gallions reach health centre what is it like to be a patient? thoreya swage...

Gallions Reach Health CentreWhat is it like to be a patient?

Thoreya Swagethoreya.swage@patient-access.org.uk

Outside a traditional surgery

People waiting on the phone, the same, unseen

The traditional model

Reception takes

call

GP sees patient

10 min slot

Problem solved

70% “routine”

30% “urgent”

60%

“All gone.Call backtomorrow”

3 week wait,high DNAs,repeat booking

See any GP/locumPoor continuity,repeat booking

Patientpressure

Rework

Face-to-face consultations vs telephone consultations

Appointment bookings by time of day

No of days wait to see a GP

Some appointments are up to two weeks ahead (or more)

About 28% are telephone consultations

75% of telephone consultations resolved there and then

Appropriateness of consultations – about 15% face-to-face not needed

Length of time for tel vs face-to-face consultations

GP continuity

What do patients think of our service?

• Administrative staff views– not enough appointments, difficult to get through on the

phone and difficult to get appointments with specific doctors – lack of appointments, unable to get through on phones– Patients get frustrated when they are unable to get an

appointment for 2 weeks– Often patients have to wait for a long time for a call to be

answered in order to make an appointment, – They have to wait too long for an appointment

• Clinical staff views– Difficult to make appointment or get through to reception.– Receptionists obstructive (though clearly just trying to cope

with demand)– No continuity with the same doctor, difficult to get

appointment on the day or when they want to be seen.– not seeing the doctor they wanted to.– difficult to get nurse appointment

My daily work at present

• Administrative staff views– it is very busy working on the reception and can be difficult

not being able to offer patients what they are asking for– stresses are caused by arguments with patients because of

lack of appointments– unable to offer appointments and dealing with upset

patients due to frustration.

• Clinical staff views– DNAs, inappropriate use of appointments– Having to follow up other Doctor's patients where I am not

happy to issue sick notes etc or have to catch up on long history in short period.

– can be very difficult, often older patients need more than 10 mins appointments. Also some patients don’t turn up often and clump problems together hence you over run, become stressed, more likely to miss things.

– People who book on the day appointments and don't turn up for them

My ideal work

• Administrative staff views– in an ideal world it would be good if every patient could

be offered what they ask for– I would like to offer patients appointments rather than

having daily arguments about lack of them.– I would like to help patients in every way, elderly

patients come in for prescriptions I would like to do it there and then not ask them to come back the next day.

• Clinical staff views– More appropriate use of appointments. More control over

my work load and continuity with patients. – for patient to get more flexibility when booking their

appointments .– Ideally i would like greater continuity with the patients – I want to manage my workload, I want to be able to

know what is going to be discussed in the appointment before the consultation

A practice in the Patient Access community looks a little different

Monday morning 8.30, Busy day, going full tilt.All carefully worked out.

Dr Chris Barlow of Quorn, oneof the earliest pioneers in 2000

The traditional view of general practice, every problem requires 10 minutes face to face with the GP

One tiny problemPerfect service

• We help all our patients, all day, every day• The Patient Access method makes this a daily reality.

A new principle is at work

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 GP

Admin question

Come and see nurse

10%

20% 10%

30%

60%

70%

“How are we going to help all our patients, all day, every day?”You answer, over five stages of the programme.

Consensus

Preparation

Staff surveyPatient surveyData captureTrainingSystem setupWhole team

New deal for patientsFeedback wallTest & learnBuild confidence

Launch day

Routine

ReviewEvidence:New measuresNew staff surveyNew patient surveyYour decision

Yes.Pledge toeach otherand to patients

What happens next?

• All to agree to a change• Change leader• Decide on a launch date• Do not book any appointments from launch date

onwards• Workforce planning (GPs and reception staff)

What happens next?

• Inform the patients– e.g. flyer, PPG, website, media, answerphone message

etc

• Train staff– Procedure for reception staff to follow

• Support provided by Patient Access training partner – before, at launch and afterwards

Which is the best pancake?

Cold and soggy

Hot, fresh and crispy