Using Normalisation Process Theory [NPT] to understand how GPs engage with eConsults

CB Matheson-Monnet A Argyropoulos C Brooks and R Guerrero-Luduentildea

OUTLINE

1 Background

2 Aims

3 Methods

4 Results

5 Conclusion

gponlinecom

[n= 858381] 2 July (Siddique 2015)

BACKGROUND

Orkload

AIMS

In early 2015 helped fund a pilot implementation of WebGP (then eConsults) in 2 Wessex GP practices

Piloted in 2016 and evaluated 6 months

1 Drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

2 How best to maximise drivers and minimise barriers to ensure successful implementation and future spread and adoption

httpswwwemishealthcomproductseconsult

BACKGROUND

Orkload

AIMS

In early 2015 helped fund a pilot implementation of WebGP (then eConsults) in 2 Wessex GP practices

Piloted in 2016 and evaluated 6 months

1 Drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

2 How best to maximise drivers and minimise barriers to ensure successful implementation and future spread and adoption

httpswwwemishealthcomproductseconsult

AIMS

In early 2015 helped fund a pilot implementation of WebGP (then eConsults) in 2 Wessex GP practices

Piloted in 2016 and evaluated 6 months

1 Drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

2 How best to maximise drivers and minimise barriers to ensure successful implementation and future spread and adoption

httpswwwemishealthcomproductseconsult

METHODS

Conceptual framework based on Normalisation Process Theory [NPT] (May and Finch 2009) [sense-making participation collective action and reflexive monitoring] informed a mixed-method observational research design (Plowright 2015)

a)Survey of GP practice staff (qualitative and quantitative data) using 16 NPT questions supplemented by questions about processing e-consults n=5 [GP1] and n=5 [GP2]

b)Semi-structured interviews n=3 [GP1] and n=1 [GP2]

c) Trends in usage and outcomes n=210 [GP1] and n=72 [GP2]

d)Patient experience (qualitative + quantitative data) n=20 [GP1]

RESULTS Survey non=NPT questions

Orkload

How long on average to process eConsults

6 mins [GP2] and 36 mins [GP1] and [63 out of n=100 took under 3 mins ie 29 mins average and assumed 5 mins overall triage time]

Confident in processing eConsults

Yes 40 [GP1] and 60 [GP2] [100]

Actively encouraging patients to use eConsults

Yes 20 [GP1] and 60 [GP2] [63]

Want your own personal GP to offer eConsults

Yes 40 [GP1] and 60 [GP2] [78]

Madan et al 2014 Edwards et al 2017 and Banks et al 2018

RESULTS Survey NPT questions

34

39

41

36

38

38

40

38

Key people drive E-consults forwardand get others involved

Participating in E-consults is alegitimate part of my role

I am open and willing to work in newways with colleagues to implement E-

consults

I will continue to support E-consults

GP2 n=5 GP1 n=5

Participationengagement

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

Orkload

RESULTS Survey NPT questions

Collective action

38

38

31

31

28

4

24

36

24

26

I can easily integrate E-consults into myexisting work

E-consults work is assigned to those withthe appropriate skills

I maintain my trust in E-consults and in other peoplersquos ability to implement them

Sufficient training is provided to enablestaff to implement E-consults

Sufficient resources are available tosupport E-consults

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

RESULTS Survey NPT questions

Reflexive monitoring

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

33

31

34

35

26

44

32

28

I value the impact of E-consults on mywork

E-consults are worthwhile

I can modify how I work with E-consults

I have access to inforeports aboutimpact of E-consults

GP2 n=5 GP1 n=5

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

RESULTS Survey non=NPT questions

Orkload

How long on average to process eConsults

6 mins [GP2] and 36 mins [GP1] and [63 out of n=100 took under 3 mins ie 29 mins average and assumed 5 mins overall triage time]

Confident in processing eConsults

Yes 40 [GP1] and 60 [GP2] [100]

Actively encouraging patients to use eConsults

Yes 20 [GP1] and 60 [GP2] [63]

Want your own personal GP to offer eConsults

Yes 40 [GP1] and 60 [GP2] [78]

