Sooner or later, it seems inevitable that geographically dispersed organisations must consolidate. GP Surgeries are following railways and banks in seeking the economies of scale afforded by serving some or all of their functions from larger units. As with railways, where operators made inconveniently personal decisions on matters of gauge and operating procedures, there are technical obstacles to overcome.
Consolidation may be a handful of surgeries forming a local hub, sharing call handling and appointment booking services. At the ambitious level, new district or county wide numbers are used to promote primary care services, serviced by call centre staff with access to local resources and specialities that would be not be feasible on a small surgery scale.
Consolidation can make more efficient use of centralised pooled resources, such as dedicated call handlers, or pools of GPs offering immediate triage advice to patients. Relief can be offered to surgeries struggling at peak times or where emergencies, sickness or training mean that it is not possible to deal with patient enquiries for a period. A consolidated hub can be better performance measured, with SLAs for call answering and to provide same day services to patients where that is the stated objective. It also allows extended hours to be serviced without each surgery offering it being burdened with the extra staffing costs.
At the smaller scale, a sudden change to the patient experience may be a culture shock. In small rural surgeries, patients and receptionists know each other and conversations start with a level of implied knowledge.
However the bigger challenges are likely to be technical. A central Call Handler will need to know which surgery the patient is registered with. Consolidation of call handling does not imply that the Clinical Databases are merged, and more often than not the central hub will need to refer to a number of separate systems, sometimes from different vendors.
Identifying patients and greeting them with their "home" surgery must be a slick process to avoid slowing things down. If an appointment is to be booked, again real time access to the correct Clinical Administration System is required to manage appointments.
Where the plan is to distribute calls to a pool of GPs for immediate triage, the system must be geographically agnostic, since it is unreasonable to expect those GPs, with their own schedules, to sit in a call centre and provide the required level of cover. A distributed group is required, with visibility of availability from the centre.
Solutions on Hand
Traditional telephony systems tend not to be up to the job, but fortunately there are now cloud based contact solutions that can handle the phone requirements and extend into other forms of patient communications, such as video and text messaging.
As data is integrated with the clinical administration system, patients can be identified as they dial in, before being transferred to a call handler. This means that the call handler is prepared with knowledge of the patient ID and their home surgery. There is the option to identify patients in groups with particular needs and give them specific information, such as encouragement to attend flu clinics.
Data integration also allows the call handler to view free/busy slots in sessions at the surgeries where appointments are available for booking. Appointments can be booked and confirmed directly. Cancellations and alterations can also be managed.
Managing triage operations is also essentially a call centre activity. GPs can make themselves available, individually or in groups, and either take inbound patient calls directly or be allocated callback slots.
A real time view of call activity and the status of other users of the system is an essential management tool, as is a comprehensive set of performance reports. It will enable managers to demonstrate that the consolidation is delivering the promised efficiency and, once running, maintain standards though SLA for call handling performance. The option to record all calls and associate the recordings with patient records mean that there is a secure audit path for activities.
Consolidation in the cloud gives many future options for enhancement. The platform can incorporate speech recognition and speech analytics software to enable patient calls to be semi automated or completely self serve, without the use of a call handler. The platform can handle video and rich text data communications in addition to voice calls.