As general practice struggles with an ever-increasing workload sending text messages, providing access to online services and voicemail bookings are some of the new systems currently saving time
Practice managers are constantly looking out for ways to ease the relentless pressure on practice services and to create additional capacity. New systems, tools and processes that reduce the number of missed appointments – those Did Not Attends (DNAs) – and/or save staff time will always catch the eye. Sending text messages, providing access to online services and voicemail bookings are some of the systems currently being used.
It is widely reported that 90% of texted messages are opened and read within three minutes of the text being received. It will therefore not come as surprise to learn that many practices are making use of texts to send appointment reminders, confirm transport arrangements, forward test results, distribute relevant public health messages and for general two-way communication with patients and identified carers. There are internal uses too, from circulating staff rotas to passing on business continuity warnings, e.g. adverse weather alerts - which can be especially useful at this time of year. Significantly, all of these uses are supported and encouraged by the Scottish Government in its eHealth Strategy (see http://www.ehealth.scot.nhs.uk/wp-content/documents/SMS-Good-Practice-Gu...). Constant developments in technology allow practices to offer more and more secure patient activated online services via the practice website typically, booking and cancelling appointments, requesting repeat medications and retrieving routine test results. Increasingly, practices are offering patients the opportunity to view allergies and medication. It is also possible to download an app to a smart phone for these services or view the practice’s next available appointment on a digital TV. Further innovations include the main GP clinical systems linking with major IT companies, for example, EMIS and Apple, to provide electronic health information along with health service related Twitter feeds. These are then displayed on the GP software suppliers’ home page. Patients can log into NHS Choices or “Google” their practice to check if these services are available at their local surgery. Although these online services are only accessible to registered users, the registration processes (distinct from registering as a patient with the practice) is simply the completion of a short, often online, form.
An increasing number of practices are experimenting with voicemail booking and 24 hour integrated telephone booking services like Vision’s Patient Partner. This automated telephone system allows patients to make, alter, cancel appointments at their convenience and is fully integrated with the practice’s clinical system. The patient can also request texts to confirm the booking and a reminder 24 hours before the appointment time, if so desired. “Virtual telephone” and “virtual receptionists” services are currently being heavily promoted in practice manager publications and websites. “Auto attendants” answer telephone calls 24 hours a day, 365 days a year with a practice specific greeting and can direct calls around the practice or transfer voicemails to email. Other companies and organisations, both commercial and from within the NHS, will provide agents (outside workers) who contact patients on behalf of the practice for a variety of straightforward admin type calls. NHS 24 (Scotland) regularly telephone patients out of surgery hours to arrange routine screening appointments with their surgery.
Undoubtedly, there are many advantages to be gained from these initiatives - for patients, practices and managers. Text messages are fast, friendly, free up staff time for other tasks and are more cost-effective than writing to patients. It may well be that patients find that for simple messages a quick text is less intrusive and more convenient than a telephone call.
Allowing access to online services means that patients can contact the practice at a time to suit them – not just within the practice’s working hours. As a result, patients enjoy greater choice, flexibility and control which ties in nicely with today’s greater emphasis on patient empowerment and supported self management.
While virtual receptionist services are relatively new to general practice, patients are likely to have encountered these systems in commercial settings and so it should be relatively easy to introduce these as a further practice service. Calls that are answered and directed quickly and efficiently will reduce patient frustration, giving a favourable impression of the practice’s services, thereby reinforcing its good reputation.
The above are intended to reduce DNA rates, control telephone traffic, in particular at peak times of day and relieve some of the pressure felt by staff, allowing the team to focus on the patients presenting at the front desk and to deal with admin tasks. All of which should delight the practice manager!
The most obvious downside is, as ever, cost. There may well be contract charges to think about and all new services are likely to have some attached training costs. Any decision to invest in new systems would have to be considered carefully, with each practice making individual decisions in light of specific costs and anticipated benefits.
Compliance with the Data Protection Act (1998) is essential. In order to minimise the risks of falling foul of the Act, practices should avoid using anything that identifies a person and their mental or physical state, ensure that staff know not to copy and paste entire emails and have a system in place for storing sent messages for a period of six months.
The security limitations of texting must be made clear to patients, particularly as the practice cannot control who is able to read any texts that are sent, e.g. family members. A well worded consent form completed as part of the online registration process will help to ensure that the patient knows and understands the full implications of using the service – as well as their responsibilities to the practice. This form should help to cover confidentiality issues too, for example, does anyone else uses the same mobile number? Ask for the names of any third parties who will regularly text on behalf of patients and create a note of contacts similar to those next of kin details kept for test results. There are templates available for such consent forms and further guidance can be found on both the Department of Health and Scottish Government websites.
Patient expectations may need to be managed too – if you allow incoming texts, how soon can a response be expected and what is seen as a reasonable number of texts from any given patient? Perhaps a notice in reception or in the practice leaflet setting out the average response time to such texts would be a good idea. It might also be an ideal moment to refresh the other notices on that board too. Be aware that reception staff may feel threatened by these initiatives and worry about their job security. If the introduction of these services is a part of a regrettable but justifiable business plan to downsize, take proper HR advice and follow it – to the letter. Otherwise, if it is not the intention, please reassure the team by saying so.
Implementing a ‘Brave New World’
Although many UK practices have already introduced electronic services (EMIS claims that an average of 45,000 appointments are booked online each month) perhaps your practice has yet to do so? Why not test the water by consulting with your stakeholders – staff, GPs, nurses and patients, possibly via your Patient Participation Group, if you have one. Would patients appreciate these services, are practice staff enthusiastic? There are bound to be mixed views, but as the practice manager you will be well placed to judge if the moment is right.
Once the decision to implement has been made the most important thing to do next is, of course, to tell the patients. They need to be made aware of the new system and given instruction on how to use it. It is likely that your supplier will give you posters and leaflets for reception and the waiting room but remember to add something the practice leaflet and website too.
If you decide to introduce a texting service then you will have to think about the content of the texts. Best practice suggests that messages should be a maximum of twenty words and in English – avoid text speak and use formal punctuation. It is best to assume the recipient has the most basic of mobile phones. In-house templates should be agreed at the outset and all messages should adhere to this basic format.
Electronic voice answering services and using agencies certainly work in the outside world. Scotland’s NHS 24 has the results to prove it. Most companies are currently offering free trial periods – so, if you are considering an electronic reception service, what’s not to like – or at least try?
General practice needs to embrace innovative ways of working. Standing still is not an option.
These innovations could be the start of a brave new future – go for it.