“We are on a journey of continuous improvement” – X-on Health on the digital front door of primary care access

In our recent HTN Now event focusing on digital primary care, we were joined by Paul Bensley (joint managing director) and Derrick Measham (research and development director) from X-on Health, for a discussion on cloud-based telephony.

Who are X-on Health? 

Paul began by establishing X-on Health’s background, stating that the organisation originated around 23 years ago, focusing on developing their Voice over Internet Protocol (VoIP) and contact centre phone system.

Paul explained: “It was a hosted system before the term “cloud” was invented. That was about 10 years after we started. Now we’re a cloud-based telephony system; however, we like to think of it as a broader communication system.” From 2015, Paul continued, they felt there was a growing “need to focus on the healthcare market, as we had a few customers who conveyed the need for more bespoke communication software to support general practice.” From that point, X-on Health focused “a lot of our product development in that area and have continued to do so since.”

As of 2023, X-on Health are working with nearly 2,000 general practice sites and have established themselves as a healthcare-centred organisation. Paul shared: “We’ve been on a journey of continuous improvement, listening to the needs of everybody from the practice manager, clinicians, GPs and patients to learn how we can make our product, Surgery Connect, as good as it can be. The journey is never finished, we are still listening and still changing the product to meet the maturing needs of our users.”

Surgery Connect, Paul explained, is “an intrinsic part of the digital front door” and is a “key part of the digital ecosystem. We have a rich integration with the main clinical systems, and we also have partnerships to analyse the data and create a frictionless ecosystem.”

In terms of staff numbers, Paul noted that they are part of Southern Communications Group which is backed by a team of around 800 staff. Surgery Connect is hosted in four data centres. “We take resilience very seriously,” he stated.

Cloud-based telephony

Paul provided a brief overview of cloud-based telephony for those who are not already familiar: “It enables practices to operate their phone systems via an internet connection, rather than the traditional physical telephone lines. I think of it like this – in the old way of delivering telephony, the brain sits in the practice. With cloud telephony, the brain has shifted out into our data centres; meaning that on-site, you just have phones, routers or potentially softphones on existing PCs.

“Cloud telephony doesn’t imply the use of softphones, but softphones are available on fixed or mobile devices. Cloud enables us to do things that we previously couldn’t do with the old system; for example, call distribution across a number of sites and organisations. We can route calls depending on patient choice or based on specific knowledge, pertaining to a patient to different groups or extensions.”

Surgery Connect 

Paul then provided some more information on Surgery Connect, X-on Health’s service to help manage patient access and rationalise communications.

He explained: “Surgery Connect works with other digital tools to provide the digital front door, allowing patients to contact their practice throughout the day – not just at the traditional eight o’clock rush.”

In terms of tangible benefits, Paul commented that Surgery Connect enables “better telephony, better communications, shorter waits and fewer calls. Similarly, integration with digital gives us better data, improved processes, better decisions and ultimately better outcomes.” He noted that sharing best practice and how best customers manage their telephony is a key aspect of X-on Health’s work.

“Surgery Connect follows the Modern General Practice Access model, which allows patients to contact their GP via the phone and – where appropriate – they are given options of dealing with their inquiry through an online resource,” he said.

Why isn’t everything online? 

Paul then considered one of the prominent questions routinely asked of digital leaders and organisations: why isn’t everything online?

Paul noted that people’s habitual patterns are a central reason, admitting that he will also pick up the phone to make an appointment despite his own awareness of online pathways and resources.

“Demography is the other main reason,” Paul continued. Using the older generation as a generalised example, he suggested that many older people will lack the ability or inclination to access online methods of referral and data access. Additionally, telephone triage is still “the main way that GPs will talk through a patient’s symptoms before advising them to come into the surgery.”

Paul noted that the social aspect of traditional telephone communication is another huge factor. “It’s reassuring to actually speak to someone, it’s a more expressive communication and we have been doing it for an awfully long time.”

X-on’s statistics

Derrick then took over the presentation, sharing some of X-on Health’s cloud telephony statistics.

“There are 26 million phone calls per month between patients and primary care, and 1.3 million phone calls a day,”  he said. “I think our peak at the moment is 37,000 concurrent calls. For us, this means on average that 11,000 phone calls are made every month for every practice – an extraordinary number of interactions with people.”