Madan et al 2014 Edwards et al 2017 and Banks et al 2018

RESULTS Survey NPT questions

34

39

41

36

38

38

40

38

Key people drive E-consults forwardand get others involved

Participating in E-consults is alegitimate part of my role

I am open and willing to work in newways with colleagues to implement E-

consults

I will continue to support E-consults

GP2 n=5 GP1 n=5

Participationengagement

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

Orkload

RESULTS Survey NPT questions

Collective action

38

38

31

31

28

4

24

36

24

26

I can easily integrate E-consults into myexisting work

E-consults work is assigned to those withthe appropriate skills

I maintain my trust in E-consults and in other peoplersquos ability to implement them

Sufficient training is provided to enablestaff to implement E-consults

Sufficient resources are available tosupport E-consults

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

RESULTS Survey NPT questions

Reflexive monitoring

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

33

31

34

35

26

44

32

28

I value the impact of E-consults on mywork

E-consults are worthwhile

I can modify how I work with E-consults

I have access to inforeports aboutimpact of E-consults

GP2 n=5 GP1 n=5

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

RESULTS Survey NPT questions

34

39

41

36

38

38

40

38

Key people drive E-consults forwardand get others involved

Participating in E-consults is alegitimate part of my role

I am open and willing to work in newways with colleagues to implement E-

consults

I will continue to support E-consults

GP2 n=5 GP1 n=5

Participationengagement

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

Orkload

RESULTS Survey NPT questions

Collective action

38

38

31

31

28

4

24

36

24

26

I can easily integrate E-consults into myexisting work

E-consults work is assigned to those withthe appropriate skills

I maintain my trust in E-consults and in other peoplersquos ability to implement them

Sufficient training is provided to enablestaff to implement E-consults

Sufficient resources are available tosupport E-consults

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

RESULTS Survey NPT questions

Reflexive monitoring

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

33

31

34

35

26

44

32

28

I value the impact of E-consults on mywork

E-consults are worthwhile

I can modify how I work with E-consults

I have access to inforeports aboutimpact of E-consults

GP2 n=5 GP1 n=5

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

RESULTS Survey NPT questions

Collective action

38

38

31

31

28

4

24

36

24

26

I can easily integrate E-consults into myexisting work

E-consults work is assigned to those withthe appropriate skills

I maintain my trust in E-consults and in other peoplersquos ability to implement them

Sufficient training is provided to enablestaff to implement E-consults

Sufficient resources are available tosupport E-consults

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

RESULTS Survey NPT questions

Reflexive monitoring

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

33

31

34

35

26

44

32

28

I value the impact of E-consults on mywork

E-consults are worthwhile

I can modify how I work with E-consults

I have access to inforeports aboutimpact of E-consults

GP2 n=5 GP1 n=5

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

RESULTS Survey NPT questions

Reflexive monitoring

5=strongly agree 4=agree 3=not sure 2=disagree 1=strongly disagree

33

31

34

35

26

44

32

28

I value the impact of E-consults on mywork

E-consults are worthwhile

I can modify how I work with E-consults

I have access to inforeports aboutimpact of E-consults

GP2 n=5 GP1 n=5

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

RESULTS semi-structured interviews

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

RESULTS semi-structured interviews

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

RESULTS Reflections

Orkload

More restricted approach of GP1 to eConsults led to only frac12 the patients offered the opportunity but this did not stop the other frac12 increasingly using eConsults n=53 or 25 over 6 months period

Number of eConsults for GP1 [n=210] was 3x that of GP2 n=72 but still lt1

Was this due to GP1 sending eConsults to patient named GP rather to on-call GPs Or to having attempted to limit usage of eConsults

Trainee GPs and lsquoon-callrsquo may explain why GP2 had lower scores for

GP2 unprepared to handle eConsults but valued them more than GP1 did

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

CONCLUSION

Orkload

GP1

GP2

Responses closer to the centreshow potential problem areas

Overall NPT scores for participation show GP1 [34 less engaged than GP2 [39]

Scores for collective action show GP2 [23] struggling more than GP1 [33] in enacting eConsults

Scores for reflexive monitoring show GP2 [30] slightly less able to assess effects and value of eConsults than GP1 [34]

