Manager Practice


Dr David


Cooper and practice


manager Fiona Paterson


for the relevant information needed to treat the patient. At Old Machar the PDFs are received in the practice Docman system and admin staff forward them to the appropriate person – be that a doctor, nurse or other staff. These are then apportioned to appointment slots for review. “Staff check the mailbox first thing in the morning and e-consults are already on appointment screens as soon as the doctors come in,” says Fiona. “The inbox is checked again at lunchtime and then about four o’clock – maybe three or four times a day.” “We decided it shouldn’t be extra work; this is instead of work,” says


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David. “So essentially if you have three e-consults to do that day then you will have fewer urgent patients.” The doctor then inputs a response into the Docman workflow and an administrator phones the patient back and reads out the advice and/or alerts them that a prescription is ready for collection, or to arrange an appointment for a face-to-face consultation. Some of the advice (including safety netting) can be pre-populated with existing text for common complaints such as viral-type infections. Advice and treatment are promised within two working days (or sooner if urgent). “It’s always a phone back,” says David. “In order to close the loop, to be 100 per cent sure the patient and only the patient has got the info, you need a phone back.” The practice is currently averaging around 50 e-consults per week which amounts to about five per cent of all practice consultations. A report by NHS Scotland covering a four-week period in 2017 found that Old Machar had saved 60 face-to-face appointments using e-consultations – the second highest in the pilot. Overall most e-consultations in the pilot were to do with administrative requests (test results, referral letters, etc) or general advice on a pre-existing problem. Common conditions included back pain, cold or flu, coughs and earache. Just over 40 per cent in the pilot practices resulted in


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WE NEED TO ADJUST SERVICES TO MEET CHANGING NEEDS. THAT’S HOW MANY YOUNGER PATIENTS WANT TO COMMUNICATE – TEXT, EMAIL, VIDEO


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face-to-face appointments and 11 per cent were dealt with by telephone consultation, 12 per cent with advice and 21 per cent were provided prescriptions. “We’ve found that most problems turn out to be fixable without an appointment,” says David. “We probably only have to see about 20 per cent of the patients who complete an e-consultation.”


FUTURE PROOF Most of the patients using the eConsult service


at Old Machar fall within the early 20s to mid-40s age group, with the oldest user so far being 92. It has proved very popular with patients and the practice has seen “exponential” growth over the last year. “The more people use it, the more people find out about it,” says


Fiona. “We have loads of repeat users because it works for them.” That isn’t to say there has not been some resistance. “Just as you would


expect in any practice we have GPs who prefer to see patients face-to- face, and patients who prefer to be seen face-to-face,” says David. It’s also not suitable for every patient and this is why the practice


chose not to make it a “blanket” access system. Says Fiona: “This would create huge health inequalities at our King’s Street branch because not all our patients have computers.” Overall the practice is very positive about e-consultations and


expects to invest in some form of online system when funding for the current pilot ends in July of this year. Old Machar has also recently expanded patient access with the option of video consulting using the Attend Anywhere platform. “We feel it’s the way to go,” says Fiona. “We need to adjust services


to meet changing needs. That’s how many younger patients want to communicate – text, email, video. What we are doing is just in line with that – the way of the future.”


Jim Killgore is managing editor of MDDUS Practice Manager 11


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