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Channel Shift in General Practice. Dr Arvind Madan CEO Hurley Group. General Practice – Case for Change 1 million appointments a day Increasing complexity Reducing finances Archaic delivery model Demoralised workforce Weak technological and estate infrastructure

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Channel Shift in General Practice

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Channel Shift in General Practice

Dr Arvind Madan

CEO Hurley Group

  • General Practice – Case for Change

  • 1 million appointments a day

  • Increasing complexity

  • Reducing finances

  • Archaic delivery model

  • Demoralised workforce

  • Weak technological and estate infrastructure

  • Substantial regulatory burden

  • Outdated commissioning models

  • Limited links with social care

  • => Industrial revolution required

Start with a frontline problem!

Turn new work from inefficient, medicolegally risky patient e-mails into an online service that improves patient access, health outcomes and practice efficiency.

  • The Resource

  • 18 months

  • Funding from CCG, NHS London, Hurley Group

  • 5 GPs in core group and reference group of 30 GPs

  • Software programmers

  • User Experience expert

  • Project support team

  • Design Council

  • 133,000 patients in 20 practices (5 non-Hurley)

  • 6 months

  • Breaking the Triangle?

  • How do youimprove access and quality whilst reducing cost?

  • Offer patients who plan to attend to:

  • transact online (appointment book)

  • stratify themselves (symptom check)

  • manage themselves (self-help)

  • use other services (sign post)

  • take phone advice (nurse callback)

  • e-consult (structured history analysis)

  • (All with medicolegal approval)

A link from

any GP’s

practice website

Nurse call backs and self help information highlighted

Practice specific pictures to boost patient confidence

Commonest conditions visible on home page

Potential for over 100 more condition templates to be built e.g. blood tests and screening tools

Explanatory video of how e-consults work

Options for patients who don’t know their condition

Use search box, from common conditions, A-Z or by body part

Options for what to do if your condition isn’t listed

On selecting condition, patient chooses between self-help, sign posting, nurse advice now or e-consulting their own GP with a response before the end of the next day

After completing some personal details which the practice uses to confirm the patient is registered with them, the patient completes a comprehensive set of questions about their condition and what help they are looking for

Red-Flag questions stop the process and redirect the patient to urgent care if they identify a dangerous symptom e.g. severe shortness of breath

Patients can email themselves a copy of their answers or a leaflet on their condition before submitting to the practice

Patient advised on what will happen next and what to do if they get worse while waiting

Patient submits completed questionnaire from website which arrives in practice generic email box as a GP summary report.

Staff then workflow or print report for GP to review.

GP report or e-consult takes an average of 2.9 minutes for GPs to analyse

GP Options on Reviewing the Report

Results of Pilot

Cystitis (female)

Depression Contraception

Knee pain



Sore throat

Rectal bleeding

Shoulder pain



What about supply-led demand - We asked patients:

What would you have done if the service hadn’t existed?

What about reducing Practice Workload?

  • Significant reductions in GP face-to-face appointment hours in 6 months (@£220K pa)

  • 50% to practice and

  • 50% to Commissioners

Equality Impact Analysis


Age 18-24


Age 25-44


Age 45-64


Over 65





57% women

43% men

25% Black and Ethnic Minorities

28% English Not First Language



75% Employed

11% Unemployed



How do Practices Feel about the System?

  • Conclusion

    • Better Access

      • Better patient experience

      • Reaches the working population

      • Enhanced patient’s earning potential

  • Better Health Outcomes

    • Earlier presentation and intervention

    • Permitsembarrassing presentations

  • Better Practice Efficiency

    • Keeps minor issues out of surgery

    • Siphons off self-help and sign-posting

    • Time-efficient e-consults replace email

    • Robust Clinical Governance

    • Medicolegally safe and approved

    • ROI for purchaser

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