Use case for out of hours and extended hours GP appointments in a federated GP environment

Brief description

A GP practice federation works together to provide out of hours (OOH) and extended hours (EH) services. When a patient requires an appointment outside their own GP practice’s open hours they are directed to another GP practice in the federation that provides appointments at those times.

On attending a GP appointment at a practice, the patient is not registered at, the GP seeing the patient will have full access to the patient’s GP record ensuring that the patient received the same standard of care. They will have access to the same information as they would if the patient was seen at their own GP practice.

Use case justification

Clinical and administration:

• Access to accurate information at the point of care reducing the opportunity for errors to occur.
• Reduction in clinical time wasted, away from the patient, collecting and collating information.
• Reduction in clinical time wasted, away from the patient, manually updating IT systems.
• Reducing the paper flow through departments/organisations by utilising the system workflow to manage tasks using staff time efficiently.
• Reduction in systems GP needs to have access to.

Patient-focused:

• Security of patient information is maintained and improved through the reduction of paper-based ‘patient identifiable documents’ in use within departments.
• Increased patient/clinician time due to reduction in clinician time spent collecting and transcribing information away from the patient.
• Increased patient safety due to the reduction in manual transcription errors.
• Better patient experience as they are not being asked for information which should already be available to the clinician.
• Better patient experience as they can book an appointment at an alternative GP practice and receive the same standard of care.

Primary actors

• GP
• GP practice nurse
• GP Connect
• GP clinical system (appointment) – the system used in the GP practice where the appointment takes place
• GP clinical system (registered) – the system used in the GP practice where the patient is registered

Secondary actors

• Patient

Triggers

• Patient attends a GP or nurse appointment at a GP practice they are not registered at.

Preconditions

• The patient’s details have been verified and entered on the GP system.
• GP staff have the correct/appropriate system access rights.
• The patient’s GP has agreed to share patient information via GP Connect.
• The patient allows this shared information to be viewed/used by GP staff.
• Electronic interactions between GP systems(s)/GP Connect/GP clinical system have been correctly configured.

Postconditions

• On success:
  • All the relevant available information on the patient’s medical history is viewable on the GP system patient is not registered on.
• Guaranteed:
  • The GP will treat the patient based on the information available.

Basic flow with alternative and exception flows

Step	Description
Step 1	Patient attends GP appointment outside of their registered GP practice.
Step 2	The GP logs into their usual GP practice system (appointment).
Step 3	GP searched for patient via NHS Number.
Step 4	The practices GP practice system (appointment) will request the patient’s record that is held in the GP practice system (registered) via the GP Connect service.
Step 5	GP Connect and the GP practice system (registered) will check that the GP practice is allowed access to the data and that the patient has not objected to their data being shared.
Step 6	GP Clinical System (registered) provides the full patient record. This will include: Medications (displayed in both date and alphabetical order) Acute medications Current Repeat Medication issues Including issues where patient has paper prescription but has not yet collected Medication marked as prescribed elsewhere Including dosage of medications in mg Past medications Repeat medications all issues/scripts to ensure that gaps in the patient taking the medication can be identified Post-dated acute medications Future issued of repeat medication where it has been amended Allergies Level of reaction What reaction occurs When allergy was reported If allegoric to the medication or part of the medication for a certain brand Example: colouring, lactose, eggs, gelatine Current problems and diagnosis Current referrals Vaccinations Compliance aids Preferred pharmacy Carer information Clinic appointments Key warnings and alerts Tests Investigations
Step 7	The GP system (appointment) imports the information supplied from the GP practice (registered). This data is now available for clinicians to view.
Step 8	The GP uses the information to assist their treatment of the patient.
Alternative path
Step 5a	Where there are not the appropriate permissions to share the data, GP Connect returns an error message saying the information cannot be returned. The GP treats the patient without access to their GP practice record.