The Diversion Myth

I heard Cleveland Henry last week, Director of Delivery for NHS Choices, pointing out that the site now has nearly 1.7 million visits per day.  At 57%, the vast majority are patients seeking advice and help from Health A-Z.  Good news, patients are educating themselves and the quality of information, all independent of commercial interests, is excellent.  We are one of 600 providers who link to the site and encourage patients to use it.

Wait a minute, that’s more than the number of patients who consult a GP each day.  All very well, but if we’re led to believe that online information will divert patients away from their GP, we’d have seen a steady drop in consultations wouldn’t we?  Not the message I’m hearing from GPs, and not the BMA/RCGP line – they’re all loaded up more than ever.

Diversion – we’ve heard it all before.  Walk-in centres, renamed Urgent Care centres, were going to divert people from A&E: the new supply has simply induced demand.  NHS111 was going to divert people from the emergency care system:  it’s now responsible for 31% of ambulance calls, and A&E is choked as ever.

When will they ever learn, diversion means chasing the end of the rainbow.  It’s a tough message to hear, but the demand is the demand.  It isn’t rising inexorably, it’s almost flat, but it won’t go away.  No, I’m not about to propose another even more cunning diversion plan.

Now if we have stopped pretending and faced the facts, what can we do about it?

  • Stop diverting.  It ends up with rework, patients trying again but using a more expensive route.
  • Stop rework demand, which is when it doesn’t work first time so patients try again
  • Stop anxiety demand, the book ahead, book early tactic based on fear of missing out
  • Deal more efficiently with the demand we know we are going to get – it’s predictable.
  • Resolve the patients’ concern first time, through the fastest, simplest most effective channel.

Sorry if this is grandmother & sucking eggs.  If this was the entire focus of the NHS, I’d stop saying it now.

Harry Longman

PS  I’ve just been told about this fascinating RCT published BJGP Feb 2014, van der Gugten et al: E-health and consultation rates for respiratory illnesses in infants.  “Although parents appreciate the information, this study suggests that an online information program on respiratory illnesses in infants does not reduce healthcare consumption.” 

PPS Heard from Fullwell Cross practice in Essex this week, in the two months since they launched their new GP Access system, calls from their patients to the local OOH hub have halved.  Oh, and complaints have dropped from 60/month to 2/month.  That’s not diversion, that’s efficient service.

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