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How embracing digital triage is encouraging patient access to Yardley Green Medical Centre, Birmingham

Date of Case Study: 10th August 2021

Practice Background

Live Date: 21st July 2021

List Size: 10,813

Yardley Green Medical Centre is situated in a challenging area in Birmingham.

Collectively, the staff at the practice cover 9 languages.

Interview with Suneel Nadella Practice Manger August 2021.

Initially Suneel was initially concerned about patients being able to use the new website, and understanding it. However, when the practice looked at the reports they were surprised at the usage especially as patients aged over 50 having been submitting forms.  They have also found it easier to communicate with patients as the forms are being triaged constantly.

Preview email: Did this cover everything you expected? Could we have provided you with more information?

Suneel has found everything extremely clear from the very first “Next Steps” email that we sent to him at the start of the implementation process. All communications have had all the information that the practice has needed to proceed with getting the site live. Though Suneel does admit that his background in IT has probably helped with.

Website Review: Did you find going through website with your “Named Editor” useful?

We only had a quick review as the site decided to go live quite soon, but found all the information correct, and understood the navigation of the site easily.

Preview website amendments: Did you feel the amendments highlighted in the website review were responded to and completed within an adequate timeframe?

The Practice only needed changes to the staff pages, which were all completed before the site went live, so there were no issues there.

Dashboard training/booking process: How did you find using/navigating the training booking document? Did you also feel the training sufficiently covered the Footfall dashboard, and how it works?

Suneel said the training was very clear – they felt it was really easy to use and the staff that have been trained feel like they have mastered everything they need to know. They will start training other members of staff within the practice soon, but wanted to start with only a small member of staff.

Go Live Process: Do you have any comments/feedback regarding our Go Live Process?

Practice found it seamless. Suneel has a background in IT, so he expected some issues to begin with such as the site going slow, but once it was live it was working perfectly. There was a delay in NHS server propagating, which meant the site was live for a while for patients to see before the practice could not see it however it didn’t prevent the patient requests being available from the practice dashboard.

Challenges, solution, benefits and results

Challenge: Identify the main problems before having FootFall.

The practice’s biggest issue was that their old website had static template information, and patients found it hard to find the information they needed. Suneel said he had many complaints from patients struggling with using the site, and he wanted FootFall to help with this.

Solution: Identify the way FootFall has been used to overcome these issues.

Suneel said that patients find FootFall easy to access and find information easy to find. He believes FootFall is very responsive, and that the compartmentalisation of screen (the rooms) excellent and easy to navigate.

Suneel has said that in the short time the practice has been live, they have had less complaints, and that the practice staff are also less stressed. Patients have also commented how easy the website is to use.

Benefit: Identify the advantages the practice has found and what they would recommend to others thinking of switching to FootFall.

Suneel believes FootFall to be such a benefit, that he pushed his PCN to joining as well. Suneel will be helping them along, to explain the process and manage implementation.

To help patients with using FootFall, they have members of staff in the practice doing demonstrations for patients. They are hopefully going to get the kiosk version too.

 

The Orchard Practice, Chessington

How embracing online digitalisation is freeing up time for The Orchard Practice, Chessington

Could you Identify the main problems before having FootFall?

Our lives were a daily hell before we restructured around how we would work once we were live with FootFall. We couldn’t keep up with demand before we had FootFall. Now we can and we can’t wait for Churchill Medical Centre to go live with FootFall.

How has FootFall been used to overcome these issues?

The Covid pandemic means that switched to a total triage mode about 18 months ago but patients would still want to book an appointment for virtually everything and that’s what reception staff would do.

Now we can control demand because we can assess whether a patient needs an urgent or face to face appointment or not. This is because we have reorganised how we work so that reception team follow up to forms submitted by patients through FootFall. They now know when a clinician needs to deal with something urgently or the enquiry can wait for a few days.

What have been the advantages the practice has found and what you recommend to others thinking of switching to FootFall.

We have been promoting FootFall to other practices already. The biggest thing for us is that we can now control patient demand and that is making them, and us, happier.

