DR AMIR HANNAN
Haughton Thornley Medical Centres, Hyde
Amir is a fulltime GP at Haughton Thornley Medical Centres. He is also the Information Management & Technology lead at NHS Tameside & Glossop, and the Primary Care IT lead at NHS North-West
"Dr Hannan encouraged me to use the practice website and I was doubtful it would be of benefit. However, I've firsthand experience that your health is in your own hands. I've used the practice website to help me manage my diabetes. I've spent only a small amount of time surfing but, because I know the links are safe and reputable, I've learnt many things to help me manage my diabetes. At my last review I was very pleased that the changes I've made have had a huge impact on my health already. I've still got a way to go but I've seen the benefits. Don't rely on the doctor to come up with the answers; get the information from the website and find ways to improve your own health."
– Blog by Lynn, patient at Haughton Thornley Medical Centres.
Lynn is not alone. Last year, our practice website, www.htmc.co.uk, received 100,000 page views. But so what? Why should this matter for us in general practice? As long as we are able to reach our Quality and Outcomes Framework (QOF) targets and meet the obligations required of us by the primary care trust (PCT) and others, why should we care about what information patients look at?
The demographic timebomb
An ageing population living with multiple long-term conditions is putting pressure on general practice that, year on year, is expected to deliver more and more with what appears to be fewer and fewer resources. As a practice manager, the challenge is to maintain quality in the practice, keep profits high and continue to maintain staff morale as well as keeping patients happy. An impossible task!
The rise and rise of the internet
You cannot help but notice how many things are now available via the internet. An increasing number of people are turning to the internet to book holidays online, download their favourite music and use Google to learn about almost anything. But could this change in society have an impact on general practice and make our lives easier, as well as maybe even make money for us while encouraging patients "to do the right thing"?
Information patients need to help manage their care
But how can we compete with the internet? Working with a GP information systems supplier, we asked: "What if, together with our patients, we provide the information they need because we know what patients need better than anybody else?"
At first that may sound odd, but just imagine how many times you ask yourself: "If only the patients knew about what we are doing or why we are doing it or how to make the best of the new clinic we have set up for them or the new service that we have helped to commission …"
Our patients don't just need to know general information about their health: they need to know exactly how their health is, what else they can do and also what other treatments and services are available to them.
Building a patient-clinician partnership of trust
When patients choose to come and see their doctor or nurse, they expect the clinician to have expert knowledge of health problems as well as the local health services and their experience of them. The patient is an expert too, with knowledge of the symptoms they have but also things they may have learned about from the press, TV, radio and the internet, as well as what other friends and family think and other conditions that may run in the family. The consultation between patient and clinician is a meeting of two experts – not just one.
Our clinical system enables us quickly to see any conditions the patient suffers with, which consultations, blood tests and other investigations they have had, as well as any letters that have come back from hospitals or other community clinics the patient may have visited.
Just as the clinical system helps the clinician to understand the condition of the patient, it could also help the patient to understand their health better too. Four years ago, we implemented a secure online computer system enabling patients to book appointments, order repeat prescriptions and access their full GP electronic health records online. This allows patients to see the same information that the clinician does.
The need for a practice web portal
Have you ever thought about getting access to your own records, even though you know everything that is required to run the practice? No? So why should our patients be any different? And how would they know how to make sense of their records?
That's why we set about making a website that teaches patients and their families how to understand their records, as well as what services are available.
What our practice website does for patients
Our practice website has a "patient control panel", which helps patients to drive their knowledge needs. Besides being able to book appointments up to six weeks in advance, order repeat prescriptions and access their records, we provide information and videos on YouTube explaining the benefits of records access as well as understanding issues such as privacy, confidentiality and the need to share information to get better care.
A section entitled "Self Care" enables patients to use trusted information sites such as NHS Choices, NHS Direct, Map of Medicine and Patient.co.uk. Furthermore, patients can learn about how to use this information, the staff and clinics that we have set up and what they will find in their records, as well as see QOF targets to see how they are doing in comparison and what else they can do.
