Digital Primary Care and Urgent Care in the NHS and internationally

Solutions to primary care decision support and supporting use of online consultations

Effective and efficient triage – the process of how best to prioritise patients in need of medical care – represents a constant challenge to both the NHS and international healthcare providers. The COVID-19 pandemic presented a major disruption to GP practices in 2020, with many consultations needing to move online. Through input into the Odyssey triage system and the NHS England toolkit for online consultations respectively, research by Professor Jeremy Dale and Dr Helen Atherton from Warwick Medical School has aided effective management of these complex problems in urgent care and primary care. The Odyssey triage system is used internationally, covering all ambulance services in New Zealand and around 30% of ambulance services in the UK and Australia. From March 2020 GPs were directed to the online consultation toolkit in order to reduce face-to-face appointments with patients.

The challenge

Ensuring effective triage is intended to allow efficient use of resources to better treat people in need. This is especially true of emergency and urgent care, where prioritisation can make all the difference in ensuring patients at most immediate risk are seen first while allowing those with less urgent needs to be directed to lower levels of response or self-care. The COVID-19 pandemic presented a further challenge for general practices with the need to substantially reduce face-to-face consultations presenting a new frontier for primary care.

Our approach

Research by Professor Dale and Dr Atherton is helping to answer critical questions which presented barriers to uptake and use of digital healthcare:

• Dale provided insights into the safety and efficacy of the Odyssey clinical decision support system in key areas, such as use of the system to accompany telephone assessment in emergency care assessment centres, before GP consultation, and at-scene emergency assessment of patients who have fallen

• This research directly influenced further development and marketing of the Odyssey system internationally

• Atherton was a co-investigator on the largest national study to date on alternatives to face-to-face consultation in primary care, and has led several studies that investigate the use of digital primary care.

Our impact

The University of Warwick has played an important role in advancing digital approaches to triage and healthcare. The Odyssey decision system is now used globally, including in ambulance services in New Zealand (100%), Australia (30%) and England (30%), playing an important role in this essential emergency care infrastructure. The East Midlands ambulance service who makes use of Odyssey have reported savings of over £10,000,000 annually, enabling them to save more lives through freeing up vehicles from non-emergency calls. Through her research and membership of the NHS England Primary Care Digital Transformation advisory group, Atherton directly contributed to the Using Online Consultations In Primary Care Implementation Toolkit launched in January 2020. With the 2020 COVID-19 pandemic, GP surgeries across England were instructed to reduce face-to-face appointments with patients, drawing on the toolkit’s advice. Atherton subsequently authored advice on assessment of text-based consultation which featured in the September 2020 NHS guidance on providing ‘total triage’ in general practice through online consultations. This guidance set out using complementary telephone and online consultation techniques to triage patients before attending physical GP premises, helping to reduce avoidable footfall and protect patients and staff from infection. Her work in this area continues with a further article, co-authored with NHS England, published in February 2021 ‘How to conduct written online consultations with patients in primary care.’