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

CONCLUSION

Usefulness in pre-consultation planning

Provides electronic record

Not clogging up phone lines

Easier access to GPs

Usefulness for suitable patients

Most patients generally satisfied with eConsults

Poor integration with clinical records

Burden of administrative work

Low percentage of eConsults

Impact on GP workload negligible

Benefit practically nil as currently used

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

Using NPT framework in a pragmatic real world evaluation enabled

Insights into drivers and barriers to embedding eConsults in daily routine practice in a long-term sustainable way

Comparing findings directly with other studies using NPT

Contributing to body of evidence about implementation ofbull online consultations bull digital health innovations

generally

CONCLUSION

Thank you for your attention cbmathesonsotonacuk

In line with NPT to embed eConsults in routine practice and ensure adoption and spread requires time resources and holisitic and supportive leaders who actively champion them (Collins 2018 Castle-Clarke 2018 Albury et

al 2018)

Discussion is on-going about how best to predict and evaluate the success of digital or technology-based healthcare innovations (May and Finch 2009 Finch et al 2015

Greenhalgh et al 2017)

Orkload

Development of a predictive modelling tool

1 what is known of trends + outcomes of eConsults

2 patient data [demographics co-morbidities medications healthcare activity 6 months and 30 days PRE to predict online consultations uptake]

The tool would benefit GP practices by enabling

a) Better understanding of which patients are likely to use online consultations

b) Better understanding of trends and which patients are likely to require further follow up 30 days POST

c) Encourage patients ldquo likelynot likely to use e-consultsrdquo to use online consultations

FUTURE WORK

Orkload

Ascertaining the extent to which online consultations have delivered in relation to

Improved access to General Practice

Reduced pressures on GP workload

Better transmission of information between GP and patients

Better patient outcomes through earlier presentation and diagnosis

More productivity and greater efficiency

Savings for Commissioners through reduction in AampE attendance and in unplanned hospitalisations

FUTURE WORK

Thank you for your attention

cbmathesonsotonacukcbmatheson1

Orkload

Ascertaining the extent to which online consultations have delivered in relation to

Improved access to General Practice

Reduced pressures on GP workload

Better transmission of information between GP and patients

Better patient outcomes through earlier presentation and diagnosis

More productivity and greater efficiency

Savings for Commissioners through reduction in AampE attendance and in unplanned hospitalisations

FUTURE WORK

Thank you for your attention

cbmathesonsotonacukcbmatheson1

Thank you for your attention

cbmathesonsotonacukcbmatheson1

RESULTS [c and d]

Orkload

a) Trends in usage and outcomes [n=210 GP1 and n=72 GP2]

23 women during working hours depression shoulder pain and back pain [MH cystitis sinusitis

cough MSK and reproductivesexual as

most common problems ^ ]

Approx 14 administrative only eConsults [225]

75 [GP1] and 60 [GP2] closed remotely [approx 60^ and 33]

Online shift 09 [GP1] and 03 [GP2] [approx 07^ to 45]

b) Patient experience [n=20 GP1]

8 out of 10 satisfied

9 out of 10 would recommend to family and friends

6 out of 10 would have asked for f2f

3 out of 10 would have asked for a telephone consultation [compared

to similar or better]

Adamson and Bachman 2010 Malagrino et al 2012 [^] Madan et al 2014 Longman and Diggines 2015a 2015b

[]Edwards et al 2017 Banks et al 2018 Farr et al 2018

Adamson SC and Bachman JW (2010) Pilot study providing online care in a primary care setting Mayo Clinic Proceedings August 85 8 704-710 Available at httpwwwncbinlmnihgovpmcarticlesPMC2912730 and httpwwwdigitalhealthnetnews26183 [Accessed on 25th Sept 2015]

Albury D Beresford T Dew S Horton T Illingworth J Langford K (2018) Against the odds Successfully scaling innovation in the NHS A

joint report from the Innovation Unit and the Health Foundation Available at httpswwwhealthorgukpublicationagainst-odds-successfully-scaling-innovation-nhs [Accessed on 18 June 2018]

Baird B Charles A Honeyman M Maguire D and Das P (2016) Understanding pressures in General Practice London Kings Fund Available at httpswwwkingsfundorguksitesdefaultfilesfieldfield_publication_fileUnderstanding-GP-pressures-Kings-Fund-May-2016pdf[Accessed 28 March 2018]

