As we continue to develop new ways of working in Scottish general practice, face to face consultations are no longer the norm. Many practices are making much greater use of telephone and video consultations and good triage systems are essential to help patients use services most effectively. eConsult (@econsult_thinks) from WebGP is a platform which provides new and easier ways for patients to get help with a problem - whether through self help, online advice or via telephone, video or face to face contact where appropriate. It is all requested online through the practice website - which removes the need to phone the practice. This episode features a discussion with Dr Kris McLaughlin of Stonehaven Medical Group who spoke to Dr Andrew McElhinney of SNUG, along with other members of his practice team, to discuss the details of how best to get eConsult up and running, and what practical issues need to be addressed.
What is eConsult, and how does it work? eConsult demo site
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This month, we have a special edition of our podcast, starting to look at online resources for Clinical Decision Support, this time featuring a wide-ranging conversation with @medmyths James McCormack, Professor of Pharmaceutical Sciences at the University of British Columbia. We discuss why shared decision making about starting treatments is a vital part of Evidence Based Medicine, where many guidelines and the Quality and Outcomes Framework (QOF) may have got it wrong, and why Scotland's move to Realistic Medicine is to be applauded. We also discuss why lower doses of medicines are often better, how Homer Simpson can help you learn and what some of the beneficial outcomes from the Covid pandemic might look like.
Visit James McCormack's YouTube site to see these educational videos and more: Evidence-based look at Clinical Practice Guidelines, Dose response curve, The surrogate battle - is lower always better?
The Best Science Medicine Podcast looks at evidence for managing common conditions seen in Primary care.
The BSM CHD risk calculator not only calculates the 10 year cardiovascular risk but lets you easily see the benefits or harms of a range of interventions for that patient.
As usual comments are welcome via our Twitter or Facebook pages.
Graham Gault is the eHealth Lead for Dumfries and Galloway and he was involved in the Scottish Government deal with Microsoft to purchase Office 365 for the NHS. He speaks to Dr Neil Kelly of the Scottish National (GPIT) Users Group (SNUG) about how he expects #office365 and @MicrosoftTeams to start to transform the way the NHS works, providing new opportunities for flexible and collaborative working online. We will be able to share documents and other files much more easily, also speak and meet online, with an impressive reduction in the need to travel and improvements in cybersecurity.
The pandemic has increased the need for remote working and been a catalyst for rapid change within the NHS. General Practices can start to benefit now from this new ability to work, meet with colleagues remotely, and share documents in the Cloud. This will greatly ease the difficulties caused by the current need to save files within local systems. NHS Scotland will also get a new email system later on this year as NHS Mail is replaced.
"Massive opportunities...the industry is changing, and our single message is that people have got to change and embrace this", says Graham.
Learn more about how to use MS Teams at:
NHSScotland - An introduction to Microsoft Teams
NHSScotland MS Teams knowledge base
MS Teams - short training videos
Dr Jim Campbell is the Clinical Advisor to the @NHSNSS National GP IT Re- Provisioning Team @GPITScotland. He has been a key influencer in GP IT for nearly 40 years and describes his journey through the world of IT as a GP in Irvine, and GP IT advisor in Ayrshire, and also his roles with the GPASS Users Group, SNUG, and now NSS and GP IT Re-provisioning, with Dr Neil Kelly @NeilGKelly) of SNUG. Jim describes moving from a world in which all prescriptions and appointments were handwritten, and how he designed a Lunar Landing game, analysed orthopaedic discharges, asked if GPs were able to record disease incidence and prevalences, and then with the GPASS Users' Group, helped support other practices and share ideas, up to the present time, when he helps clarify the requirements for the new GP systems by developing "User Stories" to illustrate these to suppliers.
How will GP IT need to up its game during the current Covid 19 pandemic? He thinks the telephone and remote access to systems will be vital. How will the current crisis change peoples' perceptions of what general practice is going to be? That will be an on-going question.
A recent series of workshops called "Transforming the Primary Care Prescribing / Dispensing Pathway" was jointly sponsored by the Pharmacy and Medicines Division and Primary Care Division of the Scottish Government. We discussed some of the matters arising from these workshops and some potential solutions for Primary Care prescribing with Dr Scott Jamieson (@DocScott82) of the RCGP and Tony McDavitt (@skepticine) a Primary Care pharmacist in Shetland.
Topics included polypharmacy, barcode problems, increases in non-medical prescribing, who should do those medication reviews, why do GPs sign thousands of paper prescriptions which could be sent electronically, how to increase serial prescribing from general practice, can smarter IT systems give us better warnings when prescribing, and how can better communication between GPs and pharmacists help everyone do things better in the future?
Thanks to Prof James McCormack (@medmyths) for use of his excellent Bohemian polypharmacy video! See also his Youtube channel and listen to the BS medicine podcast to be better informed about using medicines well.
Dr Keith Moffett is a GP in Ayrshire and is a GP Clinical lead for NSS (National Services Scotland) within the ISD (Information and Services Division) Primary Care programme with NSS. This includes SPIRE (Scottish Primary Care Information Resource) which is a data extraction service for Scottish general practices. He is involved in planning and prioritising which reports will be developed and made available to practices, e.g. regarding high risk prescribing or identification of frail patients. The LIST (Local Intelligence Support Team) help practices, clusters and HSCPs to access and link different datasets for comparative data to help with quality improvement activities. Different extract requests can now be sent out and one new idea is to extract aggregate data relating to cancer and links to lifestyle factors data collected in general practice in order to plan cancer services better.
Keith and Dr Neil Kelly of SNUG discuss the rollout of SPIRE in general practice, plans to maximise its benefit, also data quality in general practice and some ways that this can be improved. The new SCIMP 800 codes are available here. Information governance around data extraction and plans to facilitate the use and improve the quality of aggregate data are also discussed.
Find out more on Twitter: @SPIREScotland #GPclusters @NHSNSS and do give us some comments either at @SNUsersGroup or on our Facebook page.
We also hear from a number of SNUG members about what they really want for Christmas!
ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. It was introduced in Forth Valley in 2017 and we speak to Dr Lynsey Fielden of Forth Valley Royal Hospital to find out more about what these conversations with patients may involve, some of the different settings they can take place in, and also how a new electronic version may help make this information more available in the future to health care professionals at the point of need.
This new ReSPECT application is being built on the NES Digital Platform, a new initiative to try and provide a single source of trusted truth for clinical care data. "We are building a care and health data repository for use by clinicians and social workers and others across Scotland..." says Dr Paul Miller who is a GP and one of the clinical leads for the new NES Digital Service.
You can find out more about ReSPECT and also the NES Digital Service (NDS) at the following links:
In an interview with SNUG co-chairman Dr Neil Kelly, Louise McTaggart describes her experiences working with general practices in the West of Scotland over a number of years. Louise started off as a practice manager in Glasgow in the 1990s and after working for a time as a trainer and IT facilitator for practices in Glasgow, she is now the National GP IT Re-deployment manager for the National Services Scotland GP IT Re-Provisioning team. She has a long involvement with the Scottish National Users Group and has garnered much knowledge about how best to help share ideas and tips to facilitate a variety of practices as they develop and use technology in a more effective way. As the challenge of helping practices move on to the next generation of IT systems grows closer, Louise will be involved with working with suppliers to carry out testing and assurance of the new systems before they are deployed to health boards.
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