Informing clinicians and building patient trust

A personal experience impressed Dr Hannan with the power of the Map to deliver information that even experienced and conscientious GPs may not be aware of. Patients benefit too from being able to compare their treatment with recommended best practice, which can build confidence and trust in the system. For commissioners, the Map informs the discussion on what should be done and helps ensure groups don’t work as islands.

Dr Amir Hannan, a GP and primary care lead, describes the wide-ranging benefits the Map offers GPs, patients and commissioners (6:03)

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Amir Hannan: On the first day I was working at the out of hours service it was six o'clock and I had spent an hour and already seen seven patients with sore throats, as a GP that's my bread and butter and I sat there and thought gosh, what could the Map of Medicine possibly teach me that I already don't know about, I've just seen seven patients. So I decided to go on the Map in between when there was a break, looked at tonsillitis and immediately one of the things that came up was when should you refer somebody, and I sat there and thought gosh, I've seen seven patients at the out of hours and none of them have been referred to the hospital I wonder what the Map says? Now interestingly the Map came out with that if someone has had five episodes of tonsillitis in the last year, not four, not six but five, then that should be a trigger. What that suddenly told me was in the out of hours which is where you often see people with sore throats, maybe I should be asking the question, how many times have you had a sore throat and if someone says twice in the last year well okay this is the third time. But if they say five then I might turn round and say well maybe you ought to be referred to the hospital and suddenly I realised, wow, there is the power of the Map.

Interviewer: So it's challenging your own perceptions and your own knowledge and making sure, underlining the knowledge that you have?

Amir Hannan: It's probably not even challenging it at the moment it's just informing me, it's suddenly making me realise about information I didn't know, Doctor's educational needs or even the patient's unmet needs. I didn't know that actually if you've had five episodes of tonsillitis in the last year that you ought to be referred, it was the Map that gave me that, it wasn't my trainer, it wasn't all the magazines I was reading, it wasn't the Journals, it wasn't the training sessions I have, it wasn't the sitting in my training sessions with all my other colleagues, it was the Map that gave me that.

Interviewer: You're a great ambassador for the value of electronic information at the clinician's fingertips, can you tell us about your experiences of the value of health information in this way?

Amir Hannan: The biggest value actually isn't from the clinician's point of view but it's actually from the patient's point of view. I've enabled patients to access their full GP record over the internet so they can get to see everything, all consultations, all letters, all blood results, the whole shebang. Now since the Map of Medicine's become available on NHS.uk the NHS Choices website, in fact the day it became available I sent a message out to my three hundred patients saying 20 Maps are available now, please have a look at them, if you suffer with any of these conditions, have a look at the Map compare what you've experienced over the last five, ten years with what the Map says and then come back to me. Now there's all sorts of things about that, I have no idea what was going to happen, I didn't know whether we were providing a good service, a bad service or something indifferent. I didn't know whether there were things there that I need to think about as a Commissioner because they just haven't got it and the patients, within 12 hours had emailed back to me to say Doctor Hannan, there was one patient that came out and said ‘I wish I had seen the Map before, all I was given was anti depressants.' Another patient came out and said ‘actually I've seen all this and I got everything.' Now that sent a tingling down my back because there is a patient who didn't have to say that, who looked at her own healthcare that she had received by the whole of the NHS not just by me as GP, but the Councillors, by the hospital, by the Pharmacist as well as the practice and had turned round and said, I've received everything that the Map says. Now that is the kind of, the buzz that you get from that, it's unbelievable, it's higher than any kind of appraisal or any kind of audit that you've done. There is a real patient telling you they've got, and telling me the NHS has delivered.

Interviewer: You say that you are a Commissioner as well, what would you say the benefits are from a commissioning point of view of the Map?

Amir Hannan: Well one of the big questions that we commissioners have is where do we start? What do we want to talk about? As commissioners we might say that there seems to be a problem with our diabetes care or there seems to be a problem with accessing a certain kind of treatment modality, whatever it might be but they are not quite sure how are we going to change things, what are we going to change, what are we going to do? I would say it helps us to get into the discussion so that I don't think the Map should make the decisions I think people who ultimately are responsible for delivering care should be the ones who make the decisions, but the Map helps to inform us all.

Interviewer: One of the other difficulties always has been the relationship between primary and secondary care, have you found that the Map has any benefits to improving that relationship?

Amir Hannan: That's the next discussion that we are going to need to have. As practice based commissioners, as we start to commission new services clearly we don't work on our own as islands, we need to work with other colleagues in secondary care and as I said earlier in community care as well and of course patients, they are the other very important group of people to work with. I imagine that the Map will help us in those discussions because the discussions start from a point where we know 850 hours has been spent with specialists from primary care, secondary care and amongst patient groups, trying to develop something that's probably about right.

Interviewer: And what do you think is the best way of judging how successful the Map can be, because the NHS likes very much to measure things doesn't it and the success of things. How will you measure how useful the Map has been to you and our patients?

Amir Hannan: For me it's always been about my customer, the patient walking out the door feeling happy, feeling that they are getting good quality care and that they trust me as an individual but the organisation I work in and ultimately the NHS that they will do good. That should be the measure, that's the one that I'm using and I'm finding time and time again that patients using the Map get the confidence that they want and so do I.

Interviewer: Doctor Hannan thank you very much for your time.

Amir Hannan: Thank you.