Banks J Farr M Salisbury C Bernard E Northstone K Edwards H amp Horwood J (2018) Use of an electronic consultation system in primary care a qualitative interview study The British Journal of General Practice 68(666) e1ndashe8 httpdoiorg103399bjgp17X693509

Black S (2017) Online access to GPs can offer benefits to both GPs and their patients BMJ 2017359j5141 Available at httpwwwbmjcomcontent359bmjj5141rapid-responses [Accessed 20 December 2017]

Castle-Clarke S (2018) What will new technology mean for the NHS and its patients Four big technological trends The Health foundation Institute for Fiscal Studies The Kingrsquos Fund Nuffield Trust Available at httpswwwnuffieldtrustorgukfiles2018-061530028974_the-nhs-at-70-what-will-new-technology-mean-for-the-nhs-and-its-patientspdf) [Accessed on 18 June 2018]

Collins B (2018) Adoption and spread of innovation in the NHS London The Kingrsquos Fund Available at httpswwwkingsfundorgukpublicationsinnovation-nhs [Accessed on 18 June 2018]

Clay H and Stern R (2015) Making time in General Practice freeing GP capacity by reducing bureaucracy and avoidable consultations managing the interface with hospitals and exploring new ways of working Primary Care FoundationNHS Alliance 2015 Available at httpwwwnhsallianceorgwp-contentuploads201510Making-Time-in-General-Practice-FULL-REPORT-01-10-15pdf [Accessed 260116]

Curtis L (2013) Unit Costs of Health and Social Care 2013 Personal Social Services Research Unit Available at httpwwwpssruacukproject-pagesunit-costs2013 [Accessed 15 June 2016]

Diggines E and Longman H (2015) Rapid personal GP service moves patients online Digital Health and Care Congress 2015 Enabling patient-centred care through information and technology London Kingrsquos Fund 16-17 June Available at httpswwwkingsfundorguksitesdefaultfilesmediaHarry20Longman20Kings20Fund20Digital20201520askmyGP20v1pdf

Edwards HB Marques E Hollingworth W Farr M Bernard E Salisbury C Northstone K (2017) Use of a primary care online consultation system by whom when and why evaluation of a pilot observational study in 36 general practices in South West England BMJ Open 7 11 7e016901 doi101136bmjopen-2017-016901v Available at httpdxdoiorg101136bmjopen-2017-016901

Ellender M (2017) E-consultations can work in the NHS - its a learning curve BMJ 2017359j5141 Available at httpwwwbmjcomcontent359bmjj5141rapid-responses

REFERENCES

Adamson SC and Bachman JW (2010) Pilot study providing online care in a primary care setting Mayo Clinic Proceedings August 85 8 704-710 Available at httpwwwncbinlmnihgovpmcarticlesPMC2912730 and httpwwwdigitalhealthnetnews26183 [Accessed on 25th Sept 2015]

Albury D Beresford T Dew S Horton T Illingworth J Langford K (2018) Against the odds Successfully scaling innovation in the NHS A

joint report from the Innovation Unit and the Health Foundation Available at httpswwwhealthorgukpublicationagainst-odds-successfully-scaling-innovation-nhs [Accessed on 18 June 2018]

Baird B Charles A Honeyman M Maguire D and Das P (2016) Understanding pressures in General Practice London Kings Fund Available at httpswwwkingsfundorguksitesdefaultfilesfieldfield_publication_fileUnderstanding-GP-pressures-Kings-Fund-May-2016pdf[Accessed 28 March 2018]

Banks J Farr M Salisbury C Bernard E Northstone K Edwards H amp Horwood J (2018) Use of an electronic consultation system in primary care a qualitative interview study The British Journal of General Practice 68(666) e1ndashe8 httpdoiorg103399bjgp17X693509

Black S (2017) Online access to GPs can offer benefits to both GPs and their patients BMJ 2017359j5141 Available at httpwwwbmjcomcontent359bmjj5141rapid-responses [Accessed 20 December 2017]

