Background

The Surgery belongs to the Cwmtawe Cluster – a group of  practices that work together to share services and improve care  in the wider community including Cwmtawe Medical Group and Strawberry Place Surgery; together the cluster provides care for around 44,000 people in the Clydach, Morriston and Llansamlet.

Challenges

Llansamlet Surgery had been using telephone triage for many years, and in response to the push for online services, initially chose to use a competitor online consultation platform as Dr Chris Jones explains, “At the time we selected a free solution, but the reality was it only took 30 minutes for us to recognise that it was completely wrong for our surgery, largely because it didn’t allow enough control. We like to run a tight ship as we have a rather large demand, and the limitation of the competitor’s system did not help us meet the needs of our patients.”

The surgery also faced challenges in terms of managing capacity efficiently and the knock-on issues this led to such as increased waiting times and escalating workload for clinicians. Patients continued to spend needless amounts of time on the phone booking appointments, and made unnecessary journeys to the surgery to submit routine requests, creating workforce inefficiencies and causing inconvenience to patients.

As well as accentuating existing issues, Covid-19 brought additional pressures for patients and staff, resulting in soaring demand and the immediate need for remote consultations. Eager to overcome these issues and reduce the workload for GPs so that they can support everyone who needed help, Llansamlet Surgery sought a simple, effective, and flexible digital approach to manage patient workflow.

“We like to run a tight ship as we have a rather large demand”

Challenges

Llansamlet Surgery implemented innovative patient engagement solution, Engage Consult, for its outstanding features over and above other options on the market. As a user-friendly solution, Engage Consult makes patients and clinicians lives easier, safely and securely as Dr Jones explains, “Engage Consult provides control, it integrates well with our clinical system, and is slicker than other options; I tried other solutions, and nothing came close to the functionality of Engage Consult.”

Prior to the implementation of Engage Consult patients telephoned a request and a member of staff had to locate relevant information, sometimes putting the patient on hold or arranging a call back. By enabling patients to access Engage Consult directly from the practice website, it eliminates this issue in several ways. It allows patients to contact the surgery at a convenient time, rather than being limited to the time restrictions of a telephone service. Furthermore, by enabling the sharing of images, documents, and test results at anytime during the patient journey, clinicians have the data needed for efficient decision-making.

Implementation has been a smooth, and ongoing process.“The manner in which Engage Consult has been utilised has been fluid,” enthuses Dr Jones. Despite the need to limit the use of Engage Consult due to reduced clinician numbers in light of Covid, sickness, annual leave and reduced GP numbers, the Surgery is now emerging from this reduction and continues to expand the use of the solution, which provides total triage with online and video consultation.

“I tried other solutions, and nothing came close to the functionality of Engage Consult.”

Recommendations

Engage Consult appears to be an effective means of improving patient activation and access to self-management strategies for patients presenting with painful musculoskeletal conditions. Digital self-referral via an electronic consulting system is a sustainable means of patients accessing MSK outpatients without the need to see their GP and is in keeping with the NHS Long Term plan, and it is estimated that this project may have saved up to 2946 GP appointments over a ten-month period.

Initial review of the revised version of electronic questionnaires developed by Bexley MSK does appear to be safe and effective for screening of MSK pathology in an outpatients setting, and may allow for advice to be given at the point of self-referral. Of note, is the impact of COVID-19 on the project which is delayed against all milestones due to the Pandemic; it’s anticipated that a project of this scale could be achieved faster under normal circumstances and without the pressures of COVID-19.