One of our customers is a CCG that has been piloting four specialties on Consultant Connect for the last six months. Interestingly, though, they are one of three CCGs that feed into the local Trust. The other CCGs offer written Advice & Guidance (through e-RS) and our customer also uses this for specialties not covered by Consultant Connect.
The Trust recently looked at usage of Advice & Guidance across all three CCGs. What they found was that, in the past six months, the Trust had received a total of 98 requests for written Advice & Guidance across all three CCGs across all specialties. In the same period it had received more than 500 calls from Consultant Connect from just one CCG across just four specialties.
In this area, usage of telephone Advice & Guidance is an order of magnitude larger than written Advice & Guidance. Why?
Explaining the difference in usage
Usage is down to three things:
- Ease of use
- The number of opportunities for use
- The outcome of the interaction
Ease of use
Using telephone Advice & Guidance is easy. The GP calls using their desk phone or our app and is connected in an average of 53 seconds. The conversation takes an average of 4 minutes 6 seconds. All calls are recorded and tracked, so there is no paperwork. It’s so quick that approximately 50% of calls are made whilst the patient is with the GP.
Written Advice & Guidance is harder. There is the requirement to log on to e-RS, write an explanation of the patient’s condition and append any relevant documents. We understand this can take anywhere from 5 – 15 minutes, dependent on the complexity of the patient’s medical history and condition. If the answering clinician then has any questions, this will lead to further written exchanges. For a time-pressured GP this can be a significant disincentive for using written Advice & Guidance.
Opportunities for use
Perhaps the biggest factor here is urgency. If there is any urgency whatsoever in the need for Advice & Guidance before deciding what to do with a patient, a GP is unlikely to rely on written Advice & Guidance and will instead refer or admit the patient. This restricts the use of written Advice & Guidance to non-urgent matters.
If GPs have phone access to local Trust clinicians, however, they can be advised on even the most urgent patients. Across elective care specialties on Consultant Connect, 6% of calls result in the patient avoiding an unplanned admission.
Telephone Advice & Guidance is, in fact, so effective at dealing with urgent patients, we have a number of projects focused exclusively on avoiding unplanned admissions. Our project in Sunderland was recently reported on by NHS Elect, which concluded that the approach avoided 175 unplanned admissions in the first three months of the project.
The outcome of the interaction
What we mean by this is, does the Advice & Guidance make any difference? Does it help the patient either avoid an avoidable trip to hospital or make sure they get the right care first time? If it doesn’t achieve anything, GPs won’t use the system.
It’s tricky to find data on this from e-RS, but this analysis from Solihull CCG (originally published on this site last year) gives an indication why e-RS is not always well used: 92% of requests for Advice & Guidance in 2014/15 resulted in the patient being sent to hospital anyway. It’s difficult to invest effort in requesting written Advice & Guidance if your patient is 92% likely to end up in hospital anyway.
It’s different for telephone Advice & Guidance. As our benchmarks show, in the last 6 months 67% of calls to elective specialties have resulted in the patient avoiding a trip to hospital and their care staying in the community. It’s faster and better than going to hospital and it’s a good enough reason for GPs to use the service. Similarly, calls to urgent care specialties resulted in over 60% of patients being treated out of hospital or being navigated to the right care, first time.
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