The latest figures from askmyGP reporting patient contact preferences show there has been no change in the low demand among patients for video consultations.

The askmyGP data for the second quarter of 2019 is drawn from practices with diverse patient populations receiving a total of 220,000 patient requests during the period. The data illustrates patient contact by clinical episode, with video consultation with the patient’s usual NHS GP offered at no extra cost to either the practice or the patient.

When offered a choice of ways to talk to their GP, 21% (Q1 25%) of patients expressed a preference for a face-to-face appointment, 29% (Q1 28%) preferred to be contacted by secure message and 49% (Q1 47%) by phone. Patients requested a video consultation in less than 0.1% (Q1 0.1%) of cases.

While practices are not bound by their patients’ contact preferences, they use the information to guide their responses to patients. Clinical judgement always takes precedence, meaning in some cases simple queries might be addressed by a quick answer by phone or message, while more complex presentations will warrant a face-to-face appointment, even in cases where this has not been requested by the patient.

13 August 2019

Many have wondered whether patient satisfaction is affected by their chance of seeing a GP face to face.  The study done for the Exeter Annual Scientific Meeting of SAPC (Society for Academic Primary Care) analysed 14,009 patient feedbacks from 423,143 episodes managed through askmyGP from 1 January to 26 June 2019.

Presented by Ian Barratt and Steve Black at the conference.  Download pdf here.

We’re delighted to inform you today of the open access publication from Abi Eccles et al:

“BJGP: Patient use of an online triage platform”

It’s the first independent study of askmyGP and it’s well worth reading in full.  I will quote the conclusion briefly:

“Patterns-of-use and patient types were in line with typical contacts to GP practices. Though the age of users was broad, highest levels of use were from younger patients. The perceived advantages to using online triage, such as convenience and ease of use, are often context dependent.”

What comes through for me is the very ordinariness of the online demand.  It’s the same as normal demand, same patients, same conditions, same frequency by day of week and time of day.

There’s more on patient feedback too, with themes extracted which are very familiar to us.   We’ve quantified the age question in our study on “Age specific adoption of online consultations.”

What this study adds is online usage orders of magnitude greater than any previous paper, with 5447 patient episodes from 9 practices in 10 weeks.  Data collection was May to July 2017, which was our previous version 2 platform.  Since then the same principles have been carried forward to v3 with a new design and many more features.  Growth in usage means that we are now collecting the same volume of data roughly every two days.

The scope for further research is increasing daily with an anonymised database of some 300,000 episodes, unique in general practice.  If you’re an academic in the field, we welcome the opportunity to collaborate, particularly on studies of the GP practice as a whole, not just online components.

Benefits for patients and GPs are the product of system change.

Regards,

Harry Longman

PS See how patients interact with askmyGP on our Bramley Demo Practice.

To experience the GP side, start with our free online demo.

Context

The latest data from our chief analyst Dr Steve Black (@sib313) shows remarkable adoption of online consultations across all ages and 10 diverse practices.  n = 37,674 requests, date range is 1/1/2019 to 8/2/2019.

The context is all askmyGP practices operating in “total flow” mode where all patient demand goes through the system in two modes.  Online, patients submit a request for help from their NHS GP practice either for themselves (dark blue) or as a proxy (light blue), mostly children but also vulnerable adults, most over 75.  They may also telephone the practice, and a receptionist creates the request on their behalf (orange).

The key point is that all demand is covered in the chart, not from a self-selected subset of patients, and these are regular GP practices where there is no change in registration.

What the data shows

For infants and children, over 60% of parents chose to send their request online.

For young adults aged 20 – 40, over 70% submitted online.

With increasing age, the proportion online falls slowly, but even at 65 – 70 it is 40%.

Over 70 the proportion falls more steeply and significant numbers are by proxy.

Policy implications

It is clear that when designed for ease of use and universality in respect of patients and their medical problems, coupled with rapid response by providers, the online offer is highly attractive to patients.

The vision for “digital-first” providers who are at the same time traditional, local GP practices is achievable and already being achieved.

Harry Longman

Founder, Chief Executive, askmyGP

Good news has a hard time getting heard.

