Workshops session 1 Presentation: The GPFV online consultations fund: your questions answered by Jamie Bull

1. Stabilising and transforming services for the future
Online Consultations Fund
Jamie Bull – Head of General Practice Development
Programme
Garry Mitchell – Commercial & Procurement Lead
Robert Amil – Regional Procurement Specialist

2. Stabilising and transforming services for the future
About
Benefits
Process
Support
Structure of today’s session

3. Stabilising and transforming services for the future
What does it look like?
About
• The practice has a licence for a system operating via web portal +/- app
(i.e. no software to install / maintain on-site)
• A link is put on the practice website
• Patients use it as their first port of call
• information about symptoms, conditions and treatments
• ask a question / initiate a consultation with practice

4. Stabilising and transforming services for the future
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription, check
test results, book
appointment
About
What does it look like?

5. Stabilising and transforming services for the future
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription, check
test results, book
appointment
About
What does it look like?

6. Stabilising and transforming services for the future
Find information
about your symptoms
or a condition
Send a consultation
to your practice
Request repeat
prescription, check
test results, book
appointment
Type details of the problem or
question here…
Send
About
What does it look like?

7. Stabilising and transforming services for the future
The GPFV fund
£45m over 3 years … equivalent to £0.80/pt average
Available for every practice
To pay towards costs of purchasing & using solution to enable patients to consult their
practice through an app/web portal
• not about private providers
• other features not essential (eg video calls)
• join-up with other services not essential (but note pilots)
System procured by the CCG, for bigger impact and value
About

8. Stabilising and transforming services for the future
Rapid growth
• 2015: 2 systems widely available
• Jan 2018: 6 on national approved suppliers list (expected to grow)
Functionality
• currently more targeted at first contact than ongoing care (but rapid evolution occurring)
Interoperability
• currently limited - but rapid development…
• closer integration with clinical systems
• links with 111 Online
• links with NHS.uk
• Citizen ID
• links with apps & wearables
About
Software on the market

9. Stabilising and transforming services for the future
Case studies:
bit.ly/GPcapacitynet2
Benefits
Is it beneficial?

10. Stabilising and transforming services for the future
e.g. recent study - “unlikely to deliver hoped-for
benefits”
• practices had no ‘clear rationale’
• no plan re likely costs and benefits
• insufficient training of non-clinical staff
• insufficient communication with patients
Look beyond the headlines …
Yes
“access improved … better
consultations … happier
staff and patients … GP
workload manageable”
Not many
“No problems as such, but
very few patients used it
and we didn’t notice an
impact on workload”
Wide range of answers from different practices
Br J Gen Pract. 2018 Jan 30;bjgp18X694853
Benefits
Is it beneficial?

11. Stabilising and transforming services for the future
Possible conclusions …
It’s brilliant – just do it
It doesn’t work – don’t bother
Let’s learn how successful practices have done it
Yes
“access improved … better
consultations … happier
staff and patients … GP
workload manageable”
Not many
“No problems as such, but
very few patients used it
and we didn’t notice an
impact on workload”
Wide range of answers from different practices
Is it beneficial?
Benefits

12. Stabilising and transforming services for the future
Yes
“access improved … better consultations
… happier staff and patients … GP
workload manageable”
Not many
“No problems as such, but very few
patients used it and we didn’t notice
an impact on workload”
Wide range of answers from different practices
But you knew that already …
Having it confers no benefit
Switching it on is a start
Using it to full effect could change your life
Benefits
Is it beneficial?

13. Stabilising and transforming services for the future
Improved access
More convenient access, connected to the most appropriate person first
time, signposted to self help ad community resources
• e.g. Unity Health, York: GP wait reduced from 2-3 weeks to 1 day, DNAs from 10% to 3 - 5%
• eg Larwood surgery, Worksop: named GP wait reduced from 1-5 weeks to a few hours
More efficient use of GP time
Clerical queries addressed by clerical staff, some problems resolved without
face to face appointment, tests done before appointment
• e.g. Docklands Medical Centre: 40% of contacts resolved without patient needing to come in, mean 2.9 minutes’
GP time
• eg Unity Health, York: 66% handled remotely, take <10 min for clinician
More effective consultations
GP can deal more effectively with the problem because details of the history and the
patient’s ideas, concerns and expectations known in advance
• one of the first things reported by many GPs
• it is hoped that future academic research will seek to quantify this
Benefits
What are we seeing?