We had 55 calls in the month since we went live with FootFall compared to over 200 a month previously. Now reception staff are phoning patients offering appointments instead of having to tell patients who are calling in that there are no appointments available for a week. It’s nicer for our staff as patients get frustrated at having to wait in a queue and then aren’t happy when they’re told they have to wait for an appointment.

Doctors are now finishing on time, often having completed more tasks than they were expecting to.

One doctor doing an afternoon shift left at 7pm, having everything up to date, when they would usually finish at 10.

They have told us they feel positive and sometimes even relaxed at the end of the day, when they used to feel under pressure the whole time.

We used to get four or five complaints a day about the level of service we were providing before we got FootFall and we were expecting complaints from patients about the new site. However we have had just one since we went live.

Some patients have said they find it hard to navigate the site but when they’ve used it once or twice they know where to go for what they want.

www.orchardpracticechessington.co.uk

Online Video Consultations are great for assessing children

“We want to do everything through FootFall and do total online triage”.

An interview with Dr Ester Sanderson, Springfield Medical Centre – Eccles, Manchester

Springfield in Eccles has just over 10,000 patients and successfully implemented FootFall in March 2020, as part of a planned CCG-wide innovation project. FootFall was being brought into Springfield originally in March to save doing so many face-to-face appointments. Then the pandemic arrived so it came at the perfect time.

Using video

“I use it lot for children, you can eyeball kids to see them running around and see how fast they are breathing as a lot of an assessment of a child is just by looking at them.”

What has surprised her is “I thought I would use it for mental health, but people tend to prefer to use the telephone”. We were interested to learn how many ‘Footfalls’ Ester does and its between 1 and 3 video consultations per day and some clinicians do more.

The way it works at Springfield is that they have specific FootFall slots, where one of the Receptionist triage the request and if it needs to go to a GP it is booked into a FootFall video slot. So, if they need do need a video call, they can do it there and then, rather than replying ‘book a telephone call’ which defeats the purpose. They were very conscious that they didn’t want to create another lane of traffic adding to their workload, so this process works for them. She feels too that there needs to be more recognition for GPs, as this is a completely different way of consulting.

“Extra time hasn’t needed to be added to GP’s days to accommodate FootFall video appointments because we converted our unused face-to-face emergency appointments to FootFall slots, so they have 10 minutes. So, if it is not a FootFall it would have been a telephone appointment anyway, and if you don’t need to ring them – bonus!”

Back office processes

FootFall can be ‘absolutely amazing’ in the back office. For new patient registrations they don’t have to ring them anymore, patients can fill in a form themselves online and send in their ID. Springfield has also started doing remote Asthma reviews, “ the asthma forms are fantastic”,  Ester customised their asthma remote review form for her surgery and it works well. But she goes on to say that there is still a desire from staff to ring patients, for example, to explain the difference between types of inhalers to an 80-year-old instead of explaining in writing. The new process requires a change in mindset.

Training

Ester admits that it would have been nice to have some face-to-face training for the admin girls. But given the timing of lockdown this wasn’t possible. Also, they have struggled to update everyone internally on the changes. Having said that Ester thinks our remote tutorials are great. “They are short, and I can forward them to the girls instead of me having to show them”.

“All these different features are fantastic but the reality of bedding that change in is a challenge because some people get it straight away because we have a range of digital literacy within GPs”.

As with any significant workplace implementation people are getting more used to it, but initially staff don’t know how it’s going to work, because its new. Going forward Ester suggested that her practice could have video appointment slots that patients could request. Ongoing training is still needed to explain how to use FootFall video and where its place fits.

In terms of educating patients on how to use the system. Going forward they will share FootFall videos and tutorials from the Silicon YouTube channel on their social media channels to help with the uptake in video appointments and their desired move towards total online triage.

Workload management

They are used to touching a problem once and getting it done. When waiting for patients to send photo or a response sometimes 5 pm comes around and patient still has not replied. This is a completely different way of working. There needs to be more recognition for GPs as this is a completely different way of consulting. The benefits is that “If you can get your head round that fact that you don’t need to finish it now now now then I hardly ring any of mine now, which is great.”

“The ability to send photos and documents on FootFall has been a massive help too. The photos are so much better than video for rashes. Patients sending photos is great too as you can receive a before and after photo.”