Castle-Clarke S (2018) What will new technology mean for the NHS and its patients Four big technological trends The Health foundation Institute for Fiscal Studies The Kingrsquos Fund Nuffield Trust Available at httpswwwnuffieldtrustorgukfiles2018-061530028974_the-nhs-at-70-what-will-new-technology-mean-for-the-nhs-and-its-patientspdf) [Accessed on 18 June 2018]

Collins B (2018) Adoption and spread of innovation in the NHS London The Kingrsquos Fund Available at httpswwwkingsfundorgukpublicationsinnovation-nhs [Accessed on 18 June 2018]

Clay H and Stern R (2015) Making time in General Practice freeing GP capacity by reducing bureaucracy and avoidable consultations managing the interface with hospitals and exploring new ways of working Primary Care FoundationNHS Alliance 2015 Available at httpwwwnhsallianceorgwp-contentuploads201510Making-Time-in-General-Practice-FULL-REPORT-01-10-15pdf [Accessed 260116]

Curtis L (2013) Unit Costs of Health and Social Care 2013 Personal Social Services Research Unit Available at httpwwwpssruacukproject-pagesunit-costs2013 [Accessed 15 June 2016]

Diggines E and Longman H (2015) Rapid personal GP service moves patients online Digital Health and Care Congress 2015 Enabling patient-centred care through information and technology London Kingrsquos Fund 16-17 June Available at httpswwwkingsfundorguksitesdefaultfilesmediaHarry20Longman20Kings20Fund20Digital20201520askmyGP20v1pdf

Edwards HB Marques E Hollingworth W Farr M Bernard E Salisbury C Northstone K (2017) Use of a primary care online consultation system by whom when and why evaluation of a pilot observational study in 36 general practices in South West England BMJ Open 7 11 7e016901 doi101136bmjopen-2017-016901v Available at httpdxdoiorg101136bmjopen-2017-016901

Ellender M (2017) E-consultations can work in the NHS - its a learning curve BMJ 2017359j5141 Available at httpwwwbmjcomcontent359bmjj5141rapid-responses

REFERENCES

NHS England Royal College of General Practitioners Health Education England (2016) General Practice Forward View Gateway number 05116 Available at httpswwwenglandnhsukwp-contentuploads201604gpfvpdf [Accessed 27 January 2018]

Farr M Banks J Edwards HB Northstone K Bernard E Salisbury C and Horwood J (2018) Implementing online consultations in primary care a mixed-method evaluation extending normalisation process theory through service co-production BMJ Open 2018 8(3) e019966 DOI 101136bmjopen-2017-019966

Finch TL Rapley T Girling M Mair FS Murray E Treweek S McColl E Steen I and May CR (2013) Improving the normalization of complex interventions measure development based on normalization process theory (NoMAD) study protocol Implementation Science 8 1 43 doi1011861748-5908-8-43

Finch TL Girling M May CR Mair FS Murray E Treweek S Steen IN McColl EM Dickinson C Rapley T (2015) NoMAD Implementation measure based on the Normalisation Process Theory [Measurement Instrument] Retrieved from httpwwwnormalisation processorg [7 July 2016]

GP Access (nd) Comparing webGPeConsult and askmyGP Available at httpgpaccessukwhat-we-doaskmygpcomparing-webgp-and-askmygp [Accessed 15 June 2016]

GP Patient Survey (2014) Survey results and other information July Available at httpsgp-patientcouksurveys-and-reportsGreenhalgh T Wherton J Papoutsi C Lynch J Hughes G ArsquoCourt C Hinder S Fahy N Procter R and Shaw S (2017) Beyond Adoption A New

Framework for Theorizing and Evaluating Nonadoption Abandonment and Challenges to the Scale-Up Spread and Sustainability of Health and Care Technologies Journal of Medical Internet Research 201719 11e367 doi102196jmir8775 Available at httpswwwjmirorg201711e367 [18 June 2018]

Healthcare UK Department of Health and UK Trade amp Investment (2015) Promotional material The UK your partner for digital health solutions Available at httpswwwgovukgovernmentpublicationsthe-uk-your-partner-for-digital-health-solutions [Accessed 260116]

