A Step Backwards to Move Forward – NHS Five Year Plan Conference Article

Published: 17th May 2016

The following article was written as part of our contribution to a conference on the NHS Five Year Forward View being held at the Royal National Hotel in London on May 26th. You can access the original article by clicking HERE and access details of the conference by clicking HERE.

GP Patient2 FINALHere’s a remarkable story. It concerns a 77-year-old lady, Jean, who has low blood pressure. She’s on medication but that hasn’t stopped her from collapsing on a few occasions, resulting in a couple of trips to A&E. During a visit to her local practice, Jean’s GP called a consultant at the local hospital to discuss whether he should refer Jean to hospital to try and sort the problem. The consultant thought Jean’s medication needed changing and recommended that some tests were carried out, a course of action the GP agreed with. Jean didn’t need to go to hospital in the end.

So what’s remarkable about that? Is it the fact that the consultant was able to help Jean over the phone? The fact that Jean didn’t have to go to hospital after the consultant had advised? No, both of these facts, whilst happy and welcome, are not remarkable.

Here’s the remarkable bit: “during a visit to her local practice, Jean’s GP called a consultant at the local hospital…”. Normally, those words would be followed by “…but the consultant wasn’t available and, after 12 minutes waiting on hold, the GP abandoned the call and referred Jean for an outpatient appointment”. The fact is that, as clinicians have been pushed towards more modern methods of communicating, such as email and instant messaging, the old way of simply picking up the phone has become increasingly rare.

This is a shame because GPs using email to get advice isn’t working. According to one CCG, 92% of written requests for advice from hospital consultants end up with the patient going to hospital anyway. So why bother writing in the first place? If in doubt refer your patient anyway – there’s a 92% chance that you chose right!

But an old fashioned conversation is a different matter. If you can get through to a consultant on the telephone, you can share information much more quickly. One study suggests that speaking is at least four times faster than writing but that doesn’t allow for an additional benefit, the fact that a response to a question is immediate. If you allow for a response time of 48 hours to a written enquiry (the standard applied in some CCG areas), a spoken conversation is hundreds of times quicker than written correspondence.

With this speed of communication comes the opportunity to reach a much deeper level of understanding, and that affects what a call can achieve. Whereas only 8% of requests for written advice result in the patient avoiding hospital, telephone Advice & Guidance service Consultant Connect’s results show that 65% of requests for advice by telephone result in the patient avoiding hospital.

Which brings us back to Jean’s story. Stockport CCG, Jean’s area, recognises that telephone Advice & Guidance is better for both patients and clinicians, so has committed to making it available to GPs who aren’t sure whether to refer a patient. They have invested a small amount of money to implement Consultant Connect, which works by connecting with teams of consultants via mobile phones – calling each in turn until it finds one available to take the call. This means that consultants answer the phone reliably, normally after a wait of under a minute. GPs can speak to consultants during the normal patient consultation and, in many cases, keep the patient’s care with themselves.

Yes, this is a backward step in time, a return to an old way of doing things – but it’s a return to a better way of doing things. And ultimately, it’s the patients that benefit. As Jeans’ husband says, “Since Dr Woodworth changed her blood pressure pills, Jean has been able to get out and about again. If we’d had to wait weeks for a hospital appointment, I think it might well have meant the blue lights again and Jean back in hospital”.

If you would like to learn more about how a telephone Advice and Guidance service (Planned or Urgent Care) can be implemented in your area, please contact us either by calling 01865 261451 or emailing info@www.consultantconnect.org.uk.


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