A report commissioned by the Department of Health says GPs’ administrative support teams should be radically altered to cut costs. The plan would involve centralising appointment bookings through a national call centre, clearing surgeries of thousands of staff.

However, doctors and surgery staff say the proposal is “flawed”. Unison, the public sector trade union, said that remote call centres could not provide the “very personal service” that patients needed.

The report by the NHS Confederation’s Foundation Trust Network looks at ways back office functions could be streamlined. It says the message to all NHS bodies is that they must “simplify, standardise and share” to save money.

The NHS is “highly fragmented”, with a total of £2.8 billion spent on back office functions. The trust, headed by Tony Spotswood, chief executive of Royal Bournemouth and Christchurch Hospitals, recommends: “There are substantial efficiency gains to be achieved through transforming GP back office functions, such as the potential to move towards regional and national GP appointment centres.”

A Unison spokesman said surgery staff not only made appointments. He said: “A call centre cannot begin to do the job these staff do.” Doctors and their support staff were more forthright. Dr David Iles from Southampton commented “Even your average alien would consider this hilarious stupidity.”

Stephan Olsberg MD of Voice Connect comments “There are far better ways to improve the efficiency of patients booking appointments with their GP. Systems such as our own Patient Partner allow around the clock access, giving the patient the ability to book, cancel or move their appointment without the need to speak to a receptionist or a call centre”

White Medical Group is located just outside the border of Newcastle upon Tyne and consists of three sites: the main surgery is located in the village of Ponteland, with branch sites at Wylam and Stamfordham. The practice employs 6 doctors, 2 nurses and 19 admin staff for a patient list of just under 7,000 residents in total. With the three surgeries covering a large geographical area which includes both urban and rural communities, the patient demographic is varied.

The demands made on a modern GP practice are steadily increasing, and whilst the number of reception staff at White Medical Group had remained constant for some years, their workload was continually rising. The partners and practice manager decided that installing an automated phone appointment booking system could be one way of reducing this pressure, and so went live with their Patient Partner system in October 2009.

Although Patient Partner is installed at over 600 surgeries nationwide (with that number steadily rising), there were no surgeries in the area using Patient Partner at that time. This meant that the practice manager James Young was unable to see the system working in situ prior to installation.

“Although Voice Connect’s demonstration was very good, we weren’t certain that the reality would live up to it,” James explains. “We couldn’t go and see the system in action in a real surgery which made it hard to uncover any flaws, so it felt like a bit of a leap in the dark to have the system installed, particularly in relation to the integration with our clinical and phone systems.”

However, these concerns proved to be unfounded, and whilst it took a little adjustment to integrate the system with EMIS during installation, once installed everything has run efficiently. “Voice Connect ironed out the inevitable teething issues very quickly,” comments James. “Since going live we haven’t had any problems at all.  Everything has worked reliably – in fact, I have been very impressed with Voice Connect’s level of support.”

James also reports that the system has been well received by the majority of patients at the surgery and that uptake has steadily increased as patients become more familiar with Patient Partner. “Generally elderly patients can take a while to get used to the technology, but this has become easier with time,” he explains. “There was some initial concern that we would force people to use the service, but this was never going to be the case. The system is great and we find that once a patient has used it they never go back to the old system of ringing a receptionist. Some patients will always prefer speaking to a real person, so we have the best of both worlds by having both options. We plan to extend our marketing efforts with help from Voice Connect in order to continue increasing patient usage still further.”

Patient Partner’s best three features are:

1. The integration between the phone system and the clinical system.
2. The stability of the IT platform.
3. The ability to book appointments at any time which has also reduced receptionist workload.

James reports that Patient Partner has had a positive impact on call handling and general communication at all the surgeries, reducing call congestion, particularly at peak call times. The system has freed up time for receptionists, whilst making it easier for patients to contact the surgery. “The system has enabled us to monitor how we handle calls and make further improvements by providing useful statistics which allow phone usage to be closely monitored,” he adds.

“Our experience of Patient Partner has generally been very positive and if a surgery similar to ours was considering installing the system, I‘d advise them to go for it as it’s definitely worthwhile if you want to take some of the existing workload pressure off reception staff. Prior to installation, it’s worth thinking about how you market the service and how you maximise patient usage. Whilst Patient Partner isn’t cheap, it does provide good value for money. In fact, overall it’s an excellent system that does exactly what it says on the tin.”