This week we’ve seen new, comprehensive data from NHS Digital on the wait to see a GP, splashed across all the papers:

Guardian:  “One in five patients waits two weeks to see a GP”

Times:  “Millions face a three week wait”

Telegraph:  “One in ten waits three weeks to see their GP”

It’s all “true”, though I’m afraid the spin is not.  The argument that “40% are seen the same day” rings hollow with anyone who has hung on the telephone for half an hour, to be told that all the same day slots have gone.  Many of those 40% have been trying for several days just to get through.

Blame the patients, blame the government, blame whoever else we can think of.  Or take a different look.

These tiny stories from the last few days are just a handful of the hundreds we see each week from patients grateful to their GP:

Your service and reliability are amazing. Thank you! (f 85)

Amazing fast system thank you (m 41)

Amazingly swift and very easy process than trying to jugggle around work – thank you so much! (f 24)

Amazing…More personal…Super speedy  (parent, boy, 3)

Love how easy it is to speak to your own doctor . Amazing (parent, girl, 4)

Love this new system…so easy and quick , and have the problem solved without having to sit around at the surgery. (f 49)

Love ‘askmygp’. Making it so much easier to get info and solve problems whilst holding down a full time job! (f 40)

Wow. I am impressed! (m 69)

Wow, just wow.  Have been in terrible painall night…absolute godsend… Thank you so much for your skills and innovations (f 65)

WOW, great system, quick easy, and no need to travel. Many thanks (m 63)

We’re now over 4,600 feedbacks from 80,000 episodes since August, and the trend is better and better.  Please do have a look at the live rolling 7 day summary chart.   We ask patients whether it’s better or worse and the ratio as I write has moved up to 9 which is so exciting.

These patients are getting an outstanding service from their own regular NHS GPs.  The GPs have no extra funding (they pay us), and no complicated extended hours 8 to 8 hubs (that didn’t work)

Patients didn’t have to switch to an out of area GP.  They could name their own GP.   They were seen same day if needed.

And the GPs are happier too – happier professionally to be giving such a service and bringing the joy back into their working lives.

If you haven’t yet watched the Burnbrae video, please do and click for the demo at the end.  This is one of her 5,000 patients last week, helped within 2 hours: 

“fantastic service and Dr Arnott is an amazing doctor, Shotts is lucky to have all these new changes.”

How do we get this into the headlines?

Regards

Harry Longman

Hypothesis:  efficient operation of  primary care depends on  clinical  triage of all demand, to optimise the use of scarce consulting resource – GP time.

The faster and simpler the system, the more patients will co-operate.

Who does what, when and how?

Patient  “I need help…”  Make it easy to provide enough detail for triage.  Online, anytime.

Reception ”I’ll assign you to a  clinician, unless I can help you myself” (within minutes, verify patient, choose clinician)

GP  “I’ll work out how to help, usually phone, may see you, send a message, or refer” (take seconds, within minutes, from online entry)

Consult & complete – precisely appropriate for the patient and episode.

Presented at EFPC European Forum for Primary Care, Annual Conference Porto 24-26 September 2017

Download the poster here:

Porto Demand-Flow EFPC v1

A quick note with exciting news, we’ve just had our poster published at the Society of Academic Primary Care SAPC Annual Scientific Meeting in Warwick.

askmyGP has now passed over 50,000 patient episodes, 4,000 of them on the all new platform launched just two months ago.

The case study with Concord Medical Centre, Bristol, is here:

What Makes Patients Use Online Consultations

What took demand to 30% online?  In a nutshell, it’s:

– Personal (“Hello, I’m Dr Bradley…)

– Universal (all patients, all problems)

– Responsive (we’ll get back within the hour)

– Simple (“Easy to use” main theme of feedback)

We took the decision in version 2 to take OUT the clever technology we’d put in v1.

It’s much simpler, with the aim of putting patients in faster, easier, touch with their GP, and vice versa.  It builds trust by allowing patients to express exactly what they mean.

The result?  Positive feedback has shot up, both from patients and GPs.

Dr Simon Bradley comments:

“The thought that goes into putting something into writing often helps the patient to have reflected on their problem prior to initiating a request.

Then for the clinician to have reflected on the request and reviewed relevant elements of the record means we can be more aligned with the patient’s agenda.

Online communication is asynchronous which allows both patient and practice to use their time more effectively.”

