PRACTICE PROFILE  OLD MACHAR MEDICAL PRACTICE


Jim Killgore visits an Aberdeen medical practice chosen to trial an innovative online triage and consultation system


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N ESTIMATED one in five GP appointments is for minor conditions that could be managed with advice and self care, according to a 2016 report by the Local Government


Association. Another report by the NHS Alliance argues that 27 per cent of GP appointments could potentially be avoided if there was more coordinated working between GPs and hospitals, wider use of other primary care staff and better use of technology. Certainly something needs to be done to help address rising patient demand for primary care services across the UK, attributed in part to a growing elderly population and associated co-morbidity, but also the crisis in GP recruitment. One potential time-saving solution that has emerged over the last few years is the use of online patient triage services for general practice. In 2014 the Scottish Centre of Telehealth and Telecare (SCTT) set


out to investigate the technology available to facilitate online triage. Ten Scottish GP practices were selected to trial an online “first click approach” to patient consultation. A range of urban and rural practices were approached and among those selected was the Old Machar Medical Practice in Aberdeen. I recently visited the practice and spoke with manager Fiona Paterson and GP partner Dr David Cooper.


ONLINE CONTACT Old Machar is among Scotland’s largest GP practices with over 18,000 patients cared for at two branch surgeries – one in Eastern Aberdeen, an area with high levels of deprivation, and the other in the more affluent north suburb of the city. The practice has five full-time and seven part-time partners, along with over 30 admin and nursing staff. It’s perhaps not so surprising that Old Machar was selected for the


e-consultation pilot as David Cooper has a keen interest in information technology, being an executive member of the Scottish National Users Group and involved in numerous IT steering and advisory groups. “I always dread when he comes back from a meeting saying I just


said ‘yes’ to something,” Fiona jokes. David laughs. “Keeps the staff on their toes. But I’m really not techy


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at all. My interest is more along the lines: does the technology work? Is it what people want? How does it fit in systems-wise? Making it work is someone else’s problem.” The system they were asked to make work for Old Machar was


eConsult – an online triage tool developed by a group of London- based GPs along with a team of IT experts. eConsult bolts onto an existing practice website and invites patients to fill out an online form that captures symptoms associated with over 100 common clinical conditions. The tool is already in use in NHS England and Old Machar agreed to participate in a three-year trial starting in August 2016. “We saw this as possibly the wave of the future and so we wanted


to get in there early to see what it’s like, with no risk from a funding point of view,” says David. Patients visiting the homepage of the Old Machar Medical Practice


can access an e-consultation via a pop-up panel which asks them to input details on an online form. Among the options presented are help for a specific problem/condition, general advice on symptoms, or administrative requests such as test results, sick notes or a medical report. Patients are also advised of other ways to get advice either via the NHS 111 service or self care using the NHS Choices website. Before being allowed to start an online consultation, patients are


asked to confirm their problem is not an immediate emergency and that they are over 18 and consulting for themselves (not a child). The form then records patient details and takes the user through a series of questions to explore the nature of the complaint, capturing the symptoms using standard diagnostic scoring where possible. “It starts with red flags,” says David. “Say the patient has low mood. It asks: Are there any suicidal-type thoughts? In which case, it does not allow the patient to go any further. It says you should phone the practice immediately.”


WORK FLOW Information gathered using the online form is then output to a PDF document with a standard format so that clinicians can quickly review


SPRING 2018  ISSUE 18


PHOTOGRAPHS: NEWSLINE MEDIA


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