Dr Trevor Fernandes, chairman of GPs organisation Dacorum has expressed concern about massive changes to the NHS that will see budgets handed to GPs. His concerns are around the added workload and he questions the desire of GPs to take on managerial roles and their ability to operate within budgets.

He has spoken out as the government announces a new wave of ‘pathfinder’ GP groupings, which will act as precursors to the consortia that will eventually take control of 80 per cent of health budgets.

Among the new groupings is Herts Valleys Commissioning Consortium, which covers west Herts and includes the ‘vast majority’ of GP surgeries in Dacorum.

Dr Fernandes, who led the borough’s surgeries into the consortium, said: “Theoretically it’s very good. There are a number of issues which make it a bit worrying.

“My view of the groundswell of GPs is most of them have trained in order to consult with patients, and that’s what they feel most comfortable doing.”

He said the system of commissioning care for patients would not fundamentally change under the shake-up, so a body of administrators and managers would still be required. “Until that system changes I don’t see how you can get rid of 55 per cent of managers,” Dr Fernandes said.

“In view of our local overspends this doesn’t seem to be an attractive thing to take on. It feels like the government is pressing it on us with a budget that is unlikely to work so they can point at us and say: ‘It’s your fault’.

“I’m not saying it’s impossible. I would say the reason we have signed up is because we wish for financial and educational support to find our way forward and come up with the best structure locally.”

Scientists from MIT, Cornell University and University College London have created a map based on a huge database of 12 billion anonymous fixed line call records. The map shows how much people of the UK interact with each other.

The most striking aspect of the findings is that Scotland is very separate from the rest of UK, with less than a quarter of calls going outside its national boundary.

“The difference between Scotland and Wales is striking. Based on our landline data, Scotland is very separated from the rest of Great Britain: just 23.3 per cent of all call time placed or received there goes to or comes from another part of the country,” said Carlo Ratti, director of the MIT SENSEable City Lab and one of the paper’s authors.

“Conversely, Wales, in spite of its unique cultural and linguistic heritage, is well integrated with its English neighbours to the East,” he added.

Stephan Olsberg, MD of Voice Connect comments “This study shows an interesting snapshot of how the country communicates with itself.”  Voice Connect have worked with GPs to improve their patient communication across the country and have systems in universities, schools, hospitals, colleges and companies in every county of Britain.

71% of practice managers think that budgets will be tighter in the coming 12 months – yet 40% say they are likely to invest in technologies that will save the practice time, labour and money.

With the current wave of changes in all areas of the NHS, what can practice managers do to improve service whilst reducing costs? Many would see the new age of austerity as a reason for cutting back spending on technology. Few would mourn the wasted millions that have been spent on expensive, ineffective IT products within the public sector.  However, there are many other products which are starting to come into their own as they demonstrate real cost savings and patient enhancement for GP surgeries across Britain.

Whilst some new technology has promised almost unlimited benefits and delivered tiny rewards, there are certain technologies which have been quietly saving money, improving service and generally making life easier for practices and their patients. Probably the best example of this is Patient Partner, which has been tackling several very real problems for GPs. Patient Partner, and other related products from Leicestershire based company Voice Connect, have been making a real impression on surgeries, with over 500 customers across the UK. In Voice Connect’s recent survey, 100% of customers reported that Patient Partner has given patients a greater choice, and as a result patient attitude to attendance has improved.

Patient Partner works by integrating with a surgery’s clinical database. It interfaces with the telephone system and appointments manager system, enabling patients to book, check, change or cancel appointments themselves using their telephone keypad at any time of the day or night – whether or not a receptionist is there to answer the call. For example, a patient could call up at four o’clock in the morning to book an appointment for later that day when the doctor or nurse has been made available for appointments. By entering their phone number and date of birth, the system identifies the patient and is able to offer appointments that the practice has made available to the system. The patient is not only able to make an appointment at the time that suits them best, they also avoid the irritation of the engaged tone or holding for extended periods of time whilst a busy and stressed receptionist attempts to process the request.

