One of England’s integrated care systems proved the benefit of modern, cloud-telephony during the COVID-19 pandemic and is now working with X-on on new ideas to support GPs and patients
The telephone remains an important channel for patients to access primary care services
GPs in Herefordshire and Worcestershire are benefiting from modern, cloud-based telephony, following the rollout of Surgery Connect to almost all practices in the area.
More than 70 practices within the ICS have adopted the X-on system over the past three years, with the support of NHS Herefordshire and Worcestershire and utilising central funding.
Just eight practices have chosen not to buy themselves out of long contracts or have opted for other suppliers.
Alicia Dunsby, associate director of digital and technology at the Integrated Care Board (ICB), explains: “Telephony remains one of the most-important channels for patients to contact their GP and access primary care services.
“We identified that some of our practices were struggling with telephony. They were using old analogue systems, constantly looking for more lines to handle an increasing volume of calls, and still seeing calls go unanswered.
Telephony remains one of the most-important channels for patients to contact their GP and access primary care services
“We decided to help all of our practices move to modern telephony and worked with X-on to achieve that.”
NHS Herefordshire and Worcestershire serves a population of more than 800,000 people, who live in a mix of rural areas and small towns and cities.
A relatively-high and growing proportion of these people are aged over 65, and there are pockets of deprivation in some areas, including parts of Bromsgrove, Kidderminster, and Redditch. Although the area has a relatively good road infrastructure, it is 30 miles between its two main acute hospitals in Hereford and Worcester and there are public transport challenges.
There is, for example, no direct bus or train line from Redditch to either city.
Therefore, the area’s population profile and geography make primary care the first point of access to the NHS for most patients so it is essential for some form of GP practice to be open and accessible at all times.
Dunsby said this became very apparent during the COVID-19 pandemic.
“Initially, a large number of GPs had to work from home while, later in the pandemic, sickness could force smaller or single-handed practices to temporarily close,” she said.
“When that happened, it was telephone access that enabled patients to continue to access the care they required.
During the pandemic, GPs really came to understand the benefit of the softphone, because it enabled them to work from home
“Meanwhile, for GPs, the softphone features of Surgery Connect came to the fore.
“The softphone is embedded in the user console and enables the user to indicate whether they are available to take calls, to make calls, and use video conferencing from any PC, tablet, or smartphone with an internet connection.
“During the pandemic, GPs really came to understand the benefit of the softphone, because it enabled them to work from home.
“Twenty practices came on board during the final phase of the rollout because they had seen the benefits of remote working.”
GPs also like Surgery Connect’s integration with the EMIS patient record system, which means they can use the ‘patient list’ to call or send a message to individuals.
And administrators appreciate its reporting capabilities because they can assess how many calls are coming in and being answered when demand is greatest.
With the effects of COVID-19 mitigated by vaccination, and the rollout of cloud telephony complete, NHS Herefordshire and Worcestershire is now starting to work with practices on how its features could help primary care services to support each other in the face of growing demand and scarce resources.
For example, groups of practices are looking to work together out of hours when there are not enough GPs to staff every surgery, but the area’s travel challenges mean patients cannot just visit the nearest practice site.
Dunsby said this would be much easier if every practice had Surgery Connect set up in the same way.
And her top tip for ICSs and primary care networks wanting to get the most out of a cloud telephony deployment is to make sure that they do integrate.
“If I had my time again, I would ask X-on to do a standard configuration, so the patient experience is the same, whichever practice they call,” she said.
“We let practices do things their own way, and there were good reasons for that, but you would see additional benefits if you standardised.
“We have groups of practices working to support each other both in and out of hours and it has been a challenge to make sure that patients get a consistent experience because we cannot say it will be ‘press 1’ for this service and ‘press 2’ for that one across the board.”
Despite these challenges, NHS Herefordshire and Worcestershire is starting to innovate with its new technology.
For example, it is looking to implement a system that will enable other clinicians to get straight through to a GP if they need information about a patient.
At the moment, A&E and hospital doctors, community nurses, and care home staff can spend hours trying to find out basic patient details, so being able to get straight through to check a medical history or pick up medication information is not only more efficient, but could generate significant time savings.
We let practices do things their own way, and there were good reasons for that, but you would see additional benefits if you standardised
And the ICS is starting to interrogate the new source of data that Surgery Connect has created.
As an example, Dunsby said: “We had a lot of nine to 14 year olds turning up at A&E after school.
“We asked their GPs for their phone statistics to see if we could work out why, and whether improved access to another service would stop it happening.
“Having reviewed the statistics, we found out it was a one-time issue with concerns over Strep A, rather than a capacity issue.”
Overall, she adds, what is great about moving to modern telephony is the speed at which it makes change possible.
“During COVID, we were responsible for co-ordinating the vaccination effort for the local NHS and core public services,” she said.
“Naturally, there were a lot of questions to be answered so we established a line with X-on and staffed it with people who could answer them.
“Because it was cloud based, we were able to call X-on on a Wednesday and have it set up and tested on the Thursday and ready to go live on the Friday.
“The fact that we could be so responsive was just amazing.”