Modern General Practice

Modern General Practice

Consider what from the Modern General Practice approach will work for your practice. These are not new ideas but are worth revisiting.

Workflow of requests

Explore how patient requests are dealt with and what the workflow processes are within the practice. What are all the different ways a patient gets a consultation with a clinician. Consider streamlining these so that there is one queue for patients and there is less likelihood of patients sending in duplicate requests. Review in line with BMA safe working guidelines so that requests in excess of capacity are triaged and on a waiting list for the next day.

Options include:-

• Use of Online consultation software to work as a triage/waiting list.

This could include all requests from patients being logged via the online consultation software (reception enter any taken in person or over the phone) so that all requests are in the same queue and triaged by patient need (as well as, or rather than, first come first served). This should also help identify duplicate requests where someone put in an online request and then also phoned in. Requests added by 111 into the worklist slots could also be triaged and entered into this same queue.

(If online consultations are not used very much then consider how requests are recorded against the patient record and if it is possible to check the record for any other contacts/appointments before booking in appointments.)

Review the workflow set up within the online consultation software so that requests are sent direct to specific teams where possible rather than all being triaged centrally so that as much as possible each request is only processed by one or two individuals. i.e. medication requests going directly to repeat med admin team or dispenser, referral queries direct to secretarial team etc.

Review the processing of clinical queries to review the benefits of work flowing directly to multidisciplinary team versus care navigators filtering for signposting opportunities first and then triage by a non-clinician, or a higher-level triage by a clinician. Each has pros and cons.

• Consider changing to all requests being dealt with via online consultations and there being no pre-booked appointments (for GP’s and senior clinicians).

This is another step beyond the above. With this all requests (both acute, routine and follow-up) are initiated by an entry into the online consultation queue and dealt with in the order they come in. Nothing is prebooked in advance (i.e. no booking in for four weeks’ time following a consultation. It is more in the patients court; they are told if x doesn’t improve contact us in 4 weeks’ time) – recalls will need to also prompt a patient to contact the practice when their review is due. Then GP’s and senior clinicians start the day with no prebooked appointments and work off the triaged waiting list in the online consultation software. Continuity of care is more challenging but can still be achieved.

This has pro’s and cons as patients can’t prebook for days convenient to them, they have to contact the practice when they are available but could also reduce DNA’s as if the patient is not available when they reach the top of the list they remain on the list until availability aligns.

• Use of Care navigators / signposting.

Review what is being filtered out by an initial triage, via the online consultation system and on the phone and in person. Ensure staff who are the first point of contact are up to date with all alternative services. Pharmacy (Pharmacy First options available), Services available for self-referral (physio, CBT etc), use of additional services (Health and Wellbeing Coach, Social Prescribing etc.) So that the appointments that come to GP practice core staff are those which only they can deal with.

Telephone system

Review the functionality to ensure maximum benefit from any new cloud-based telephony. Utilise the expertise of the provider and the ICB digital team.

Functionality to review.

• Call back functionality.

This should prevent missed calls. For instance, where a staff member leaves a message for a patient to call the practice but when the patient calls back, they can’t get through. The call back functionality can prevent delays and multiple attempts in reaching each other.

• Call routing

Use of the ability for the patient to select from a list of options (press 1 for …, press 2 for … etc) and be routed directly to the correct team (prescriptions clerk / secretary) without all calls going through reception. This saves time instead of multiple staff members dealing with each call.

• Call hunt groups

Ability for additional staff to log into the main reception line phone group in busy times, and the phone system ring on multiple handsets or hunt for the next available staff member. Some staff can then log out of the group after peak times and leave the group as core receptionist(s)

• Utilise any home workers.

Ensure the system is set up for remote access to utilise any home workers.

• Consider how you could work with other local practices where you have the same phone system.

Consider Switching off Online Consultation (OC)

Under the CAIP scheme there is a desire from NHS England to steer practices towards engaging with the components of the Modern General Practice Access model. One of the three domains of CAIP is a requirement that ‘OC is available for patients to make administrative and clinical requests at least for the duration of core hours’. NHS Digital confirms that ‘switching off OC systems can allow the practice to manage patient demand and to ensure they are not overwhelmed by requests’

Given that patient demand, and therefore patient safety management, is part of day-to-day life in a practice, the use of OC in the singular is hugely significant. Most practices have many strands to their OC offering, not all of which need to remain open for the requirement under CAIP to be met as long as OC is available for patients to make administrative and clinical requests at least for the duration of core hours.

It therefore follows that, to facilitate patient safety at times of high demand by proactive demand management, practices are still able to turn off some of the strands of OC to ensure they are not overwhelmed by requests, as NHS Digital state in their webpage ’ it is important to note that each practice manages their Online Consultation Systems in the way they best feel allows them to deliver care to their patients and there is a widespread variation in how the systems are used’. One size does not fit all and closing some strands of an OC system certainly could be viewed as being good proactive demand management to protect patient safety, which could be jeopardised by unread messages arriving and not being able to be dealt with.

For the CAIP declaration for domain two to be able to be made, and remain valid, we would encourage practices to ensure that a patient always has one strand of Online Consultation available to them to make the administrative and clinical requests at least for the duration of core hours – but it is up to the practice to decide exactly how patient demand via OC is best managed in the interests of patient safety and the practice not being ‘overwhelmed’ – this could mean closing some or most of the strands of OC that might ordinarily be available from their system forms for the various patient contacts.

Do consider the GPC’s latest guidance on the CAIP payment declaration:

Ability to Update DOS

The DoS (Directory of Services) feeds into the NHS Service Finder and is used by NHS 111 providers to inform where they signpost patients to after they have followed their ‘Pathways’ triage and have a disposition.

The DoS will give 111 providers a list of services which are open within the timescale of the disposition and who are able to provide the services needed.

We are in discussion with the ICB about how practices could keep this information up to date.

Practices can ask the ICB DoS team to update DoS on their behalf if they have any approved closures or changes which warrant amending the DoS.

Modern General Practice Transition Funding.

For practices considering implementing Modern general practice there is implementation/transition funding avaialble until March 2025.