Dr Arvind Madan

Hurley Group GP Partner

Co-Founder of eConsult

Former National Director of Primary Care and Deputy Medical Director, NHS England

Fast Facts eConsult• Started as an internal experiment in my practice

• Algorithmic dynamic questionnaires for every symptom or condition presenting to primary care

• Includes range of self-management tools / services

• Patient enters via practice website or NHS App

• Supplemented by photos and documents

• Asynchronously managed by MDT

• Aligned to day-to-day practice processes

• Average time to triage or close case is 3-4 minutes

• Large volume of admin requests e.g. Fit Notes

• Remote closure pre-Covid was 70%, now up to 97%

• So less than 1 in 20 patients need to come in

• 5% red-flagged and 3% supply led demand

• Growing range of ways to close the eConsult safely e.g. navigation to service, message, phone, video

• Popular with clinicians, who can work from home

• Popular with patients who have 24/7 access

• eHubs now beginning to form to aggregate eConsults across practices

• Improved outcomes e.g. mental health

• Moving into remote monitoring of LTCs

• Working on how to flow cases using AI

• Now 26M lives covered in 3,000 practices

• 124 MoD sites, including 10 international locations

• 2.5M eConsults done, no major significant events

• One eConsult submitted every 5 seconds

Live GP

PracticesPatients

Covered

Impact of Covid-19

Digitising Urgent and Emergency Care

Before…

Issues with current system:

• Critical cases may not be picked up early enough

• Lack of consistent history and patient required to repeat history many times

• Long waiting times

• Anxiety inducing environment

Book in Wait… Triage nurse Wait ~ 4 hours Clinician

Patients now follow a digital journey to access healthcare at the ED

After…

Automated check in,

history take

Automated obs, links to

record

O2Pulse

Blood

Pressure

Saturation

Respiratory

gases

Risk stratify NEWS2

clinician

Medical emergency

Majors

Majors/ minors

Pharmacy/ GP/ home

Minors/ UCC/ redirection

Signpost to

appropriate care

Joining up the systemPrimary Care has moved to Total Triage, and will want to embed

long term

• Popular with patients - 24/7 access and reduces unnecessary

visits

• Popular with clinicians who can triage, route and control workload

• Range of ways to manage patient remotely expanding all the time

• Ability to progress to AI routing and eHub working

Urgent Care is rapidly adopting a triage first approach, through

the 111 call handlers, 111 Online or other triage tools, like eTriage

• Fewer unnecessary attendances

• Right case to right advice or clinician, first time, every time

• Automation of check-in, observations, clinical prioritisation

• Improved safety and clinician productivity

Outpatients

• Ability to supplement referral with a structured history from

the patient improves the triage decision

• Increasing range of ways to manage the outpatient case remotely

• 10 Year Plan to reduce by 1/3rd

Primary Care

Urgent Care

Out Patients

Right case to right

clinician

through right modality,

first time, every time

We transform the way you deliver care

Used by over 3,000 practices

Available to over 26 million patients