Online consultation re-procurement


To:          GP Partners

                Practice Managers

                Practice IT leads 

Sent: 13th August 2021 for action by 24th August 2021 

As you may know, practices need to undertake a process of re-procuring their online consultations tools over the next few weeks. There are various contract end points currently in place as, across the CCG, there are various systems in use, namely eConsult, EMIS Online Consult, AccuRx Patient Triage, AskMyGP, Dr. iQ and Engage Consult.

The CCG has been working with the NHS central procurement hub to find the best option for procurement. The best approach appears to be via the Digital First Online Consultation / Video Consultation framework (DFOCVC: https://buyingcatalogue.digital.nhs.uk/solutions/dfocvc001), which gives us a number of options: 

  1. Practices can simply place an order for the product they want to use. The price will be fixed at whatever is on the framework. Procurement experts we have been speaking to think those prices are relatively high and will exceed the 24p-per-patient (24ppp) budget that the CCG has received. Any practice is free to go down this route but will only receive 24ppp and will need to pay for the extra from their own resources. At least one practice in NEL has already chosen this route. 
  1. The preferred route is for the CCG to work with the procurement hub to undertake a mini-competition. This will involve the CCG asking practices what sort of system they wish to use. There appear to be three basic types of system: 
  • Questionnaire based systems require the patient to answer questions to effectively gather the sort of information that a clinician might do within the first two or three minutes of a consultation. Numerous choices of questionnaires depending on the presenting problem, with some self-help guides. Depending on the answers given, patients will have further questions to answer in order to gather as much relevant information as possible. These systems have the ability to raise a specific ‘red flag’ when a patient answers some key questions in certain ways and as above, advise the patient to immediately contact another service such as 111, 111 online or 999 and the form cannot be completed. Systems tend to have an inbox that practice staff use to review the OCs they have received and assign them to the appropriate clinician or team for further action. 
  • The second category is similar to the first in that they are questionnaire based but they use an artificial intelligence process to guide the questions and make suggestions around diagnoses and most appropriate team to deal with the problem. Information is presented to the practice in a dashboard including an assessment of urgency to enable the practice to consider priority. Practices can work with suppliers to tailor the system to fit more closely with the ways each practice wishes to work. The practice can, if they so choose, be informed of OCs that have resulted in a recommendation for the patient to contact 111 or 999 in hours, and can choose to let the patient submit these to be flagged as urgent, in hours set by the practice. 
  • The third category are for free-text based systems that only require a small number of data fields to be filled in by the patient such as their identifiers, along with free text boxes for patients to tell the practice their concerns, symptoms, etc. There are generic red flags symptoms the patient must answer on each form and if any are ticked, they advise the patient to immediately contact another service such as 111, 111 online or 999, and the form cannot be completed. These systems are generally easier for patients to use but give little structure to the information that the practice receives. The quality and detail of information provided by the patient can therefore vary greatly. This system will require the practice to have an internal process to triage and allocate to the appropriate clinician.

In order for the procurement team to have a good understanding of demand we have created a short online questionnaire. Please ensure that only one response is sent from each practice. Your answers to the questionnaire do not commit your practice to anything at this stage; it is simply to give the procurement team a feel for demand. Please complete this questionnaire by 24th August 2021: https://docs.google.com/forms/d/e/1FAIpQLSe7dllue5YnZg2T8tW2oYKaEjMrMfH68eldmv9HW2Zp49h-dA/viewform?usp=sf_link 

Once the level of demand has been determined, the procurement team will run the mini-competition, asking providers to quote based on the expected number of patients needing to be covered; the expectation being that the more patients covered, the lower the cost per patient is likely to be. Responses will need to be evaluated and a moderated score arrived at. If you would like to be involved in the evaluation process, please indicate on the questionnaire. 

The aim is to provide a choice of three different systems depending on how you wish to operate. Assuming a good percentage of practices are interested in each system the price should be within the 24ppp envelope. There is no requirement to ultimately choose either the type of system you choose in the questionnaire or to choose any one of the three selected as a result of the procurement exercise; practices can choose to buy direct from the catalogue. 

Ideally, all practices in a PCN will use the same system so that they can explore opportunities to work more collaboratively in the future, potentially having a central triage and administrative function to deal will those OCs that don’t require continuity of care. We appreciate that this may evolve over time but it would be good for PCNs or other groups of practices to consider this approach. 

Any contract entered into via the DFOCVC framework will be for a minimum of three month, after which it can be changed with just a months’ notice. In the event that you wish to change supplier, it might be necessary to contract with your existing supplier for three months in order to be able to ensure a smooth change over. If you have any questions, please contact the Digital First team on elhcp.digitalfirst@nhs.net 

Many thanks for your time. 

 

Dr Laura Scott

Dr Maryam Ahmad

Martin Wallis

Clinical SRO

Clinical SRO

Managerial lead