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How I used IT to streamline my practice

Innovative use of technology in a practice can save time and money. Dr Shane Gordon explains how he introduced computer systems to manage clinical queries and appointments

Innovative use of technology in a practice can save time and money. Dr Shane Gordon explains how he introduced computer systems to manage clinical queries and appointments

Seven years ago I developed a website for the practice I was about to join. Patients took to it with great enthusiasm, not least our older patients – the so-called ‘silver surfers'.

Early on we instituted electronic request of repeat prescriptions – an innovative move at the time. A third of such requests are now made via the website.

We also provided health information on the site along with all the usual practice leaflet information, and patients could email with administrative queries and feedback about the practice.

Despite its success, the site began to feel a little creaky, prompting the decision to revive it and extend the range of services we were offering through it.

Emailing of medical queries

One of the main features of the new site, which is due to go live shortly, is the facility for patients to start a clinical conversation. They may email describing their symptoms and asking whether they need to see a GP straight away, or ask for advice on treating certain symptoms. The duty doctor will have time allocated to review that day's emails and will aim to respond within one working day, depending on the question.

Confidentiality is a big concern: the one-way flow of information from the patient to us can be encrypted and secured. However, we cannot send any confidential information back the other way as we cannot be sure the email reply will go to, or only be seen by, the right person. So we will contact them using the data stored on our clinical system, which we know is correct, rather than responding to the address the email is sent from.

41228952The reply might be sent by email if the response is very simple, such as advice to visit the pharmacy or to come in and see a nurse. We will ensure the response doesn't contain any personal information. If the GP needs to see the patient they would get one of the administrative staff to arrange either a face-to-face or telephone consultation.

We have a protocol and staff are trained accordingly but the confidentiality rules are the same as in everything else we do.

Online administration

The new system will also offer:

• Online registration forms, which patients can print off, complete and then bring into the surgery, saving one trip. Eventually we hope to have complete online registration.

• Change of address or phone number, which can be submitted electronically.

• Ability to cancel or rearrange existing appointments through the site.

• Downloading of forms such as those for self-certification for sickness and pre-payment for prescriptions

• Links to patient information sites such as and NHS Direct.

• Booking of appointments – initially we are just opening this facility for chronic disease clinics as they are a well-defined group of patients who know they have to come at set intervals. We hope to open up online booking of acute appointments in the future but we are wary of the risk of disadvantaging people who aren't able to use the internet.

The cost of the new site was about £6,000 for the initial bill and we predict it will cost £2-3,000 per year to run. This money will be saved in administrative costs – we won't be cutting staff but we will be freeing them up to do more productive work. It also creates a more pleasant atmosphere for people to work in and removes stress.

Monitoring appointment capacity

Possibly the most time-saving technology in the practice is a semi-automated spreadsheet that I developed to anticipate any discrepancy between capacity and demand. It allows us to build a rota of clinical staff on a weekly basis and calculates how many appointments we have available so we can see several weeks in advance what the capacity of a surgery is going to be.

Once the rota has been inputted the spreadsheet shows names of clinical staff down the side and sessions along the top.

In each slot there is a drop-down menu customised for that particular staff member. For example, mine shows a normal surgery session, an on-call surgery session, a minor surgery session, a day when there are no appointments because I'm working on practice-based commissioning, and so on. If the practice manager chooses an on-call surgery the spreadsheet automatically fills in the number of GP appointments available in that session.

It does this for all of the clinical staff, then adds them up by session, day and week so we can see the distribution of appointments for the days of the week and the week in total. We know from monitoring what demand is likely to be during the week so we can see where there is mismatch between capacity and demand and either alter the rota or employ a locum.

The spreadsheet allows us to do this well in advance. It has been extremely useful in terms of smoothing our demand; we very rarely now have the situation where we don't have enough appointments.

It also counts up the GPs' on-call sessions, which saves potential arguments!

Dr Shane Gordon is a GP in Colchester, Essex, associate medical director of NHS East of England, chief executive of Colchester PBC group and PBC Federation national co-lead

How we developed the new practice website

Central to any innovation in our practice is customer satisfaction – we only undertake steps that add value for the patients.

We mapped both the administrative and clinical processes patients go through when they contact us – do they pick up the phone or physically come into the practice? The idea was to reduce the amount of face-to-face contact that patients have to make with the practice; most of the problems we have with access are bound up with patients having to physically come into the building or to telephone us.

If we remove those administrative contacts – such as when people have to come in to pick up a form, enquire about a referral or chase up a test result – then we can maximise staff availability to deal with things that genuinely need a face to face contact.

In the planning process we mapped out the information flow like a test result. We took representatives of staff from each team (reception, administrative, secretarial, nursing and medical staff) who all contributed.

Previously, if a patient wanted to ask about a test result they might book an appointment just to find out what had happened to it. With the website people can send an email and we can either email back saying it's not ready yet and that we'll be in touch or contact them to tell them the result.

The same staff deal with the queries but leaving out face-to-face contact saves a lot of time. Ongoing training will ensure the systems run smoothly.

The new site was due to launch as this article went to press: go to

Other tech Dr Shane Gordon

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