We were delighted that Anthony Fitzgerald, Director of Strategy and Delivery at NHS Doncaster CCG joined us on our recent Telephone Advice & Guidance in Practice Webinar to explain how the service is used in NHS Doncaster CCG. This article covers the key points that Anthony made about his experience of commissioning Consultant Connect and are taken from a written transcript of the live webinar.
Why Consultant Connect?
When NHS Doncaster CCG first introduced the service in August 2017 it was launched with three specialties and is now available across 15 specialties which includes an emergency line as well as elective. Antony explains; “We implemented the service I think for five reasons:
- We were high referrers in Doncaster, 6% more than our peers, 12% more than the England average.
- The e-RS system, and at the time in advice and guidance wasn’t working for us, it was inconsistent, it was sometimes slow, that varied across specialties, but the feedback we were getting from GPs was that something wasn’t quite working in terms of e-RS and the written guidance elements of it.
- We’d tried referral management centres in primary care, and there hadn’t been a good experience here in Doncaster, and what we were trying to get to was rather than a set of GPs essentially referral managing other GPs, we wanted to improve the access to the specialist consultants as soon as possible, hence why we tried to explore this avenue.
- We wanted to improve the relationship and the way that consultants and GPs interacted, I think there’d been a feeling across the clinical community that we’d lost a little bit of that for one reason or another and actually a system that allowed that real-time conversation was one of a series of measures to improve relationships between primary and secondary care, and we did want to improve patient experience,
- We did have quite long waiting times in some specialties back in August ’17 and frankly we still do in some, but this was seen as one of the ways to improve the patient experience in terms of waiting, if indeed they didn’t need a secondary care appointment.”
Initial fears (prior to implementation)
Anthony described the barriers initially faced;
- “The first was this fear of initial extra workload, for secondary care consultants, ‘you’re adding me another task on top of what my job plan was’. Because the system builds into the rotas of secondary care consultant staff it allows the most available consultant on that rota to be able to pick up that call, so that (fear) was negated quite quickly once it was explained.
- The medical legal side of things – who’s responsible for a patient at any one time and what happens as a result of Consultant Connect telephone call rather than the traditional audit trail of written advice and guidance. We negated this with the fact that every call is recorded, and at any time we can go back and audit those calls if indeed we need to do so.”
Top tips for other NHS Areas
If you are considering introducing Consultant Connect, Anthony has this advice;
- “Sell, sell, sell, this isn’t just a case of implementing a system, you’ve got to bring the hearts and minds of people with you first. Some specialties have been less up for it than the others. In fact you’ve got to do that before you even start rolling out the system, so champions are absolutely crucial, clinical champions to getting this up and running.
- Consultant Connect is complimentary to written advice and guidance rather than a replacement for e-RS. If there’s an element of urgency, where a GP is slightly worried about a patient, they may prefer Telephone Advice & Guidance.
- Connection rate is crucial, particularly in primary care, so the more the phone can be answered, the more primary care will use it.
- Incentives are crucial as well;
- for hospital managers, that’s job planning
- for commissioning, it’s appropriate demand management
- for clinicians, it’s quick access to advice by its very nature
- for patients, it’s the ‘there and then’ nature that they appreciate the most.”
Performance and the future
As of February 2020 there has been 5,175 calls to Consultant Connect of which 3,595 have been answered. This is a 70% answer rate overall, Jonathan commented that “when compared to some hotlines which often have between a 10% – 20% chance of being answered, this is very high.” Of those calls:
- 41% resulted in a referral being avoided
- 7% resulted in an admission being avoided
- 7% diagnostics requested
Antony went on to explain; “I’ll be honest, from a commissioner perspective it’s saved us money, purely from the fact that we haven’t made that referral. But more importantly it definitely has improved the relationships between secondary and primary care, we think, you know, there’s much more now a name to somebody as opposed to a specialty.”
“Like many of you will have done, we have stepped down routine outpatient and elective care and we have written to all primary care and all secondary care clinicians selling Consultant Connect as the default. Secondly the guidance on non-face-to-face appointments and the way that we need to shift the traditional system of outpatient appointments, really lends itself to a system like this, I think the tariff and the blended tariff will help and the changes of the incentive there, but we need to work that through. Thirdly I don’t see any reason why Consultant Connect or an advice and guidance system can’t be used for mental health community care, etc. Doncaster’s part of a, like you all will be, an integrated care system. We’re having conversations across South Yorkshire and we’ve asked more about how we take a collective regional approach to elective care, and obviously there has to be consistency across hospitals on a system like this, if that’s going to work. “
“ I do find the responsiveness of the (Consultant Connect) team very helpful and I would say that it’s not just a case of implementing and then away you go, that’s not been my experience, (The Consultant Connect team) has been very responsive. So we are looking at this (project) in terms of continuation. We’re always evaluating the things that we commission, but at the moment I would broadly say that we’re happy with where we are in Doncaster and I do think it fits with the national agenda going forward.”
To read a written account of the webinar Q&A, please click here.
Delegates at the webinar were sent a handout pack which you can also access below:
- Enhanced Advice & Guidance
- Experts explore Telephone Advice & Guidance, other A&G tools and share top tips
- Real life business case example for Advice & Guidance
- Enhanced Advice & Guidance – Performance Benchmarks
- Access the Webinar recording
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