Commuters in particular report the frustration of being unable to find out the availability of appointments before they have to set off for work. Patient Partner empowers the patient to book an appointment the night before. In this scenario, the system not only helps the patient to avoid these frustrations but also has the effect of reducing calls to the practice in the morning, and potentially taking pressure off the extended hours appointments.

An added benefit for GPs is that using Patient Partner can result in a drop in DNA rates because patients are able to cancel appointments that they no longer require. Not only does this reduce wasted appointments, it also frees up additional spaces that other patients can book with their GP, thus easing waiting times at the surgery.

Surgeries that have installed Patient Partner report up to 80% of available appointments are booked through the system. Each time a patient does this, the receptionist’s time can be spent either dealing with other patients who need more assistance or carrying out other duties within the practice. As a result, patients obtain a better service and frequently report higher levels of satisfaction with their GP.

Voice Connect’s recent survey also reveals that 93% of customers, who have had the system for 12 months, have experienced a reduction in calls to reception. It is always difficult to see how short the payback time for a system such as this is, but most practices report that within a few months of patients getting used to the system they couldn’t do without it.

Another example of how Voice Connect can help GPs both save money and improve efficiency is through the use of the new service they offer known as VC Smart Mail, which allows surgeries to send out letters without having to physically print, stamp and post them themselves. A surgery can send out letters to selected groups of patients or send a single letter via their PC, and choose when the letters need to be sent out. The letters are printed, enveloped and posted off-site. This not only frees up the administration staff of the surgery to do other tasks, it works out as a saving of up to 40% per letter for the surgery. With surgeries sending out up to tens of thousands of letters over the course of a year, this saving can add up to significant sums in addition to releasing administrative staff time to do other possibly more important tasks.

Whilst of course it is great to save money, patient care has to remain a surgery’s primary concern. Fortunately, both solutions mean that the patient is experiencing a superior service, and in the case of Patient Partner, is offered more choice. So, the combination of both saving money and improving patient service is possible when the right type of technology is used.

See details of the report from the BBC here

Improved patient communication is thought to be one of the reasons for the improvement.

Dapdune House Surgery www.dapdune.co.uk is located in central Guildford near to the University of Surrey campus. The surrounding area is urban with an increasingly mixed demographic and comes under the control of Surrey PCT. With a current patient base of over 11,500, the practice is large and busy. At present, there are 7 GPs and 3 GP registrars, plus an additional team of 15 support/ admin staff and 15 ancillary staff which include health visitors, practice and district nurses and community midwives.

Like many GP practices across the UK, Dapdune House Surgery experiences a surge of telephone calls at certain times of the day, with the peak time on Monday morning. With so many patients phoning to make appointments at specific times, Practice Manager Duncan Mann and the practice partners felt that one way of relieving call congestion would be to introduce an automated appointment booking facility. Having looked at the Patient Partner system, the first on the market to offer this service, the Dapdune management team decided that the system was what they needed and went ahead with installation in February 2007

“We decided to implement the Patient Partner system because we wanted to improve access for our patients and make it easier for them to get in touch with us,” comments Duncan Mann. “However, our primary motivation was to relieve the burden on our busy reception staff, especially at peak call times. We didn’t enter into it lightly: to ensure that the system was right for us, we visited a neighbouring practice to check out how it stacked up in real life so we could see it working in situ.”

Since installing the system, the surgery reports that it has helped with many of their communication issues. “Patient Partner is working well for us, although we probably haven’t been as proactive in promoting the service as we should. We do encourage patients who visit our website to use the service, particularly at busy times such as first thing on Monday morning. There’s no question that it has helped us to reduce call congestion at peak times and has eased the burden on our receptionists whilst our patients now find it easier to contact the surgery. We would like to see a greater take up of the service out of hours, but to achieve this we really need to take the initiative and advertise the facility more extensively as it is such a useful option for both the practice and our patients.”

Given how Patient Partner has eased communication between the practice and its patients, Duncan is surprised that the patient reaction hasn’t been more openly enthusiastic. “We haven’t had a great deal of patient reaction – it has been strangely muted,” he explains. “This may be a positive sign as I presume people would make their feelings known if they didn’t like the system. Patients have become used to what technology can do and tend to expect facilities such as online booking so that may also be a factor.  I do receive occasional comments that it could be more patient friendly, but in my experience it is hard to see how, given the sophistication of the software needed to run the system.”