Patient behaviour

“People put things on FootFall that aren’t urgent, but urgent isn’t a thing anymore”. This practice is not booking routine appointments; instead, are trying to do everything on the day. So, if patients need to see someone in two weeks, Ester recommends patients should ring up in two weeks or put a FootFall request in. There are a few practices who, if you ring up the Receptionist will fill out a FootFall for you.

Patients also need to understand that just because it has been logged on FootFall, they won’t get an instant response.  Response times are set by each practice to whatever is decided is an appropriate time to respond. This response time is clearly communicated on the form before completion and helps patients to understand when they can expect a response.

Currently though, if patients have not had a response within an hour, they still ring up for a telephone appointment. Essentially patients still need a little time to get used to the new process. If they are expecting a communication from their practice, they should check their email first, instead of reaching for the phone, as it may not be a telephone response they receive. However, Ester says they haven’t had any negative feedback from patients using the video consultations. “This is a change of process, but patients love it.”

 The future

 “Yes, I would definitely recommend. I really want to have everything go through FootFall”.

For the time being some patients continue to ring up when they should instead fill out a FootFall request instead of using FootFall. If they did complete a FootFall Clinicians could just reply to the request online or the receptionist could reply. This is only something that will change over time as the new process becomes familiar to everyone.

 

Online Consultations with your GP in Norfolk and Waveney

“In Good Health the Norfolk and Waveney Health and Care Partnership”

An interview with Strawberry Hill Medical Centre

Ali, an administrator at Strawberry Hill Medical Centre is responsible for looking after patient requests that come via the FootFall dashboard, which can number anything from a handful a day or 20 to 30 that arrive overnight. “Dealing with them is a speedy and simple process and fits easily into Ali’s workload. Ali applies the same methodology that would be applied to a phone call. The request is either dealt with or referred onwards to a clinician”.

“The doctors say they can process three or four FootFall enquiries in the time it would take them to see a patient, so as well as channelling enquiries away from doctors when possible, those queries that they need to deal with can be dealt with by a clinician quickly.

When patients put an enquiry through, they receive an automated reply telling them they will receive a response within a set time frame. In practice, Ali is able to deal with most enquiries within the day. Indeed, sometimes she responds within minutes.

Patients say they appreciate the convenience of the service, which they can access at any time, and also the speed of the responses. Ali said: “Our doctors are very good at mentioning the FootFall service to patients as a way of promoting it to them. Those who are already using it are extremely positive and tell the doctors they like it.”

So does Ali have any advice for fellow professionals who are launching, or considering launching, a FootFall website? “We really love having FootFall, as you can tell. I’d just suggest people make the most of it and remember it can evolve,” she said. “Since we introduced FootFall we’ve added on asthma review forms, alcohol screening and smoking screening. This all saves us time and the patients appreciate not having to come into the surgery unnecessarily.

“Here in Newbury, we have a centralised maternity hub, which all pregnancies are referred to. So pregnant women can refer themselves via FootFall, to be contacted by a midwife. So, when you’re pregnant, you no longer need to visit the doctor first!”

www.strawberryhillmedicalcentre.co.uk

Chapel Row Surgery

Dr Jimmy Lennox GP Chapel Row Surgery

“The triage element within FootFall has led to increased practice efficiency. It has helped clinicians to plan their day and deal with less urgent questions from patients online rather than seeing the patient or speaking to them on the phone.” “In all areas of the practice it gives more time to answer patient requests and to do so at a time that is convenient for the practice rather than ‘on demand'”. “It gives the practice a tool with the potential to re-distribute workload away from appointments and busy surgery times.”

www.crsurgery.co.uk

 

In the News

GP practice reduces appointment waiting times by 90% with new online system.

Fakenham Medical Practice, in Norfolk, said patients who had to previously wait four weeks for a face-to-face appointment can now expect one on the same day or within 72 hours.

The online system, called FootFall, which patients are encouraged to use, lets them report symptoms or ask their practice questions at any time. The practice then, during working hours, looks at the request and responds within a certain time-frame and connects them with the right person or support…

Read full article