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Arvind madan innovativeapproachestoprovidingbetteraccesstoservices

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Arvind madan innovativeapproachestoprovidingbetteraccesstoservices

  1. 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. 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. 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. 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. 5. Patient select their condition
  6. 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. 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. 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. 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. 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. 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. 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. 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 Open 24/7

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