Setting the request limiter

How can you limit the number of requests patients can submit through Patchs?

Ideally Patchs should be unlimited and turned on 24 hours per day, 7 days per week. But from our experience and through our research, we understand practices only have a certain number of staff to deal with patient requests and a certain number of hours in the day to deal with them. This is a particular problem if staff members are off work unexpectedly e.g. for sickness.

Having too many requests to deal with can increase staff stress and worsen the problem. That's why we've made it possible to limit the number of requests you receive each day, should you wish, to match the capacity you have, and to turn off Patchs when you're closed.

Clinical vs non-clinical request limits

It is possible to limit clinical and/or non-clinical requests in Patchs. 

• Clinical requests are New health problems, Ongoing health problems, and Other types of requests
• Non-clinical requests are Medication and Admin types of requests

You may wish to put a higher non-clinical request limit (or not limit at all)  so that patients can still request medications when you're closed.

How to set request limits on Patchs

Loading the Demand Limiter

Go to 'Edit practice' under your name in the top menu (if you work across multiple practices that use Patchs this may appear as 'My practices' instead):

To edit your practice's request limit settings go to 'Demand Management' using the tabs at the top of the page:

Edit the 'Maximum number of requests patients can submit throughout the day' fields to update the request limit settings for your practice.

Setting Daily Periods

You can split each day into a number of time periods (up to 6) by clicking the edit icon:

Choose the number of time periods you  want the day to be divided into:

Finally, confirm your choice by clicking the change number of periods button.

Updating the Intra-day Limits

Clicking on a daily time slot (above) will load the request limits for the day (below):

In the request limits for the day you can enter the maximum number of requests allowed for each time period separately for clinical and non-clinical requests. When a request limit field is left blank the number of requests (of the particular type) patients can submit in that time period is unlimited.

Click 'OK' to update the limits for that day

Copying Request Limits

You can duplicate the daily request limit settings to one or more other days:

Choose the days you want to copy the current day's request limits to and confirm by clicking the Duplicate day button:

Click the 'Save changes' button at the bottom of the page to confirm the limits.

What standard messages do patients see when Patchs limits have been reached?

Patients will always see a message stating that Patchs is closed - either for clinical and/or clinical requests. For example:

If you tick the box 'If maximum requests limit is reached, show patients the next time Patchs is available for requests', patients will be told when Patchs is next open:

The patient will then be advised when Patchs is next available for requests. For example:

The 'Help' link they see directs to this article.

You can also create custom messages for patients when Patchs limits have been reached.

How many Patchs slots should we offer patients?

This should be tailored based on how your practice works, how many staff you have available, and what your patients want. Here are two potential approaches:

1. Unlimited: leave the rate limit blank so there is no limit on the number of requests patients can submit. In our experience for a list size of ~10k using Patchs for Total Triage, you will receive roughly: 200 requests on Mondays, 150 on Tuesdays and Wednesdays, and 100 on Thursdays and Fridays.
2. Scaled with Staff for clinical requests:
   1. Count how many clinicians you have working on Patchs.
   2. Decide how many Patchs requests you want each of them to receive.
   3. Multiply those numbers together. For example, if you have three GPs working on Patchs, and you want them to receive 20 requests each, your clinical request limit would be 3x20 = 60. How many requests you want each clinician to receive is a personal choice, and dependent on the practice and individual clinician. You can take a similar approach for non-clinical requests by working out how many staff members will be dealing with non-clinical requests. That may be non-clinicians such as receptionists, but it may include clinicians too.

 In our experience, somewhere between the following is ideal:

• Minimum: 12 requests per 1000 patients on your practice list per week. So for a list size of 10k that's 120 Patchs requests per week. Anything less than this and patients will get frustrated and you won't reap the benefits of Patchs.
• Maximum: 12 requests per 1000 patients on your practice list per average working day (i.e. averaged across Monday - Friday). So for a list size of 10k that's 120 Patchs requests per working day on average. Anything more than this and you risk being overwhelmed. This is an average figure, so you may get more on some days and less on others. For example, if you were doing 'Total Triage' without limits on the number of requests you received, you would expect more requests on a Monday and progressively fewer throughout the week. 

The skill is finding a happy medium between these boundaries. Each practice is different, and you will likely have to experiment until you find a good fit. The good news is you can view patient feedback in real-time (including when patients can't access Patchs) to see how you're doing.

If you're already using another online consultation system and are switching to Patchs, then a good rule of thumb would be to take how many requests you receive from your current online consultation provider on a 'good' (i.e. manageable) day and convert those to Patchs slots.

Using the On/Off switches

You can quickly stop new requests being submitted by patients to control online demand by using the request limiter buttons on the unassigned inbox.

If you use the off switches in the Unassigned inbox you will override any schedule you have set. Patients won't be able to submit requests regardless of what you have put in the limits table. They also won't be able to see when Patchs is next open for requests if you have chosen to display that information. They will see:

Don't tell patients to use Patchs if it's reached capacity or turned off. This may sound obvious, but we've seen it happen! Clearly this doesn't provide a good service to patients and they will just get frustrated.

I don't want patients to submit requests when we're closed - when should I turn Patchs off?

Patients have 30 minutes to write a Patchs request before they are timed out. Therefore if you don't want to allow patients to submit requests when you are closed, you should switch off Patchs at least 30 minutes before you close. You can see if a patient is still writing a request from warnings on the Unassigned inbox...