We describe five conditions (diabetes, hypertension, heart disease, eczema and depression), one preventative medicine (immunisations) and one normal condition (pregnancy) as a framework to help them construct their own personal information needs. The site features links to local self-help resources, eg, Off the Record, and local sports information too.
Even better, we have added advice and links to the top 40 self-help conditions patients come to the GP with and even a section for teenagers and their own health concerns based on a questionnaire.
Our site features articles written by patients on how to use the out-of-hours service or Choose and Book, and how access to their records means they can be better prepared for the consultation with a clinician.
We are using the combined expertise of the patient as well as the clinician to develop content relevant to our patient population. This includes information on smoking cessation, alcohol, chlamydia testing, swine flu … the list goes on and on. By mixing practice-generated content with PCT, regional and national content, as well as from trusted third parties (eg, the BBC), we hope to give a balanced view but one that patients enjoy.
We have started recording meetings we have held for patients and posted them online so that they are available for other patients and the public to see too. Meeting topics range from "Heart Disease", "HPV Vaccination, Smears and Cervical Cancer" to "Are You Empowered Yet?"
There is even a talk for practices that may wish to offer records access and want to know how to do it the Haughton Thornley Medical Centres way! The "Patient Zone" includes the minutes of the patient participation group as well as pictures of events they have attended and messages from the group's chair.
Practice staff members don't need to know how websites work to do this – all training was provided by the information systems supplier and adding content to the site is essentially the same as using MS Word. All content is fully editable and we can, and do, add pictures, videos, articles and web pages as often as we want. It's our website and we can do what we like with it. There's no sponsorship, so editorial content remains completely independent and in our control.
Benefits for the practice
An informed patient who is empowered to make their own health choices could make your life easier, more enjoyable and make money for the practice too.
This is all about win/win. Patient involvement should make you and your clinicians' work no more difficult but ideally easier. It should not make your work any less enjoyable but possibly more enjoyable and finally it should make no less money but ideally more money.
Patients who have access to their GP electronic health records, as well as information from the practice telling them how to look after themselves, are more focused on their own care, have a better understanding of their treatments and are working in our "comfort zone" instead of asking for rare investigations because "so and so says so".
Such patients bring trusted knowledge to the table and appreciate what we are doing, rather than being antagonistic. They want to help build the partnership that we already enjoy, are keen to follow the latest guidance – consequently supporting QOF – and, as a result, become "good patients" who are a pleasure to work with.
Anecdotally, such patients seem to be in the surgery less often, as they know more of what is going on and hence free up appointments for others to use too.
Improved communication for the practice manager
Just as the public website helps patients to know what is happening, so the "intranet" provides an opportunity for us to promote the latest developments, guidance and advice for staff on the "intranet" – a password-protected area that only staff can access.
Being on the world wide web means our intranet can still be accessed at home by part-time staff if they wish to. It's like the noticeboard in the reception area, but available for all staff to see, and which our practice manager can update whenever he wants to. All our protocols, important leaflets and even pictures of a recent party are available for the staff to see whenever they want to. We have even added YouTube videos for staff updates too.
With more than 800 patients now accessing their records and more patients turning to the website to know what to do next, it seems general practice is ideally placed to use the benefit of the internet to help deliver an even more personalised service for patients.
Could a practice-based web portal, enabling you to actively add your own information supporting patient care, be the next thing for you too, to help run your practice even more efficiently, effectively and safely, saving you money and enabling your patients to get even better care?
Some final words from another of our patients, Margaret, on our blog:
"I love to use the www.htmc.co.uk website to manage my own health. It may be that I want to access my health records to print information when I am going to the hospital. By following the various links, I was able to look up information about an operation I needed to have. The information was very easy to understand and there was even a diagram. I found the information very useful. I was not anxious when I went for the operation, as I knew exactly what to expect. I have even used the site to look up information for friends and family. The up-to-date information on swine flu is very good."
Patient empowerment at the heart of general practice.