Information regarding new appointment system

The way you make an appointment is changing from 1 February.

Background

From 1^st February the surgery will be updating its access routes and streamlining the process to get a GP appointment. The Government GP recovery plan sets out requirements for surgeries to become more digital.

Many of you are aware the current situation in the NHS is very difficult. Demand on services simply outstrips supply. This has led to long waiting times and the need to prioritise based on clinical need. This is no different in Primary Care or at Twyford Surgery.

The staff in the surgery are working tirelessly to meet these demands and provide appropriate medical care. This includes everyone, from front of house reception teams to clinicians, as well as the secretarial and administrative staff working hard behind the scenes.

We know and appreciate that the 8am rush for a GP appointment is stressful at a time when you are probably worried about a health issue. With the new telephony system, we can analyse call volumes and outcomes. At 8am we have over 50 calls into the surgery within an hour, but after 9/10am this volume drops dramatically to around 10 an hour. The reality is that the majority of health complaints do not require an urgent appointment based on clinical need. Thus, the system itself can create more stress than necessary.

To address this demand-capacity balance in 2019 the Government pledged to increase “GP appointments” by 50 million a year, and that they would recruit 26,000 additional staff for this purpose. It’s important to note that by ‘GP appointments’ they mean the entire General Practice team, which incorporates a host of different healthcare professionals – not just GPs.

Multidisciplinary staff working is likely to continue. This means that there are new direct routes to see a wide range of health professionals with different skills who will be able to help with a variety of health needs. We must use their expertise wisely to enable more efficient and effective patient care, and this means that you may not always see a GP despite thinking you need to.

Furthermore, the government has asked that general practice surgeries become more digital, and this is part of their Road to Recovery Plan for General Practice.

Impact at Twyford Surgery and Planned Changes

We have reviewed all the available ways of managing this digital transformation and spent a long time analysing our own data, the available systems and how to use them and why.

We have decided to implement a new digital triage system. This will help in some way to reduce the burden at 8am, and ensure you see the right person at the right time.

For this we will use a healthcare software system called Anima. There are many surgeries in the area and beyond who are now utilising the same software.

The forms will ask for a short amount of clinical information such as:

• What the nature of the symptoms/problem is
• How long they have been present for
• What concerns or ideas you might have about it
• Type of appointment you would prefer

This will provide the duty clinician with essential information to process the request and triage it to an appropriate clinician or administrative staff.

This will mean we can avoid duplication of work, avoid unnecessary appointment use, and enhance your clinical experience. If you are unable to fill the form in due to online access issues, we will do that for you when you call reception.

Reception will be working with the duty clinician to arrange the appointments and advising patients of the outcomes of request submissions.

Routine follow up appointments or annual health checks for example with Nursing staff or for smears, diabetes and asthma checks or immunisations etc, will be more available to book yourselves directly online or through the Anima website.

We understand that implementing changes may have some hiccups initially, but we believe this new system is a positive step for improving patient care. We appreciate your patience and hope you see the long-term benefits of these enhancements.

FAQs

What action do patients need to take now?

Please go to: Anima (animahealth.com)

Look at the information around the ANIMA system. It is vital that we have as many patients registered with an account as possible to avoid issues from the 1^st of February. Then from the 1^st February you can simply start using the system when needing to access our service.

How will the system work?

For a new healthcare issue or follow up of a new problem we would like you to submit an ANIMA medical request.

To begin with we will aim to address all requests on the same day submitted, so only submit if you’re available for a call or in-person appointment that day. The duty clinician will review your request and suggest a phone or face-to-face meeting or recommend other actions like a blood test. The Anima system and reception will promptly inform you of the outcome and any necessary visit details, all on the same day as your request. Please avoid submitting if you cannot be reached.

If you require a medical note or have another administrative query you will be able to fill in an Anima admin query.

For follow-up care after a consultation, clinicians will either book this in directly with you, or ask that you fill in a new Anima request once you have followed the recommended advice/had the advised test/after the set amount of time. Again, this should be on a day that you are able to have a consultation by phone or face to face.

For routine reviews of long-term conditions or prescription reviews you will either be invited to book an appointment directly through available clinic times on the Anima system, or you will fill in a medical request to state your screening/review is due. You will receive a link to book this directly. You will also be able to call to book these in as usual.

Why are we making this change?

We think the current system doesn’t work. It doesn’t work for you as patients, and it doesn’t work for us as reception staff or clinicians.

At 8am we get a huge influx of calls, and although the new telephony system helps you to queue, 3-6 reception staff cannot answer over 50 calls all at once; this still results in waits on the phone and being told all appointments have been filled for on the day issues once your call is answered. We know how frustrating this is.

It is in line with NHS England digital directive and makes sense in a world where you can book hair appointments or restaurant tables online that we aim to move towards a similar digital approach for your convenience. An ideal world would be where everyone with an urgent need is seen on the day and all other routine needs are met within a two-week time frame. Unfortunately, due to insufficient funding and a shortage of staff in our current system, achieving this ideal scenario is not possible. However, by making these changes, we aim to prioritize appointments based on clinical needs, ensuring that urgent requirements receive prompt attention.

