berkley practice what is it like to be a patient? jo newton jo.newton@patient-access.org.uk

Berkley PracticeWhat is it like to be a patient?

Jo Newtonjo.newton@patient-access.org.uk

“How To Get Your Life Back,

Save More Money

and Have Happier Patients

Within The Next 12 Weeks”

Familiar?

Familiar?

Before Patient Access GPs, PMs and receptionists said…I’m

embarrassed when I see

rows of patients waiting

We’re going to have to get

another GP in at a cost of

£100,000.00

We all feel

totally drained

& I know that

patients aren’t

happy either

I’m annoyed by the huge number of

DNAsI dread the inevitable

phone blitz at 8 every

morning

I can’t take the

aggression from

frustrated patients

anymore. I can’t magic

up an appointment

Not To Mention The Patients…

I’m frustrated that I

can’t speak to my GP

when I need to. I’m

very tempted to

change surgeries

A lot of the time I

don’t even need to

see the GP, so why

can’t I just phone,

save the travel cost,

hassle & my GP’s

time?

We’re told to ring at

8 but can never get

through because

they’ve told

everyone to call at

8.

It’s a joke!

Why do I have a 3-

week wait at my

surgery & yet I hear

of others who see

their doctor the

same day?

Receptio

n takes

call

GP sees patient10-min

slot

Problem solved

70% “routine”

30% “urgent”

“All gone,call backtomorrow”

3 week waitHigh DNAsRepeat booking

See any GP/locumPoor continuityRepeat booking

Patientpressure

Reception takes call

GP phones patient

Problem solved

Come and see GP

Admin question

Come and see nurse

20%

20% 10%

30%

60%

60%

How Patient Access Works

A Typical Receptionist Day With Patient Access

Reception takes call

Admin question

20% solve

20% bookto see nurse

Just 60% list

for GP

Nurse

Per Week, Patient List Of

8,000

10-12% of patients call

28% on Monday

220 – 270 calls @ 2

mins

7 to 9 hours of calls

Other days 4.5 to 6 hrs

Many more calls will come

in the morning, but will

spread as a result of good

service

GP phones patient

Problem solved

Come and see GP

Come and see nurse

10%

30%

60%

A Typical GP Day With Patient Access

Per Week,

Patient List of 8,000

6-8% call for GP

Mon - 28% of the week

130 to 180 calls on Mon

80-120 calls on other days

Plan for 40 each per GP per

day

40 x 5 mins plus 16 x 10 mins

Total consulting time 6

hrs/day

Availability of nurse

consultations can reduce this

by ≈ 40 mins/day

Mornings more phone calls,

becoming more face-to-face

late morning & into afternoon.

A Practice In The Patient Access Community Looks, Sounds, Feels Different

Dr Chris Barlow

of Quorn, one of

the earliest

pioneers in 2000

Monday morning

8.30, busy day, going

full tilt.

All carefully worked

out.

Evidence from practices in the Patient Access movement

60% of calls don’t typically need an appointment

A rapid and safe system, where patients that need

to be seen are

7% list increase with no extra GP sessions needed at

Oak Tree Health Centre

We’re now saving

20% of GP working hours and A&E attends are

50% below Liverpool average - Dr Chris

Peterson,

GP at The Elms & Liverpool CCG

Urgent Care Lead

The Relief of Working Efficiently

What do patients think of our service?

• Administrative staff views– Not very happy – wait to see GP & opening hours– ‘Patients satisfied with system – can get to see GP at

their demand whatever day or time’

• Clinical staff views– Wait too long but then receive a good service– Can’t get through, access, inconvenient times, can’t

book ahead– Can’t see doctor so offered nurse triage which helps

My daily work at present

• Administrative staff views– Work very stressful– Can’t get work done, feel dissatisfied

• Clinical staff views– Face to face triage– Busy busy busy

My ideal work

• Administrative staff views– Want to help patients– Happy in current role– Would like to meet patients demands

• Clinical staff views– ‘Would like less stress and improved access’– ‘Would like to start at 9am, be in control and finish on

time’– ‘Would like to continue to do telephone triage’

Fear losses if changes are made?

• Administrative staff views– What will the effects be long term?– Will we lose control of GP appointments?– ‘Staff sanity and loss of control of appointments’

• Clinical staff views– How will my role be effected? (nurse)– None

Consultations all face to face, 6.5% of list per week, avg

Average wait to see a GP is 7 days. Imagine just 1.