Patient Partner’s top three features

1. It is a stable and reliable system.
2. The level of support from Voice Connect.
3. The ease with which the system can be configured.

Duncan is also pleased with the support from Voice Connect. “On the whole, we have been well supported by the Voice Connect team throughout,” he says. “The system has been efficient and relatively trouble free. The reports that accompany the system are useful and provide us with valuable feedback to help us make the most of it – although it would be good to have proactive generation of reports delivered via e-mail.”

Finally, Duncan has this advice for other practices who may be considering implementing Patient Partner. “To find out if the system is really for you, talk to other existing users to ensure that you understand the benefits and limitations of the system. You also need to spend some time thinking through how you will introduce it to patients to ensure that you make the most of its capabilities. For us, Patient Partner has relieved the pressure on our phone lines and has improved communication – in fact it does exactly what it says on the tin.”

See here for more details.

Patient Partner from Voice Connect is used to help improve communications to patients – including offering advice to patients whilst on hold to book an appointment.  The on hold information can be targeted at specific groups – including those at risk from heart attack & stroke.

For details click here.

Patient Partner gives GPs the ability to give information to patients whilst they are on hold to book an appointment.  This information can be targeted to the patient in question – so for example a smoker can be given details of programmes to quit or a diabetes sufferer can be given diet advice or told about clinics being run at the practice.

It’s one of the many ways that Patient Partner can help improve patient communication for GPs.

Blackwater Medical Centre is located in the town of Maldon in East Essex. The surrounding area is largely rural, including some significant wildlife conservation areas, and also attracts many sailing enthusiasts. The centre itself is one of two surgeries in the town and employs six full time GPs and one part time doctor in addition to a total of 22 staff in a range of clinical and administrative roles. There are over 14,000 residents from the town and surrounding villages on the patient register: the patient demographic is predominantly elderly.

Since this time, Practice Manager Lesley Beale reports that the service has lived up to expectations and is working well at the practice. “We anticipated that Patient Partner would benefit staff by easing pressure on the switchboard, and releasing more time to attend to other essential duties which enhance patient care,” she comments.  “The general reaction from patients has also been very positive. There were some initial issues with dates of birth for twins, triplets and elderly people born before 1909, but these have all been resolved very quickly by Patient Partner. The system has achieved our objective of improved access by making it easier for our patients to get in touch with us and make appointments, and our patients seem very satisfied with the service. It has also improved the speed with which we are able to handle calls as people are now able to bypass reception and make appointments automatically.”

Lesley believes that the service is an important step forward in offering patients improved choice and that, as word of the system continues to spread, that it will play an increased role in further improving call handling efficiency. “We feel that Patient Partner could do more to reduce congestion at peak times, but I think this is purely because the service has not been well advertised by the reception staff as yet – the patients need to know about the system and be encouraged to use it for it to have maximum impact.  Hopefully this is now resolving and the system is becoming better known amongst our patients.”

Lesley is impressed by Patient Partner’s functionality and when asked, can’t think of any way in which the service could be improved although she mentions that the automatic back up function, which backs up their clinical system daily for a short period of time in the middle of the night could be inconvenient for any patient wishing to call at that time.  This is because Patient Partner requires access to their clinical system and cannot obtain it during back up times.  “Obviously our clinical system has to be backed up so there is nothing that can be done about this, but it could be annoying should a patient choose to phone at this particular time.”

This minor, unavoidable technical issue aside, Lesley is very pleased with the system and feels that it does what was promised. “We have found Patient Partner to be an innovative service which gives our patients increased choice.  If used correctly, the system can save patients time and money, particularly at the high call volume times which can be problematic for any surgery.  It also offers our patients the opportunity of getting appointments quickly and easily. It is no longer necessary for patients to have to ring at 8am and so alleviates the congestion and rush in the mornings.”

In fact, Lesley is so impressed with the service, that she would have no hesitation in recommending it to others. “If a surgery like ours was considering switching to Patient Partner I would encourage them to do it as the system does improve patient choice.  In a nutshell, I think it’s great!”