Sharing an example from Peel Hall Medical Practice, who have been using Surgery Connect for the last two years, Derrick said: “The total number of inbound calls at Peel Hall has reduced by over a half using some of the features we provide.”

Overall patient experience has been significantly improved as a result, Derrick added. He went on to demonstrate that the practice has seen a 77.3 percent reduction in call time, meaning patient queries are being dealt with much quicker. “A huge contributor to this has been our patient callback feature, which is a technology that allows people to avoid queuing on the phone and listening to hold music or messages. We then phone them back when they are at the front of the queue.”

These results have been achieved largely through X-Flow, which Derrick explained is their “tool for graphical call flow editing. It is a very simple drag and drop editor which allows anyone to edit their inbound call flow features.” Other features include text-to-speech and the ability to add in your own prompts “in your own voice if you wish, along with a simple option to add new menus and route patient calls to the right people at the right time.”

Further supporting features include a Wallboard, which provides full visibility of the phone system for the user, allowing them to “go back in time and see how they have been performing. There has been a real iteration loop of looking at what’s going on, making changes and seeing if it’s worked.” There is the ability to link X-Flow to calendars so that there are “different routes for different people at different times of the day or year” Derrick said, and another key feature sees patients who would like to go to the online consultation form “sent a link straight away via SMS, which has significantly reduced the number of calls at Peel Hall.”

Finally, Derrick highlighted how Surgery Connect reporting offers detailed metrics reports which allow users to “really drill down into detail, see what’s going on in the system and make decisions off the back of this information.”

Phonebar: improving patient access

Moving on to some of their latest projects, Derrick moved the conversation to focus on Phonebar – software they have developed over the last few years.

He said: “We have always had integrations with the clinical system, but they have been separate from the phone. With our Phonebar application, we’ve implemented a web softphone into the actual application itself. So it is really supporting the move for telecoms gradually coming onto the desktop and away from the handset in the corner of the room.”

One of the central aims of Phonebar is to support workflow and reduce the burden of admin tasks around telephone calls. Derrick went on to highlight some of the application’s features, which include click-to-call from the patient record; inbound patient identification pop-ups; photo requests via SMS or email; colleague availability; and internal and external directories.

“The patient identification pop-up is particularly useful,” he said, “research has shown it saves around 18 hours per user over six months. It may not sound like a lot but used in conjunction with some of the other features, these little wins all add up over time and produce something significant overall.”

Derrick continued: “The appointment list is unique to us, providing support for clinical triaging by allowing you to view the contact history for each patient and view all previous communications. Then you have the option to file that back into the system.”

Derrick then highlighted photo requests, explaining they can be sent ahead of time or during a consultation. He noted that there are no apps required; the patient receives a secure link either via SMS or email, and admin staff can send photo requests as well along with allocating the clinician that the photo is sent to. He added that a key feature of Phonebar revolves around clinical integrations, explaining that “all interactions can be filed back to the patient record to create continuity.”

Looking to the future, Derrick explained that research X-on completed indicated that seven percent of calls are to check an appointment, whilst three percent of calls are to cancel. For just two activities, this correlates to a significant number of calls, he said, “so we will definitely be looking at implementing time-saving measures to reduce this.” They are currently looking at developing check and cancel functionalities via X-Flow.

Looking ahead

Derrick emphasised X-on Health’s strong desire to expand their support more broadly, saying: “We don’t want everyone to go on a two-year discovery on their own. We’ve got a number of resources in place already in terms of training, support, information and help guides online. We also have our own online user group and we are about to collate all of those resources into our Surgery Connect Academy, which is due to launch soon.”

Paul then took over to summarise X-on Health’s developmental roadmap of the future, which forms part of their ongoing journey to “enhance the potential of digital voice.” One of the ways in which they will do this will see them “enhancing the appointments list functionality, with the ability to automatically place patients into the waiting room. This will cut down the time between consultations which will benefit both clinicians and patients.”

Concluding the session, Paul stated: “We are talking to a lot of our partners in the digital space to give more self-serve control, which will involve exchanging communications to and from digital solutions. Finally, data is hugely important; we have vast amounts of data and we see this as an opportunity to learn how access is being performed – and help us to optimise the patient experience.”

Thanks again to Paul and Derrick for joining us.