Aha.  Time.  The only absolutely finite resource.

Time for recreation too – enjoy the weekend.

Regards,

Harry Longman

Download pdf:  What makes patients use online consultations?

“It’s lovely not being shouted at 24/7”

Receptionist Karen’s first comment to me was both startling and predictable.  Her Somerset practice launched their demand led system two weeks ago, and since then she has been able to help every patient.  Three weeks ago she and her colleagues were turning away one in five patients (we measured it) but they have moved straight into the super league, with a median response time from the GPs of 26 minutes.

The GPs love it too, but I find they are more buttoned up and try to find at least one thing to grumble about.  “I’ll be home early so will have to put the kids to bed,” said one.

That didn’t take too long did it, or seem so hard?  It was four weeks of preparation, to abolish the old system and start the new.

So why aren’t we hearing about this from the commentariat?  I get a stream of dismal blogs from Nuffield/King’s Fund/Health Foundation (why don’t they just merge, it would save all those personnel transfer costs?) wringing their hands about how hard it is to change anything.

Another one today on General Practice at Scale, is it working?   Yawn.  Fiddling with structures, the obsession of policy makers who should get out more and ask “WHAT WORKS?”.  Instead we’re told,

“Motivations… centred on a desire to offer better access…

Most strikingly, what the survey revealed was just how long enacting change can take – at least two years to even begin to achieve what they’d set out to do.”

Useless.  And no measure of performance is even offered.  This is why Deming said that motivation is fine but worthless on its own.  The question is “By what method?”

Method is central to our work and it’s so repeatable now that the outcome is binary:  either the practice decides to change, and it all happens within a month, or it doesn’t, and nothing much happens at all, ever.

But method is not static, we are continually learning and having to adapt.  Another Midlands practice told me yesterday they are learning lots from having a GP in reception, sometimes even taking calls from patients, and their performance is rocketing while demand is falling.

I’m not going to call it a trend yet, but if you are a demand led practice you’re probably enjoying the sunshine dividend today.  Have a great weekend.

Harry Longman

PS  Learning a lot from askmyGP users too, with over 1200 episodes and 130 patient feedbacks on the new system, 55 suggestions from staff, a terrific response.  We’ve already put dozens into service and next week’s plans include one for low using practices (they will get an email notification of an online demand) and one very much anticipated by high users.

GPs have been emailing patients because it’s convenient – but it’s not secure and poorly controlled for IG and patient safety.  From next week those on the Transform programme will be able to securely message patients in a two way conversation.  It’s going to be another huge time saver.  Will let you know how it goes.

“When the Facts Change, I Change My Mind. What Do You Do, Sir?”  There’s a lengthy discussion on who said it first, perhaps not Keynes or Churchill, but never mind.

I’ve been saying that there is no evidence of patients being diverted from seeing their GP through online help, and now that’s changed.

Our evidence is from two hard tests to see whether askmyGP can reduce demand.  The first is to measure overall demand (by analysing all consultation records for practices in time series over months) and we’ve seen no measurable change up or down, a valuable finding in itself.  Demand doesn’t increase even when 20% of it now arrives online.  Nor have we seen overall reductions.

The second test is at the patient level, where we offer symptom specific NHS Choices information to patients.  Many view this and find it helpful, but very few are deflected from consulting:  we measure this continually, so far only 30 out of 38,000 episodes.

Then this Dutch study arrives, high quality evidence of 12% overall demand reduction.  Enormously interesting, because the Dutch registered list and capitated system is similar to ours in the NHS (though insurance funded).  The reduction was over 2 years and the result not only of the technology but also a complex intervention of GPs advising and encouraging their patients to use it.

But the technology matters too.  It’s notable that while NHS Choices is also very popular, there is no evidence of demand reduction as achieved by thuisarts.nl.  It was created by NHG, the Dutch equivalent of RCGP.  The differences between the two websites may appear subtle, but the fact is, one of them works.

Our aim with askmyGP has always been to make it easier to manage demand, and it’s delivering.  One practice manager told us this week, “can’t tell you how helpful the online system is”.

But reducing demand has been an aspiration, subject to finding something that works – perhaps we are now a little closer.

Some of you reading this may be in a position of power and influence.  With these new facts, I know what I’d do.

Harry Longman