Unassigned inbox

When you first receive a request from a patient, the request will appear in the Unassigned inbox.

Typically non-clinical users like receptionists will initially review and triage requests, and either deal with them themselves, or assign them to clinical users if they require input from a clinician. 

Request being viewed by another member of staff

From the inbox view

A handy eye icon will appear in your Patchs inbox when a request is being viewed by another member of staff.

On the request details page

A yellow border will highlight the request details page when the request is being viewed by another member of staff. Hover over the eye icon to see who's currently viewing the message. Don't worry, you can still process the message while the alert is active!

Request details

Clicking on the request will load the patient's request so you can see all of the details.

Patient details and registration status

If the request is from a patient who is new to Patchs and their details have been matched in the clinical system - you should verify their contact details.

To do this you should check the contact details the patient has put into Patchs match those in the clinical system. You can see their contact details by hovering the button.

Specifically, you should to check the following details match:

1. Phone number
2. Email address
3. Home address 

It's especially important you check the email address is correct, as this is main way patients are notified about messages you send them - it's also the main way the patient verifies their Patchs account.

If any contact details don't match, or if any are missing in the clinical system...

...you should first contact the patient to confirm they signed up for a Patchs account. The best way to do this is by telephoning them - ideally you should use the number you have for them in clinical system, though this may be out of date.

If the patient confirms they signed up for a Patchs account you should then confirm which contact details are correct - the ones in Patchs or those in the clinical system.

If the ones in Patchs are right, and the ones in clinical system are wrong, you should update them in the clinical system.

If the ones in Patchs are wrong, you can either:

• Ask the patient to change them themselves.
• Edit them yourself in Patchs.

Once you have verified the patients' contact details., click the I have verified patient's contact details button to make the warning disappear. If the patient updates their details in future, this message will re-appear.

Further reading

See pages 42 and 43 of Using Online Consultations In Primary Care: Implementation Toolkit.

If the patient request has been submitted by a carer, or from a new patient who cannot be matched in the clinical system you should review their registration status.

Carers can submit requests on behalf of people they care for via Patchs. This function can also be used by care homes to submit requests for multiple residents. 

When the Carer registers on Patchs they do not need to be matched versus the clinical system because they may not be a patient at your practice. The patient they care for will be automatically checked in the same way as a normal patient (described above), but you will need to manually verify in the clinical system that the carer is correct for this patient.

There are 3 options:

• If the patient is registered at your practice and the carer is correct select Patient Registered and Carer Correct and this will unlock the request.
  
  
  
• If the patient is registered at your practice but the carer is not correct you should update their registration status to Patient Registered but  Carer Incorrect. Then click the 'Rejected - Patient Not Registered' button, to advise the carer by email that you cannot respond to their request because they are not a registered carer for this patient. 
  
  
  
• If the patient is not  registered at your practice you should update their registration status to Patient Not Registered. Then click the 'Rejected - Patient Not Registered' button, to advise the carer by email that you cannot respond to their request because the patient is not registered at the practice.
  
  
   
• All requests are 'locked' until the patient has been confirmed as registered.  

Add an urgency and assign the request (if required)

Having verified the patient details and confirmed their registration status you should add an urgency status by answering the 'How clinical urgent is this message?' in the 'Triage decision' section.

Adding an urgency helps you and your colleagues know which requests need attention first.

A detailed discussion of how to make triage decisions, including the clinical urgency, is provided in this article here.

You should then assign the request to the individual (or group) who is best placed to deal with the request.

• Clinical requests should be assigned to a clinician or clinician group
• Non-clinical requests should be assigned to a non-clinical member of staff or non-clinical group.

The benefits of assigning requests to other users are that:

1. It can decrease workload.
2. They benefit from an all-in-one system - they can reply to and video call the patient all within Patchs.
3. It doesn't clog up the patient record.
4. It's better for teaching and monitoring Patchs AI. 

We recommend triaging and assigning requests within an hour and sending a message to the patient to let them know you have received their request. This will decrease the likelihood of them calling you and chasing a response. 

If you are able to deal with the request yourself, you can deal with it from the Unassigned inbox or assign it to yourself. 

If you have dealt with a request from the unassigned inbox, you should then complete the request. 

Individual or group inbox (after assignment)

Add a triage decision

When you manage a request in your own inbox or from a group inbox, you should first of all add a triage decision. We recommend doing this first then updating them later as necessary. Further information on how to do this, and why we recommend doing it first is in How to make triage decisions.

Contacting the patient

Replying to a patient or requesting more information

If you need more information from a patient to complete your triage or want to reply to the patient with advice or information, you can do so directly through Patchs.

You can reply to the patient from the bottom of the chat history on the request details page.

And you have the choice of the message being:

• Reply required: patients can respond to your message.
• Reply not required: patients can acknowledge your message but cannot respond.

