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At the heart of general practice since 1960

How our email triage system has saved 35 appointments a week

Dr Bart Tyszka explains how offering patients access by email has improved patient access and made life easier for GPs in his practice

What we did

We are a growing practice in Orpington, Kent, of 8,500 patients, three GP partners and two salaried doctors. About two years ago we decided to set up systems to enable patients to contact us by email because we didn’t have the capacity to deal with the numbers of patients contacting us by phone.

They can email us in two ways. First we have an urgent triage email, which is checked by the doctor dealing with urgent on-the-day appointments between 8 and 10am. The doctor calls the patient back that morning for a phone consultation, inviting them in if they need a more complex consultation.

This is the same service that patients get if they phone first thing for an urgent appointment, and it eliminates the need for them to battle to get through on the switchboard. For example, a mum who has been up all night dealing with a vomiting child can send an email that night that will get picked up first thing.

Our patients can also send emails asking for advice to a general email address, which we respond to within 48 hours (during the working week). A member of admin staff accesses the account once a day and in most cases forwards the emails to the duty doctor. These can include issues such as prescription queries, requests for test results or referrals, photos of skin rashes and patients wanting antibiotics for a UTI. This service is particularly useful as we have a lot of commuters among our patients and can send electronic prescriptions to a pharmacy near their work, which saves time for GPs and patients alike. Older patients are quite happy with the email system - over-70s email about test results and other issues.

Challenges

One of the main concerns was that we would be overwhelmed. But as yet, patients have not abused the system and the workload is manageable. We also don’t have trouble with patients emailing the urgent triage inbox with a non-urgent problem, but if this happens we email back explaining their mistake. We also send an out-of-office reply to emails sent to the triage account at times when the account isn’t checked, reminding patients to ring if their problem is urgent. If an urgent email ends up in the non-urgent inbox, admin staff flag it for a GP.

We’ve addressed the medicolegal repercussions partly by gaining patient consent to email them before we respond to anything they send to us to check their identity. From then on it is the patient’s responsibility to ensure their email is secure. We warn them that while NHS servers are generally secure, their private email addresses are not and they may want to be careful about information they share. Recently, a member of admin staff accidentally revealed 4,000 patient email addresses while sending out a patient newsletter. While no clinical information was shared, we now have the protocol of making sure two people check an email if it’s being sent to a large mailing list.

Results

We estimate we’ve saved between five and seven GP appointments a day as a result of using both email systems, although due to population growth it’s difficult to calculate precisely.

Up to 10 triage emails come to us a day requesting a phone call from the doctor. We deal with about 40% over the phone. In terms of general emails from patients, there are about 30 prescription requests and up to 20 general queries each day. Fewer than 10% of general queries result in a face-to-face appointment. We get positive feedback on a daily basis from patients.

Because of the way this has improved our access, we are a rapidly growing practice, taking on 1,000 patients in the past year. Although it seems a daunting task to grapple with at first, I would definitely recommend other practices give an email system for patients a try.

Dr Bartolomiej Tsyzka is a GP in Orpington, Kent

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Readers' comments (15)

  • As more practices practice unsafely it will have cost impact, which is currently subsidized by the whole profession. The actuaries will eventually catch up with you

    This seems ill though out and a desperate response to a real issue. Surely discussing with other practices about minimum safe numbers of consults - taking a airline safety approach may force NHSE's hand.

    NHSE are happy for you guys to take on bigger risks, and then close you down when they find a chance - why take that risk.

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  • just wait for an email to be missed/wrongly read/accidentally deleted/IT problems to risk.
    more risk being taken due to real issues regarding recruitment and financial pressures.

    once pt gets used to the system it will also get overwhelmed like my tel list which now I had to place a limit.

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  • Saves 6 appointments a day - that's an hour. How long does it take to read and reply to emails and call some of the patients. The easier you make access, the more demand - this has been proven for Dr. 1st.

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  • 10:50 -- Why is this unsafe practice? Because of the mode of taking requests (e-mail) or the fact that the clinician is managing those requests over telephone?

    If the former, surely a responsive system like this is going to identify high risk requests more rapidly than an engaged telephone line or a receptionist booking into a rigid appointment system? There would have to be a contingency plan/safety net in place in the event of a power cut/loss of Internet connectivity. I would suggest an auto-reply message to the e-mail to confirm receipt and suggest the patient contact the surgery by a certain time if they have not received a call regarding their urgent query.

    If the latter, I disagree - telephone consultations are not appropriate in all situations, but a skilled clinician with adequate resources to see patients face-to-face if clinically indicated or strongly desired by the patient should be able to manage the associated risks. At the very least, they are better placed to manage these risks than a non-clinical staff member booking patients into a rigid appointment system with, say, a 2-3 waiting time.

    The teething problems aside, it sounds like this has been reasonably well thought out to me.

    12:34 -- I don't share that experience of a doctor-first system. Our demand has stabilised, A&E/OOH attendances have dropped, and continuity/satisfaction has improved since we've been using our own variant of this model. And it's an established system -- we've been using doctor-led triage for nearly five years. Each to their own, but it works well for plenty of surgeries.

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  • We need to move with the times and embrace social media and technology. Patients wish to correspond by email we should help them.
    In our practice we use emails a lot. It is much better than a phone call and also there is a written auditable trail.
    Well done for sharing your innovative idea

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  • Harry Longman

    What's interesting here is the willingness of both parties to try the new channel, and see benefits even from an insecure and unstructured system.
    The real potential is for asynchronous, remote communication to be the normal channel, as we will then make large and sustainable time savings. But that needs proper structure, governance, clinical content and great service. With that, we've seen 45% of demand move online at one practice.

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  • What is the total appointment offering of the practice per week? Given the list size, I'd guess probably 4 GPs a day - maybe 30ish appointments each. So we're looking at saving under 5%.

    This looks like a very marginal ROI for the time spent on it, and increased wastage on reworking the same patients.

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  • "We need to move with the times and embrace social media and technology"

    We wonder why general practice struggles!

    Again medicine should be bounded by science and evidence not twit or twitter trends!

    For drug trials there is substantial data that has been established for how to safely monitor and this has been costed into a drug trial.

    The true costs of 'innovative' schemes will only start having an impact over the next few years. What is interesting is that many practices that moved to phone call/gp triage have now limited the number of calls as the demand has caught up with the capacity that is provided.

    I work in an innovative industry, but to not recognize the risks and associated costs is naive. because the risks will be there.

    As soon as you open up to email, you risk having no control over demand at all. We do use email to monitor pts on drug trials but then we fund 100's of research fellows across the country who are effectively on call 24/7 to allow us to do this safely and legally

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  • 9.16am - "As soon as you open up to email, you risk having no control over demand at all."

    E-mail or not, I don't think GPs have a great deal of control over demand anyway!

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  • I commend this practice for trying a new way to manage demand. There is no perfect appointment system, and whatever system is used there will be risks to be managed. It sounds like this system is working well for the drs in this particular practice. What's important is they feel more in control, and therefore less stressed. And so long as patients are consulted and involved, they can be powerful advocates and allies. We can't keep on doing more of the same!

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