14. Stabilising and transforming services for the future
Potential shift to ‘click first’ for patients:
e.g. Rydal practice (N London): 40% contacts online within 3 months
e.g. Unity Health (York): 87%
Yes … if they know about it and are encouraged by staff
Where patients are not engaged by the practice, the service is hard to find on the website or staff are
not confident in describing the benefits, patient uptake can be very low.
This is not surprising, but it is sometimes overlooked by practices. Recent academic publications
confirm this.
Potential shift to ‘click first’ for patients
• Rydal practice (suburban): 40% contacts online within 3 months
• Unity Health (suburban and student): 87% online
Use crosses the generations:
Benefits
Do patients use it?

15. Stabilising and transforming services for the future
Safety standards
Detailed standards published by NHS England, October 2017, covering legislation / standards for clinical
safety, cybersecurity and information governance.
National approved suppliers established, January 2018, giving additional assurance regarding essential
functionality and financial stability.
Indemnity providers’ view
Inform provider. No additional cost.
Follow GMC and CQC requirements for good care, see in person if clinically appropriate, don’t break confidentiality,
check patient agreement with management plan
Contact provider if…
• non-GPs are consulting (?additional cost)
• consulting with private patients (?additional cost)
• consulting without the record (?additional cost)
• consulting online with under 16s (may not be covered)
Benefits
Is it approved?

16. Stabilising and transforming services for the future
Publication of full requirements
and planning guidance
CCG plan
Plan approved by NHS England
Funding allocated to CCG
CCG procures systems for practices
Practices go live
30 Oct 17
November
and
December
January
onwards
National webinars for practices and
CCGs
Planning support for CCGs from NHS
England regional team and national
commercial and procurement Hub
Procurement advice and support
from Hub
Ongoing programme of showcases
(through General Practice Development
Programme)
Marketing materials and support to
engage with patients
Process
Launch process

17. Stabilising and transforming services for the future
Support for procurement
National Commercial and Procurement Hub will create an approved suppliers list to be used in a
dynamic purchasing system (DPS). Requirements:
relevant functionality
meet all appropriate standards (inc IG and cybersecurity)
organisational capacity to meet demand
financial stability standards
The Hub will keep the DPS updated with new features, standards and suppliers
CCGs can then run mini competitions using the list
• assurance re standards and state-of-the-art solutions
• fast procurement (min 15 working days)
• best value for money
DPS
launch
in Jan 18
Support

18. Stabilising and transforming services for the future
Practice usage
• Staff need to be confident in describing new
channel to patients
• Response needs to be timely
• Need to direct work to the most appropriate person
New marketing
resources and
support
Support from
Patient Online
implementation
leads
Patient usage
• Patients need to know about the system and be
confident in the benefits
• It needs to be easy to find on the practice website
Support being provided:
Support for practices
Support

19. Stabilising and transforming services for the future
Monitoring and learning
Monitoring
• Management information will be gathered quarterly as part of the General Practice Forward View
monitoring system.
• Uptake by practices
• Systems being used
• Performance of the Dynamic Purchasing System
• Alignment with other digital services (as they come on stream)
• Patient usage statistics (number and type of contacts, demographics)
Deeper learning
• A sample of practices and localities will be invited to participate in providing much more detailed data.
This will generate more insights into the impact and critical success factors. Lines of enquiry will
include:
• Patient utilisation (e.g. clerical / clinical query, new / existing problem)
• Outcomes (immediate disposal, re-consultation rates, time taken)
• Patient and staff experience
Support

20. Stabilising and transforming services for the future
Policy information:
bit.ly/gpfvonlineconsultations
Case studies:
bit.ly/GPcapacitynet2
Support
england.onlineconsultations@nhs.net