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Same Day Appointment Triage using Online Consultations

Improving Access to Same Day Appointments: Information for patients

 

Being able to see a health professional at the right time is one of the most important concerns for patients. For many years in Stonehaven this has meant calling the surgery at 8.30 am and booking a “same day” appointment. Traditionally this was with a GP. More recently this is equally likely to be with an Advanced Nurse Practitioner.

The current system we have generally works well but, as with any system, it is not perfect.

We want to introduce changes which we believe will result in several benefits for our patients. To achieve this we plan to introduce a system of triage to the “same day” appointments service.

This does NOT mean that you will NOT be able to get an appointment on the same day that you contact the practice but rather that you will be asked to provide some information to the practice which will allow us to make an informed decision to help gauge the urgency of your request and also to ensure that they are seen by the most appropriate person at the right time.

To do this we are going to introduce a triage system based on our new online consultation service – eConsult -which is available through our website www.stonehavenmedicalgroup.scot.nhs.uk . Any requests for a “same day” appointment will now need to be submitted through eConsult and we will guarantee a response within 2 hours to any online consultation submitted before 12 noon.

This system will not apply to any request for future appointments, home visits or urgent/emergency medical concerns – these will be still be dealt with by our admin team and duty doctor and can still be made by calling the surgery.

The potential benefits of this are

THE MOST URGENT ISSUES ARE IDENTIFIED QUICKLY AND PATIENTS WILL BE OFFERED EARLIER APPOINTMENTS IMPROVING PATIENT SAFETY

IMPROVED CONTINUITY OF CARE - YOUR INFORMATION WILL BE PASSED TO THE GP WHO KNOWS YOU BEST WHENEVER SAFE TO DO SO

SEE THE RIGHT PERSON FIRST TIME – THE INFORMATION YOU PROVIDE WILL HELP YOU SEE THE MOST APPROPRIATE MEMBER OF STAFF FOR YOUR CONDITION

IMPROVED ACCESS FOR All PATIENTS – ALL REQUESTS WILL BE SEEN AND TRIAGED RAPIDLY BY THE SURGERY TEAM

IMPROVED ACCESS FOR All PATIENTS – NO LONG QUEUES AT 8.30 AM HOPING TO GET THROUGH FOR AN APPOINTMENT – REQUEST YOUR APPOINTMENT ANYTIME, ANYWHERE

MORE CONVENIENT FOR PATIENTS – SOME PROBLEMS MAY NOT REQUIRE A FACE TO FACE APPOINTMENT AND CAN BE DEALT WITH OVER THE PHONE SAVING YOU FROM HAVING TO COME TO THE SURGERY

We know that changing a system which has been established for a long time does not come without challenges and risks and this is why we want to inform patients about our plans and the reasons behind them with as much detail as possible. We do believe that over time contacting the surgery through the online services could be the first choice for most patients for all issues.

We also want to reassure patients that this test of change in our system will be continuously monitored to ensure that it is both safe and providing the high quality service we expect it to. We will use objective measures, feedback from patients and feedback from staff from the outset to help shape the ongoing use of such a system or indeed to recognise if it is not the correct approach and should be stopped.

There will be a number of concerns and worries about this change for many of you and we have tried to address some of these for you now through our Q&A section below. There may be other issues or concerns that we have not yet identified or considered and we would welcome any queries or feedback (good or bad).

 

Why are you making these changes?

General Practice faces many growing concerns which could affect Stonehaven Medical Group without the correct planning and preparation. People are living longer and with more long term health problems and require more medical and nursing input for longer. Patients are going to see their GP twice as many times each year as they were 10 years ago. There is increasing difficulty for practices to recruit and retain doctors or other staff to work in their surgeries and in the Aberdeen area we have seen practices close down as a result of this.

Continually developing and modernising the way we work as a practice will help us provide a high quality service to patients while ensuring that Stonehaven Medical Group remains a strong and sustainable medical practice for the future so that this care can be provided to generations of families to come.

What is wrong with the current “same day” appointment system?

The greatest concerns we have with our current same day appointment system are

  1. There is no filter to help to identify which patients are the sickest and need the most urgent appointments.
  2. It is difficult to provide the level of continuity of care that we would like i.e. being able to see a GP that you know well and who knows you well
  3. GPs see many problems that could be seen by other health professionals while other health professionals see patients with problems that would be best managed by seeing a GP.
  4. Some patients are seen for a face to face appointment that either could have been dealt with over the phone or by a different service e.g. pharmacy, physiotherapist, minor injury unit

Too often at the moment the patient could see the wrong person at the wrong time and we want to make changes so that more patients are seeing the right person at the right time.

When are you going to start this new system and what will change?

From Monday 8th October the system will change and we will be asking that all same day appointment requests are made by submitting an online consultation through our website. Currently we guarantee a response to online consultations by the end of the next working day. With our new proposed system we are guaranteeing that if you submit an online consultation before 12 noon that we will get back to you within 2 hours. Any online consultations submitted after 12 noon will be responded to as quickly as possible and with a guaranteed response of 10am the following working day.