You can send a message to the patient in a number of ways:

1. Manually type a message: simply enter the text of the message you want to send in the text box:

• When you send a reply required message, this is what the patient sees:
  
  They can type their response and press submit. 
  
  
• When you send a reply not required message, this is what the patient sees:
  They can only click Close message to acknowledge they have seen your message.

2. Attach images or documents: You can attach images and documents to your messages by clicking the Add attachment button on the left.

Only png, jpg, jpeg, and pdf files can be attached with a maximum allowable file size of 5mb. 

3. Send a template (including NHS self-help links, Advice, Individual questions, Question sets and Questionnaires): Patchs provides a prebuilt library of advice links, message templates and questionnaires that you can send to the patient in just a few clicks by clicking the 'Pick message template' button. For further information, see Picking message templates. You can also build your own templates with our custom template builder, which is detailed here. 

All messages and responses are displayed in the request chat history:

Patients see one message at a time, so we don't advise asking multiple questions or sending multiple pieces of information in one message. If you do this, patients may miss them.

For safety reasons, you should instead send multiple messages to patients one after the other. Patients are shown the next message in sequence after they have responded to or acknowledged the first one.

Doing it this way ensures that patients reply to every question you ask, and that they acknowledge every piece of advice you send.

Therefore it’s important to only send messages as ‘Reply required’ if you actually need a response from the patient. This is because, if the patient doesn’t reply, they won’t see any messages you sent afterwards.

There is a countdown in the bottom left of the images above that tells patients how many messages they have left to view.

Awaiting a patient response

When a patient replies, the message moves to the personal inbox* of the staff user who sent the message. It will display the status: 'Patient message received for you'.

*The patient reply only goes to your personal inbox if the request is left there. If the request is moved to the 'Awaiting Reply' inbox, any responses go to the unassigned inbox.

If a patient doesn't reply, they will automatically be sent reminders. To find out more about reminder settings and how to configure them, take a look at this article.

If the patient continues not to reply to a message that is in only the Awaiting Response inbox (i.e. all tasks have been marked as done and a triage decision has been entered), then the request can be manually completed and the request will be moved to the Completed inbox.

If automatic completion has been enabled for your practice and a patient (i) doesn't respond to a message within a specified number of days and (ii) the request has been sent to the Awaiting Response inbox, Patchs will automatically complete the request.

Adding SNOMED codes and comments (optional)

• Diagnosis, symptom, or activity codes, to help with:
  • QOF achievement
  • Making sure your patients' notes are searchable in EMIS
• Consultation notes. If you speak to a patient on the phone or see them face to face.

Once SNOMED codes and comments have been saved into the clinical system they cannot be deleted from Patchs, and can only be edited directly in the clinical system.

Adding a task to other practice staff (optional)

When triaging a patient request if you want to assign a task to another member of staff you can do so by selecting the Tasks selector tab. 

This will open the 'Tasks' page where you can view existing tasks and add new ones.

From the Tasks page you can add a task by:

1. Choosing who to assign the task to
2. Describe the task
3. Click Add task
   
   

The new task will then be visible at the top of the Tasks page:

And the request will be added to the 'Tasks' page of the staff member with a status of Task for you.

Video (optional)

If you want to video call your patient to discuss their request, you can do this by clicking on the Video selector tab.

To learn more about Patchs video consultations, take a look at this article.

Completing a patient request

When you have finished dealing with the request you should complete the request and save to the clinical system as required.

When completing a request, the 'Complete message ' button will complete the request and move the request to the Completed inbox.

The 'Complete message and save to clinical system' button will complete the request, move the request to the Completed inbox and save it into the patient's record. 

If your practice has the 'Save questionnaire answers to clinical system when message is completed’  feature enabled, then questionnaire answers will be saved to the clinical system when you 'Complete message and save to clinical system'.

The 'Complete message and save to clinical system as attachment' button will complete the request, move the request to the Completed inbox and save it into the patient's record as a pdf. 

Requests with outstanding tasks

If the request has an outstanding task for another member of staff, you can move the request from the group or individual inbox to the inbox of the user who has been assigned the task. It will remain in the inbox of the user with the outstanding task until the task is complete.

Once the task is actioned, the request can then be completed.

Requests awaiting a patient response

If the request is awaiting a response from the patient, you can move the request from the group or individual inbox and it will remain in the Awaiting Response inbox. From here, it can be completed if no patient response is received.

The Completed Inbox

The Completed Inbox  shows all patient requests that have been completed. It can be accessed from your list of inboxes.

Each row shows the date and type of the request along with a request summary and patient name. The most recently completed requests will show at the top of the list.
You  can use the search box to find completed requests for a particular patient.

Request Details

Clicking on the request will show details of the initial patient responses, messages to the patient and triage decisions.