A collaborative approach to support Primary Care demand

A collaborative approach to support Primary Care demand management: In-hours GP Triage Lynn Huckerby, Associate Director, Service Transformation and Digital, NHS 24.

Overview • • Strategic Context A Collaborative Approach ‘Test of Change’ Aims In-hours GP Triage Lessons learned Short video clip Next steps

Strategic Context • Multi-disciplinary, multisectorial urgent care coordination – Urgent Care Resource hubs • Oo. H Services ~ 24/7 • Co-location, co-working, coproduction and co-learning

Strategic Context continued Health & Social Care Delivery Plan • Right Care, Right Time • Once for Scotland Practising Realistic Medicine • Personalised Approach to care • Improvers & Innovators Digital Health & Social Care Strategy • Use familiar tools and tech to support health & wellbeing • Technology as the enabler New GMS Contract • Multi-disciplinary team • GP as expert generalist

A Collaborative Approach Stakeholder Engagement (public, partner & staff) Evaluation Change Model Quality Improvement Project Management

‘Test of Change’ Aims • Demonstrate a new way of working, both for NHS 24 and local GP practices • A reduction in the numbers of patients requiring ‘same day’ face-to-face consultation • Support primary care demand management • Enhance patient experience and raise awareness of alternatives to care provision • Improve patient experience

Overview of the GP Triage Service The formal test of change provides the basis to develop a coordinated, scalable solution through an outbound GP Triage model during the in-hours period for patients requesting a same-day GP consultation. The service effectiveness and patient experience will be improved when the handover points become seamless and more responsive, enabled by the incremental evolution. The test of change evaluated a 5 month period from mid-November ‘ 17 to April ’ 18 across practices in Branchalwood (NHS Lanarkshire) and Riverside (NHS Lothian). Branchalwood (patient list 5, 775) was identified as a practice experiencing operational challenges and Riverside (patient list 19, 040 post merger 1 of the largest now in Scotland ) is developing an Integrated Primary Care Hub. Both of these changes required significant operational support from NHS 24 to manage patient demand. The patient journey has been captured on the diagram below, which shows how practices liaise with NHS 24 for patients to receive care. While this differs between practices, this should provide a high-level overview of the stages involved for a GP surgery to engage with NHS 24. 7

Data: NHS Lanarkshire Branchalwood – Outcomes, Nov to 21 April 2018 100% 90% 80% 999 Total A&E Total 70% GP Total ANP Total 60% T/room total Spk. To Total 50% HV Total Routine Total 40% Optician Total 30% Pharm total Selfcare Total 20% NR Total 10% 0% Nov Dec Jan Feb Mar Apr

Data: NHS Lothian Musselburgh – Outcomes, to 20 th April 2018 100% 999 Total 90% A&E Total GP Total 80% ANP Total 70% APP Total MHNP Total 60% MHOT Total Paed/ other Total 50% T/room Total Spk to Total 40% HV Total 30% Routine Total Optician Total 20% Pharm Total Selfcare Total 10% 0% NR Total Other Total Nov Dec Jan Feb Mar Apr

GP Triage tests of change: impacts GP satisfaction GPs have reported a marked increase to overall wellbeing and job satisfaction as a direct result of appropriately redirected workloads 6, 288 calls Improved patient education NHS 24 triaged over 6, 000 calls across the two practices in a 5 month period from November-April As patients become more familiar with the service, they recognise that there alternatives to GP appointments including other professionals and the use of digital self -service 8. 27 minutes 70% GP appointment reduction The average call time for NHS 24 staff engaging with patients was almost identical to the business case assumption of 8 minutes NHS 24’s triage service directed over 90% of demand for same day GP appointments to more appropriate services at Riverside practice in February 2018 Enhanced patient experience GPs have been able to increase average consultation time to 15 minutes as patients with more complex needs

GP Triage: lessons learned Key areas to focus on as the service develops • Operational staff need resolution to key IT issues (e. g. access to patient records) Technology • As the service evolves, technology should be embedded to increase process efficiencies • Need for relevant alignment between 111 service and GP triage service • Data capture methods need to be established for the practices and internal NHS 24 data requires to be more accessible Data • Operational partners should receive automated reports from NHS 24 systems • There should be appropriate alignment of clinical and information governance support as this service develops Patient experience • While informal qualitative information on patient experience has been captured, this needs to be supported by regular and robust data capture through an evaluation framework • Empowerment towards self-care/self-management through ‘redirection’ • The patient journey must be mapped and reviewed to maximize benefit and efficiencies Staffing • Effective senior leadership and senior clinical decision making at the front end - is vital to the ongoing success of this work across the system

Link to Video

The next steps Plans for further development of the GP Triage model 1 2 3 Sustainable model The current call model for the GP service relies on an outbound call model. We will evolve the service through co-design based on the patient, partner and staff needs to deliver a safe, effective, patient-focussed service. Enhance technology and digital access An improved technology capability will enable more efficiencies across care pathways. Extend practice listings Results to date point towards a potential positive impact across the Health & Social Care landscape should this be extended.

Thanks for listening CONTACT: Lynne. Huckerby@nhs 24. scot. nhs. uk @lynnehuckerby 1