Can I still phone and book an appointment with a GP or Advanced Nurse Practitioner in the morning?

No. If you call the surgery trying to book an appointment with a GP “on the day” you will no longer be able to book one. The exception to this will be children and we will still allow direct booking with our Advanced Nurse Practitioners “on the day” for children under the age of 16 although an eConsult can still be submitted for children from ages of 6 months upwards.

 If you feel your problem is urgent then your details will be passed to duty doctor who will then contact you and triage your complaint over the phone.

I want to book a same day appointment for my child - what should I do?

Parents of children from age of 6 months upwards can still use our online consultation service to request an appointment. There are fewer options for children in comparison to adults and if you are not certain if any of these are suitable for your child then please call the surgery and we will be able to offer you either an appointment with an Advanced Nurse Practitioner or to speak with our duty doctor. Children under 6 months of age cannot use the online consultation service and we would advise parents to contact the surgery directly and we will be able to offer you either an appointment with an Advanced Nurse Practitioner or to speak to the duty doctor.

What if I want to request a home visit?

If you feel that may require a home visit you will still be able to call the surgery and the admin staff will assist you by passing a message to our duty doctor who will then call you back.

Won’t this take longer?

The average time take to complete an online consultation is between 5 and 10 minutes. At peak times you can wait 5 minutes or more to get through to our admin team to book an appointment – you could already have completed most of your online consultation in this time.

This system will also take away the pressure of having to request your appointment at 08:30 exactly or having to wait until the day that you know your usual GP will be working. We know the phone lines are very busy at 08:30 and you can often get through only to find you are number 30 in the queue. Just submit your consultation anytime before 12.00 and we will get back to you within 2 hours. You can also provide us with a lot more detail in about your issue in advance so that if you do require a face to face appointment this will be a better overall consultation experience for you. Furthermore it is likely that some of the issues or concerns that people have will not require a face to face appointment and could be dealt with over the phone – this will save you having to come to the surgery.

Can I still book an appointment with my GP for a future date?

Yes. You will still be able to book an appointment with a GP in advance – a pre-bookable appointment. These can be booked up to 12 weeks in advance.

What if I do not want to use the online consultation service?

 We respect that this may be the position of some of our patients. In this case you will be offered the next available pre-bookable appointment with a GP or if you feel your problem is urgent to speak with our duty doctor.

What if I cannot use an online consultation service?

We know that a small number of patients might have difficulty using this service if they have limited access to or limited capability to use a smart phone, tablet or computer or have poor internet access. We would firstly ask you to see if any family member could help you to submit one. If this is not possible then please inform our receptionists who will be able to offer you assistance over the phone. You may be offered alternative appointment options or  one of our GPs may call you back. We will ensure that no one is unable to access an appointment when they need one. All of our receptionists are highly trusted members of staff and are bound by the same confidentiality agreements that the doctors and nurses are and they may ask you for some information to pass to our doctors.

We will always do our best to help you find a solution.

I know I need to see someone – why can’t I just book directly?

You will still be able to book directly for future appointments. We know that many patients will need to be seen for a face to face appointment as they do now but it is important that you are seen by the most appropriate person for your condition. This new system is designed to try and improve access to healthcare professionals and not to limit it. By providing us with this extra information we can help both you as an individual and also our patients as a whole.

There may be times when we review the information you provide and decide that you do not need to see someone and we will let you know the reasons for this. It is important that appointments are available for patients who need them most and reducing inappropriate appointment use is an important aim of this change.

I have attempted to submit an online consultation but the programme wouldn’t let me and advised I should call for urgent help – what should I do?  

An additional benefit of the online consultation programme is that it is designed to recognise symptoms which may be associated with a higher level of risk and warns patients of this. You will not be able to progress with the consultation and complete it. If this does happen to you then we would ask you call the surgery and advise the admin team of this and they will put you in contact with our duty doctor who will be able to help you.

What will happen once the surgery has looked at my online consultation?

Once your consultation has been received it will be passed to the triage team who will review it as quickly as possible and guaranteed within 2 hours. Once they have reviewed the information then you will be contacted by the surgery staff. We expect that the vast majority of patients will fit into one of the following outcomes

  1. You will be offered an appointment that day – this will either be with a GP or an Advanced Nurse Practitioner and appointments will continue to be spread throughout the day to try and give you some degree of choice of a time that suits you best. More urgent issues will generally be offered earlier appointments.
  2. You will be contacted for a telephone consultation – in some cases we may decide that you do not need to come to the surgery for a face to face review and we will contact you by telephone
  3. You will be offered an appointment at a future date – this is most likely if there is a particular GP that you normally see who is not available that day to deal with your consultation.
  4. You will be directed to another health professional or service to help you deal with your consultation – examples of what this might be are the practice pharmacist, physiotherapy, a community pharmacist or a minor injury unit
  5. You will be given advice or feedback from the triage team by one of the members of the admin team – in some circumstances the triage team may feel that advice on self management of your condition is the most appropriate outcome and they will ask the admin staff to contact you to advise you of this and where to seek further help if appropriate


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