Wide variety of demands on reception (NB many in “other” are GP or nurse requests)

Monday is MUCH busier than other days

High demand at 8-9am, but reasonable spread through the day. 97% of requests agreed – high!

One third of patients are walk-ins. This is high, again suggests it’s hard to get through.

45% of patients request a named doctor

Vast majority of patients want to see the doctor today- that’s why they called today.

Consultations – more on Mondays, good

55% of consults are acute or exacerbations, ie best dealt with today.

Very few phone consults at present, 97% f2f, but of the 4 phone consults, all resolved.

In your view, 38% did not need a face to face. Even more will be evident.

Continuity: despite patient views, yours is that it matters only 27% of consultations

Consensus

Preparation

Detailed planningStaff surveyPatient commsWhole team meeting

New deal for patientsPredicting demand & matching capacity.Patient & staff feedback

Launch day Routine

Review

New measures help tuning.Build confidenceAffirmation

Yes.Pledge toeach otherand to patients

Launch programme - just 12 weeksto a happier, less stressful practice

Simple, but the whole system changes

PA Navigator measures the flows, which vary by GP & practice.

Reception takes call

GP phones patient

Problem solved

Come and see GPAdmin question

Come and see nurse

10%

20% 10%

40%

50%

70%

Phone consults take about 3 minutes

Four practices, 17,000 patients, 9 months to May 2011

Traditionally, all patients

take ten minutes. Why?

Clarendon, a training and teaching practice in Salford.

Previously drowning in demand, now feelingon top of workload

Before• Frustrated, stressed

doctors• Miserable reception staff• Unhappy patients• Reputational issues• List size effect

After• Reduced stress!• Abuse of reception staff

gone• All patients who need it are

seen• Saving one clinical session

Within 12 weeks, response time median 30 minutes(now 19min)

Golden Rules

• If telephone lines open 9am, so do Dr callbacks• All patients are called back – no Doctors appointments

made by receptionists• Call back within the hour• All Drs on telephone call backs (exception Duty Dr or

locum/trainee)• Call patients in for face to face from mid morning (and

mid/late afternoon)

“Patient Access has given us a new lease of life” Dr. Kam Singh

• Work on the whole practice system with the whole team.• Change is hard. We make the process easy and fast.• 5 stages over 8-12 weeks, knowing how you are doing• Every practice differs. You make the decisions.

You lead. We guide you through the change.

Consensus

Preparation

Detailed planningStaff surveyPatient commsWhole team meeting

New deal for patientsPredicting demand & matching capacity.Patient & staff feedback

Launch day Routine

Review

New measures help tuning.Build confidenceAffirmation

Yes.Pledge toeach otherand to patients

Launch programme - just 12 weeksto a happier, less stressful practice

Evidence now links method with outcomes

Access & ContinuityTransformed, measured,

understood.

Patient safety & satisfaction

GP control of work load, staff job satisfaction

20% reduction fromfaster response

Lower costs within practice

Lower A&E attendance

Lower OP referrals and emergency admissions

GP service innovation- new thinking

20% reduction through improved continuity

& management

“I can see my own GP”

“Stress has melted away”

“We’re saving GP sessions”

Matching supply with demand coming in hour by hour enables outstanding patient service and the sense of

flow.

Loadmaster chart shows variation by day and hour.

Changing to demand led planning: the volume ranges of patient requests ranges from 5.5 to 10% of

list per week.

Note: 1. Practices have effectively unlimited access 2. Coding and data quality issues may affect comparisons

Safety: either doctor or patient can call for a face to face. Conversion rate falls through the day,

and varies by GP.

Calls after 1700 result in only 7% conversion

to ftf

Data from Thurmaston HC, 25/7/11 – 3/2/12. n = 10,367 callsBubble chart: area of circle in proportion to number of GP calls made by hourAssumptions: all GP appts booked following GP phone call, at time of call

1 in 3 called in at 8am, falling to 1 in

5 before 11

Over time, your patients are 20% less likely to attend A&E

At mean deprivation, line

shows 21% saving

Best fit line for 31 Patient

Access practices

Best fit line for 8,000 practices

Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH

Crucial to match demand & capacity

Monday Tuesday WednesdayThursday Friday Saturday Sunday0%

5%

10%

15%

20%

25%

We know that clinically urgent demandis about 23% of consultations (blue)

Offering an urgent only servicemeans a daily work profile with only around ¼ demand at weekends

Hence lower requirement for sessions

OOH one GP for approx 8,000 patients

When service is all day, by 1800 it drops off