Currently there is also a lot of duplication of work, unnecessary appointment use due to misunderstanding of healthcare worker roles, or wastage. This system will allow us to manage this better resulting in greater efficiency and appointment availability.

For example: we currently have on the day appointments with GPs used for things such as chasing hospital clinic appointments; issues for which an appointment has already been prebooked but this appointment remains uncancelled; patients having been advised to ‘speak to their GP’ by a hospital team when this should go to admin staff; simple requests for routine medication prescriptions or annual blood tests; other requests for administrative letters, or health problems which could have been dealt directly with by an allied health professional.

What if someone is not able to complete an online form due to personal accessibility limitations?

We have assessed our population, and we know that this will apply to a small number of patients. They will be able to phone reception and reception staff will take the information over the phone.

What information will be requested on the form?

Some basic information on what your complaint is, the basic symptoms, for how long and whether you have any specific concerns about it, such as worries about underlying cause or specific need for treatment.

The Anima system is similar in some ways to the 111, in that it follows an algorithm.
It guides you through initial checklist questions, flagging any RED FLAG symptoms and prompting you to seek emergency services. In such cases, you will be redirected from the request, and if you disagree, you will need to restart the process. After the checklist, you can provide additional information in free text format.

What outcomes to requests will there be?

This might be information about self-care, directing you to another care supplier such as the pharmacy or social services. It might also include an appointment being booked with a clinician (GP, nurse or allied health professional), or requests sent directly to administrative and secretarial staff to process.

Will all requests lead to an appointment with a GP?

No. As above, you may be given an appointment with another healthcare professional within the Twyford Surgery team, or you may be advised to speak to a community provider such as the pharmacy or health visitor. You may be sent some written advice, or you might be asked to have a certain test e.g. blood test, first.

Will it be possible to request a certain clinician?

Continuity of care is an important aspect of primary care and where possible we will endeavour to meet requests for certain clinicians or maintain consistency with follow up with the same clinician. However there may be cases where clinical need requires flexibility in this regard.

Will it be possible to state how urgent the need is?

Absolutely. People generally have a good sense about how urgent their needs are, so alongside the other clinical details you give this will be important information. There may still be times when the clinician feels differently. It maybe you underestimate your need, and we want to see you sooner, conversely we may judge the need is less urgent than you thought.

The Anima system is also very clever. As well as the clinician reviewing information and deciding on what is needed, the system will flag up and highlight requests submitted that look like they need quicker attention, so that the clinician will see these quickly and review them sooner.

How will I be notified of an appointment?

The system we are introducing is called ANIMA. It has a lot of functionality and will notify you of an appointment outcome via email. For face-to-face appointments you will receive a call or text message confirmation from reception staff. We have decided not to contact you on top of the Anima notification just to let you know you will get a call, hopefully for obvious reasons.

We stress again that initially, after introduction of this system, appointments will be offered on the SAME DAY as the request is placed. So be ready for an appointment that day. If you are unable to receive the call or come in, you will be asked to resubmit a request another day.

If the outcome to your request is advice or information only, then you will receive this by email or text message.

How will I book a routine review that is due?

Asthma, COPD, diabetes, heart failure, contraception etc reviews will be prebookable in advance. When these are due you will be sent a link to look at available appointments to book directly. If you receive a screening letter for a smear (which we are not notified of necessarily) you will be able to complete the online form through Anima advising that this is due and you will similarly then be sent a link to look through available appointments to book directly.

Demand over capacity – what will happen?

Of course, this system will not create us any more appointments. We hope that directing people to the most appropriate person will free up a little more appointment time due to increased efficiency, but undoubtedly there will still be times when we simply cannot meet demand on certain days. In this case those patients who are felt to need medical assessment will be directed to 111. This is in line with national guidance.

It is crucial clinicians practise safely and there is strong evidence that providing care well above available resources compromises patient safety. To receive the best care, you do not want to be the 50^th person that GP has dealt with on that day!

How is this system fairer?

Currently the appointment system is essentially first come, first serve. It relies entirely on you telling us how urgent the need is, and (understandably) how many times you have already tried to make an appointment. Some patients may choose to wait or schedule appointments weeks in advance, potentially not aligning with their clinical needs. There are also those who struggle to call at 8am for various reasons and this creates further problems when all our on the day appointments are filled commonly in less than an hour.

This system will allow everyone an opportunity to provide the same clinical information for a GP to review and make appointments based on clinical need.

It will free up telephone time for those who struggle to get online, so that they can phone and the same information gathered by a receptionist to be processed in the same way.

By prioritizing clinical need, we believe this system establishes a fairer approach to serving all patients.

Will Twyford Surgery be reviewing how the system works?

Yes, as with any system change there are likely to be issues that arise, some we may have predicted, and others that catch us off guard. We hope that you will understand this may be the case and that the system will evolve over time.

To help the system improve we value your input and encourage constructive feedback from patients. We have also been open with all members of the Twyford Surgery team that we need feedback on how it works for them too.

Please provide constructive feedback, comment or suggestions through info.twyford@nhs.net