1. Transforming General Practice Online access for patients = efficiency for GPs Harry Longman harry@gpaccess.uk @harrylongman

2. Demand by time of day, painful. Rydal GP, charts by PA Navigator

4. Remote Asynchronous Which mode? Synchronous Local ££££ £ ££

5. Remote Asynchronous Remote Synchronous Local Asynchronous Local Synchronous Triage to appropriate mode

6. Mrs Brindle is at home, with a sore knee, describing the problem to seek help from her GP

7. Dr Hannan receives the history instantly, decides to call.

8. Mrs Brindle takes the call from Dr Hannan: reassurance and a prescription to pick up. Takes 2 minutes

9. Exploring symptoms to give a structured report Example, “chest infection”

10. The patient reviews the history & sends. GP can now make fully informed decision.

11. 80,000 questions…

12. Traditional model, see all patients 36 x 10 min = 360 min 36 calls Total 360 min

13. Telephone all patients 15 x 10 150 min Total 330 min, saving 30 min 36 x 5 min 180 min 36 x 5 min 180 min 36 calls

14. All patients access online 11 x 10 min 36 x 1 min 7pts 11 x 5 min 36 submissions Total 210 min, saving 150 min

15. Demand turns out to be stable, predictable and manageable, GP telephone led Rydal Group practice

16. Average wait time to see a GP falls off a cliff Bourne Galletly MP, charts by PA Navigator

17. The limit of performance in a telephone led system? Rydal GP, charts by PA Navigator 14 minute median response time is stable. Little benefit in improvement

18. Demand shifting from phone to online over 30% in two months. 2/3 medical, 1/3 other Phone message changed Website live New phone message by GP

19. Replacement, not additional demand. Face to faces have dropped 15% Website live New phone message by GP

20. All ages are using it, 0 to 94 years old. 60/40 female/male split is usual GP demand

21. Most users are patients, but parents and carers are important too.

22. An idea of clinical conditions: very varied, long tail distribution. 83% are symptoms.

23. 20% by type are 50% by volume. Top 10: Skin condition Chest/throat infection Cough Ear/nose/throat Back pain Digestion Abdominal pain Rash Anxiety Headache

24. Patients are happy to spend their own time giving their history, most between 2 and 12 minutes.

25. Some feedback left online… This seems like a good way not having to explain your private symptoms to the receptionist. I like this; I don't have a lot of time to wait on the phone so would prefer to deal online. I can see myself using this all the time now. Used because of difficulty contacting practice while I am at work. It is not always convenient to discuss personal issues. been excellent so far! I used this system because of the delay in a telephone call to the surgery taking a long time to answer. I felt as if it asked a lot of questions, some didn't appear to me as a lay person to be relevant

26. While 79% present one problem, 21% with more than one is significant.

27. Most users want help from any GP, just 22% ask for a named GP

28. Ease of use All demand Rapid service

29. "Listen to your patient, he is telling you the diagnosis" William Osler on a screen

30. Independent Research Cambridge/ RAND Europe GP-patient relationship

31. Be a patient at… www.bramleysurgery.co.uk