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Online consultations at Unity Health, York

Up to 2. New consultation types
August 01. 2017
Robert Varnam
At Unity Health in York, online consultations have made their workload more sustainable, improved access and quality of care.
Unity Health is a 7 partner practice serving 23,000 patients in York. 70% are university students, while the rest are a typical suburban population. 
The problem
In 2015 and 2016, the practice recognised there were significant challenges with access. It was not uncommon to have waits of 2-3 weeks to see a GP. Ten percent of appointments were wasted because the patient did not attend, further compounding the difficulties getting an appointment. The patient survey showed falling satisfaction - in February 2016 89% of patients expressed dissatisfaction with accessing care.
Clinicians felt they were rushing through their work, and concerned that care was increasingly unsafe. "We were felt like we were fighting a losing battle each day, and we weren't necessarily prioritising the patients with the greatest needs", reports the practice nurse manager. 
What they did
In Sept 2016 the practice started offering online consultations, and encouraged the majority of their patients to make the website their first point of contact. Patients with complex needs were identified and they were encouraged to call the practice directly instead. Contacts submitted by patients using the online system are reviewed first by a senior nurse. They answer queries, connect the patient with someone else in the team or book an appointment as appropriate. Many of the subsequent appointments are on the phone.
Depending on the patient's need, they may be asked to have a blood test or gather additional information (such as a sleep diary, blood sugar record or symptom score) prior to their appointment. This allows the appointment to achieve more. 
Impact
87% of patient first contacts are now online. The practice receives 150-200 online consultations per day. The practice is now coping much better with its workload and has significantly improved access.
  • The waiting time for a GP consultation has reduced from 2-3 weeks to 1 day.
  • DNAs have reduced from 10% to 3-5%.
  • For every 3 online consultations received, 1 is converted to a face to face consultation.
  • GPs report getting more done in each consultation where the initial contact was online, because they have more information at the start.
  • Patient response has been positive, with many fewer complaints about access and a growing number of unprompted positive comments. The results of the next patient survey are awaited.
  • Receptionist time has been freed up, allowing the practice now to focus on training them in active signposting, providing additional benefits for patients and the practice. 
  • There is now a more detailed text record in the patient notes of how patients have presented when they first contact the practice than previously, when there may have been a detailed discussion with a receptionist but this was not documented. The practice regard this as safer.
  • GPs report that the management of some presentations has changed significantly. For example, patients with uncomplicated hay fever symptoms receive advice and signposting to help from the pharmacy as the first line, helping them take more control themselves and reducing the need for GP appointments. For other problems, much better use is being made of the patient and doctor's time. For example, someone presenting with uncomplicated lethargy is likely to have relevant blood tests done and a sleep diary completed before their appointment with a GP. This enables the GP to accomplish more in the consultation with the patient, and it provides the patient with a definitive management plan more quickly. 

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