice and start addressing their
symptoms.
“If I had referred Mrs Hamilton, she would have needed to attend the hospital for an appointment, with
the inconvenience of travelling and finding parking. Following this, the consultant may have written
back suggesting the same measures. Instead, with Consultant Connect, it all happened during one
appointment in primary care.”
A Patient Story – Jean Hamilton
11. What Makes It All Work?
Low cost,
high savings
Savings from avoided
unnecessary hospital
visits are a multiple of
costs
< 6 weeks
setup
Fast roll-out,
typically under 6
weeks
No hardware,
no integration
No hidden
technical spend
IG
compliant
Call recordings stored
securely for access by
GP and consultant
Inclusion in
CQUIN
Specifically cited by
NHS England in
CQUIN 2017-19
engagement draft
Proven
technology
Platform performance
optimised through
experience of many
calls, CCGs and Trusts
Attractive economics Fast simple setup
Reliable platform World-class support
Account
management
Management of your
project from setup to
launch to business-
as-usual
Reports and
data
Regular reports
available via account
managers and online
portal
12. Oxford Centre For Innovation, New Road, Oxford OX1 1BY
T: 01865 261467 E: info@consultantconnect.org.uk
Notas do Editor
Intro – RT, Director of Consultant Connect, previously
This presentation is about the simplest of initiatives, called Consultant Connect, which just makes it easier for GPs and Hospital Consultants to make contact with each other via phone
The initiative is part of the wider objective of improving integration between clinical team as referenced in the 5yr Forward View and most likely all STPs
And it’s for good reason – when GPs and Consultants talk to each other it does seem that they are able to resolve many patient issues without patients going to hospital
And yet there have been a number of systems put in place over the last few years whose unintended consequences have been to actually push GPs and Consultants further apart
So lets talk about one of the main reasons GPs call Consultants – to get specialist advice on a patient-specific issue
Option 1 – Written advice
Well established and well used
HOWEVER:
It can take time to write and respond
Can significantly delay the patient pathway
HAVING SAID THAT:
Very good if the patient issue is not time sensitive
BUT WHAT IF:
The patient needs prompt attention (eg they are in pain or the GP is worried) and cannot wait for written advice to arrive
Then they will typically seek more immediate “Telephone Advice” – which is the second option
Also an established concept – but with GPs having to battle through switchboards or trying to remember various hotline numbers.
All we have done is turned the ‘Phone a Friend’ option into a structured Advice & Guidance system – so that ALL GPs have the option of getting advice EITHER via:
WRITING – if complex or non-time sensitive; or
PHONE – if simple or time-sensitive
Its very simple ..
Been going since June 2015
50,000 calls pa currently across 25+ ELECTIVE, URGENT and MENTAL HEALTH specialties
38 CCGs, 1500 practices, 11m patients
Connection rate 70-80% - not a 100% solution
Connection time/call duration
Really good feedback – largely about how brilliant it is to get excellent advice
Looking at a few client examples (anonymised)
Note:
Not high volumes of calls – roughly 30 odd calls per specialty per month – because GPs use the service wisely
Lots of calls avoid patients going to hospital – because GPs only call regarding cases where they don’t know quite what to do with a patient or need a bit of support
Its great to know that it generates ‘whole-system efficiencies’ but even better to know that it is making a positive difference for patients.
Here is a patient case study that Stockport CCG generated that serves as a good example.
Meet Jean Hamilton
Suffering from low blood pressure; experienced falls in the past; and had already been to A&E twice
Would normally have been sent to A&E a third time
Instead Dr Simon Woodworth called CONSULTANT CONNECT and spoke to Dr Richard Bell
Agreed immediate adjustment to medication and blood tests so SAVED the patient from having to go to hospital again
Greatest value for patient – fast advice and prompt treatment
So what makes it all work
- Financials are clear for the NHS
- It’s good technology
- BUT the bit that is critical is the account management and engagement support – getting engagement from consultants who are already overloaded with patients – making GPs aware of YET ANOTHER new initiative
If you have any questions please find me in the foyer or call our office