Longman H and Diggines E (2015a) No more hanging on the telephone Patients seek help online RCGP Annual Conference Glasgow 1-3 Oct Available at httpgpaccessukevidencercgp-2015-no-more-hanging-on-the-telephone [Accessed 9 Oct 2015]

Longman H and Diggines E (2015b) Online access transforms GP productivity and patient experience Available at httpwwweuprimarycareorgsitesdefaultfilesLongmanpdf [Accessed 1 April 2018]

Madan A et al (2014) The Virtual Medical Practice Pilot report Hurley Group Available httpsgpaccessukwordpresswp-contentuploads201508e-consult-pilot-report-2014pdf [Accessed 6 Oct 2015]

Malagrino GD Chaudhry R Gardner M Kahn M Speer L Spurrier BR LaRusso NF (2012) A study of 6000 electronic specialty consultations for person-centered care at The Mayo Clinic International Journal of Person Centered Medicine 2 3 Available at httpwwwijpcmorgindexphpIJPCMarticleview266 [Accessed 27 March 2018]

REFERENCES

Matheson CB (2016) Implementation of WebGP and e-consultations in Wessex GP practices Southampton UK Centre for Implementation Science University of Southampton Wessex Academic Health Science Network httpseprintssotonacuk3971891

May C Murray E Finch T Mair F Treweek S Ballini L Macfarlane A and Rapley T (2010) Normalization Process Theory On-line Usersrsquo Manual and Toolkit Available from httpwwwnormalizationprocessorg httpwwwnormalizationprocessorgnpt-toolkithow-to-use-the-npt-toolkitaspx [Accessed on 25th Sept 2015]

May CR and Finch TL (2009) Implementing embedding and integrating practices an outline of normalization process theory Sociology 43 3 535 554 doi1011770038038509103208

NHS England (2013) Prime Ministers GP Access Fund Improving Access to General Practice Available at httpswww englandnhsukgpgpfvred [Accessed 18 November 2015]

NHS England SQW and Matt MacDonald (2015) Prime Ministers GP Access Fund Improving Access to General Practice First evaluation report October 2013 Gateway number 04123 Available at httpswwwenglandnhsukwp-contentuploads201510pmcf-wv-one-eval-reportpdf [Accessed 18 November 2015]

NHS England Royal College of General Practitioners Health Education England (2016) General Practice Forward View Gateway number 05116 Available at httpswwwenglandnhsukwp-contentuploads201604gpfvpdf [Accessed 27 January 2018]

NHS England (2018) GP online consultations systems fund Available at httpswwwenglandnhsukgpgpfvredesigngpdponline-consultations-systems-fund [Accessed 27 January 2018]

Patients seek help online RCGP Annual Conference Glasgow 1-3 Oct Available at httpgpaccessukevidencercgp-2015-no-more-hanging-on-the-telephone [Accessed 5 June 2016]

Plowright D (2011) Using Mixed Methods Frameworks for an Integrated Methodology Thousand Oaks CA SAGE PublishingRoland M (2015) The future of Primary Care creating teams for tomorrow Leeds Health Education EnglandPrimary Care Workforce

Commission Available at httpheenhsukwp-contentblogsdir321files201507The-future-of-primary-carepdf [Accessed 22 May 2016]

Siddique H (2015) More than 1 in 10 people in England could not get GP or nurse appointment The Guardian 2 JulyThe Information Centre (2010) GP Earnings and Expenses 200809 Provisional Report Produced by the Technical Steering Committee

September 2010 The Information Centre Leeds Available at httpwwwpssruacukpdfucuc2010uc2010_s10pdf [Accessed 15 June 2016]

The Information Centre (2010a) Investment in General Practice 200304 to 20092010 England Wales Northern Ireland and Scotland Annex A1 Summary table for England The Information Centre Leeds Available at httpwwwpssruacukpdfucuc2010uc2010_s10pdf[Accessed 15 June 2016]

REFERENCES

Useful resources [needs updating]

httpwwwbmjcomcontent350bmjh1513

httpswwwgovukgovernmentpublicationsthe-uk-your-partner-for-digital-health-solutionsthe-uk-your-partner-for-digital-health-solutions

httpgpaccessukevidence

httpaskmygpuk

httpwebgpcomhttpwwwdigitalhealthnetnews29915webgp-to-reach-millions