Really! I can See the Doctor Right Now?

You might not have noticed but something exciting has been happening in Birmingham: you can now speak to a GP when you want to, not when you’re told to!

Modality Partnership is a single GP organisation that operates across 13 different locations in Sandwell and Birmingham. One of the first GP “super practices”, Modality has the advantage of having small practices working closely in local communities with the medical and technological opportunities that come from being part of a bigger organisation. Modality employs almost 250 staff and serves around 60,000 people.

As Director of Product Design for Digital Life Sciences I worked with Modality to re engineer the organisation and to change the way that patients access care.

Part of our project was to create a centralised and properly staffed call centre for patient appointment booking. Along side this we now give users of the services different ways to reach their GP, to use the jargon, we’ve designed and delivered a multi-channel access model for patients. It’s been a success and I will tell you more later.

This initial stage was all done through Wave 1 of the Prime Minister’s Challenge Fund, designed to improve access to general practice and stimulate innovative ways of providing primary care services. All with the aim of enabling GPs to open from 8am to 8pm seven days a week.

There are a number of components we’ve introduced that combine to make Modality’s service sing-

The Hub
A centralised call centre staffed with enough people to answer the demands of booking appointments… this sounds bafflingly straightforward but, as many of you will know from your own experience of making GP appointments, it is rarely straightforward.

GP Call Back
People can request a call back from a GP usually within an hour. This works as a triage to establish if the patient needs be seen face to face but we’ve also found that 66% of the time that call with the GP solves the problem. And with the other 34%, they can then come in to see their GP later that day.

Skype
Instead of a phone call, patients can choose to have a call back or appointment on Skype, with or without video.

Modality Web and App
People who are registered with the Modality Partnership can use the Modality website (on desktop, tablet or phone) to:-

  • arrange a same-day Skype or phone appointment
  • book routine face-to-face appointments
  • find contact details for practices
  • view directions for how to get there
  • find information on out-of-hours services

This can also be done on the Modality App.

In addition users of the website also have access to a whole range of Vitality guides that support self diagnosis and self care. There are also guides for healthier living, student services and contraception advice. Both the web and app are integrated with NHS England’s mandated Friends and Family feedback mechanism to gauge opinion on Vitality services.

So people can get through quickly and easily to book appointments, and actually because of this, they’ve started to call when it’s convenient to them. The result is that the Vitality hub takes calls throughout the day, not just at 8am, so they can more effectively manage staffing and have the right number of call handlers as there are less peaks and troughs throughout the day.

Other digital tools are being trialed in Modality with the goal of changing passive patients into active participants in managing their own health and well being. This activity is supported by staff in to give patients the confidence and support to use these tools when appropriate.

Video Prescribe
GP or specialists email patients a personalised playlist or video postcard containing short videos that explain their condition, diagnosis and how Vitality treat such a condition.

The videos also enable patients to meet members of the local team involved in their care, understand the local services available, and hear other patients describe their own experiences of living with the condition.

Modality Plan
This is an online health journal. So for example if you’ve been diagnosed with diabetes, Modality Plan can help you to reflect on your health, find out more about your condition and organise your thoughts so that you can take a more proactive role in discussions with health professionals, your family and friends.

There are clear benefits of having a multi-channel access model supported by health professional who can recommend localised tools and apps. It promotes primary care as the first point of patient access across multiple services and reduces demand on A&E services, freeing up bed days and enabling ambulatory care to be handled in a primary care setting.

The programme is half way through roll-out with 35,000 people on the patient lists having been transitioned onto the new access model. We are finding that:

  • Almost 800 calls per day being answered by call centre staff, with over 1000 calls on a Monday meeting previously unmet demand. The average booking lasts only 2 minutes and the average service level is 87%.
  • The average call time of a remote phone or Skype appointment is 7 minutes 22 seconds, 23 % less than the standard 9 minute 45 second appointment. Mainly because patients use this to ask quick questions or double check, whereas normally they would have to book an on-site appointment.
  • As a result of 66% of patients being dealt with remotely and the average appointment time dropping by almost 25%, clinicians time is used more efficiently, increasing capacity by approximately 10% without increasing resource.
  • Only 35% of telephone consultations are converted into same day face-to-face appointments, completely driven by patient demand.
  • Due to the elimination of future bookings, the number of missed appointments has dropped by over 70%, producing a calculated saving of around £3000 per month for large practices.
  • Demand for appointments is equalising throughout the day, easing the historic 8am bottleneck as patients realise they can access their primary care team when they need them throughout the day.
  • Approximately 300 patients per day are using the online service, staying on the site for an average of four minutes.
  • Appointment capacity has increased by up to 40% in some participating practices and with appointment utilisation increase by up to 37%.
  • Patients can now leave feedback in person, via surgery check-ins, a website or an app. Over 60% of patients think the new system is better than before.
  • Removing all possible duplicated, initial findings are suggesting a significant reduction in A&E attendances from the previous year.

The service is starting to deliver a more patient-centric service and the digital approach is enabling Modality patients to have better access to their care and in a manner in which they choose.

Over the next year Digital Life Science will finesse and developing the process with the goal of developing a 24/7 GP service.

So not only are the sparrows singing in Birmingham, they’re singing for you. I think that’s quite exciting.

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