How do you square the circle of patient access, patient choice and Primary Care workload?

It looks like iPLATO may have an answer. After a meeting today with Kieran Waterston (Regional Client Director at iPLATO Healthcare) I got to see what the next few months are going to look like. It is really interesting to see and there seems to be a real drive to help both sides of the patient demand vs GP supply equation.

The highlights for me where:

- Improving access

People will often give examples of how they can book holidays on their phone, do their banking, etc. with minimal hassle, but try to engage with your GP and its a different situation. Look at their website, ring their telephone number, go to the surgery, maybe you can email them or even send them a letter.

I often hear the argument that if you make GP too accessible then the rate of unnecessary appointments will increase. I do agree with this to a point, but the converse is also true, if it is too hard to make an appointment, then by the time you see the person, what may have been easily solvable, becomes more difficult to treat and takes longer to resolve.

iPLATO allows appointment cancellation through their messaging service. Cancelling an appointment is as simple as sending a text. This then opens up appointments that would otherwise be blocked by non-attenders, so patients that needed to be seen that day, rather than be added on as extras, can be seen in normal working hours.

Their new app is improving the process to make appointments with the surgery. Once set up patients can easily make appointments directly into the GP’s system. So what is to stop an overwhelming number of appointments being booked, or appointments being booked unnecessarily?

And I think that is the most well thought out part of the app. It encourages patient education. Not merely booking an appointment, but suggesting other avenues to care, including a telephone consultation, an appointment with a nurse, a review at the local pharmacy and online help.

The app does not try to triage or make suggestions, but provides the patient with relevant information to make an informed choice. The app is non-blocking, if a you really want a GP appointment, then you can book one, but it will let you know there are other options.

- Increasing digital engagement of patients with their surgery

How, as a GP surgery and promoter of health can you reach all of your patients or the right patients with the right message? As an example, it’s flu season and it’s time to start immunising those at risk. Rather than sending out letters, ringing patients or putting notices up in the waiting room, what if you could text all patients that need an immunisation and let them know to make an appointment?

Better still what if you could inform them through the myGP app and they make the appointment themselves.

But the possibilities are endless, let patients know there medication review is due, their chronic disease needs reviewing, there is a new group that they would benefit from. Let people know that their medication combination needs changing due to new evidence.

As an advocate of Primary Care research, the ability to identify patients who may potentially be eligible to help with research and letting them know quickly and easily and having an almost instantaneous “tell me more” or “I’m not interested response” is a fantastic prospect.

So what does this mean for GP?

Many apps and companies that I have spoken to demonstrate a similar model for improving access and ‘helping’ general practice… …and it is the exact opposite of iPLATO. There is a push to try and ‘understand’ why a person is making an appointment and then funnel the patient to the most appropriate path.

It is understandable as this is the model used at the moment with 111. The problem is that apps such as these will always err on the side of caution, they will have a low threshold for an appointment and often don’t consider patient choice. In a time when medicine is trying to lose its paternalistic attitude, telling patients what to do seems a backwards step.

The problem with this low threshold is that more appointments are often booked unnecessarily. Throughout my day, I lose count of the number of times a patient will state “well I didn’t know whether I should make an appointment, but I didn’t know where else to go”. What if they did know where to go? What if they knew, that seeing someone else may be more appropriate and probably even quicker. You don’t tell them to do that, but given them the option, and if they still want to see their GP, fine.

So in a world where the general trend is to push workload and clinical responsibility to the GP, here is a company that is trying to empower the patient once again. Providing the right information at the right time to aid them making the correct decision. Fantastic work, keep an eye on iPLATO, they are ones to watch.

Declaration: I do not have any financial or other relationship with iPlato, which may be considered as constituting a real, potential or apparent conflict of interest.