parkside surgery what is it like to be a patient? harry longman, patient access...

Parkside SurgeryWhat is it like to be a patient?

Harry Longman, Patient Accessharry.longman@patient-access.org.uk

“How are we going to help all our patients, all day, every day?”

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

Launch programme12 weeks to a different practice

What do patients think of our service?

• Administrative staff views– Some patients get frustrated that they can’t have what they want– Mainly seen on the day they request...if ring before 11.00 will get in the

same morning with a GP– A few patients don’t like...new systems, and have booked appts earlier so

they have a time and date– Some patients don’t like to volunteer information

• Clinical staff views– Appreciate being able to see the docs quickly...surprised to be offered an

"on the day" appointment. – Easy to get in when wanted but not always with the GP they want– Appointments waiting time recently 4/52– "Like the continuity “ (provided they get it of course)– Like ease of access...flexibility– We are generally liked personally and patients seem to appreciate that we

try to get things right. Reception held in very high regard by patients (some that have transferred from other practices.)

My daily work at present

• Administrative staff views– My (phone) duties are...often non stop!– Stresses are generated from the number of patients the GPs need to see

every day to keep on top of the workload.• Clinical staff views

– 30-45 patients, some trivial, 11 hour days routinely, often more, feel drained...some features of burn-out. No time for meetings/management stuff, quality beginning to slip as a result.

– Getting busier, lot of inefficiencies in how we work, on call surgeries 'abused'

– A lot of the time is spent on "paperwork" type issues...arising from telephone and face to face consultations...overflows into my days off... at least 2hrs remote working...every day off and Saturday and Sunday.

– Long surgeries...Non-stop stress– Overwhelmed..12.5/day hours here...and at least 4-5 hours...from home

on days off. Current system fragile...no space for unexpected... burnout a real possibility.... On some days I hardly speak to anyone else in the team...pinned to the computer/ phone or seeing patients.

Outside a traditional surgery

People waiting on the phone, the same, unseen

The traditional model

Reception takes call

GP sees patient10 min slot

Problem solved

70% “routine”

30% “urgent”

“All gone.Call backtomorrow”

3 week wait,high DNAs,repeat booking

See any GP/locumPoor continuity,repeat booking

Patientpressure

Rework

Evidence of busy times at 8am, and not much later.

My ideal work

• Administrative staff views– Flexibility...upbeat...positive...friendly– To be able to offer more appts as this is sometimes difficult. To always

be polite and helpful to patients. – Workload...more manageable.

• Clinical staff views– Manageable lists.... Fewer inappropriate attendances.– More efficiency and not feeling...risk of missing the really important

ones– Less of the "paperwork" element. – Variety of clinical problems. Time to have regular clinical meetings so

the standards at the practice are maintained, time to manage elderly frail people better. The partners need time to be ahead of changes in the NHS, to manage the practice in a planned way and have time to communicate changes properly with all of the team.

Fear losses if changes are made?• Administrative staff views

– Patients will be wary...if can’t get what they need at the time they need.– Need to be kept aware of the changes and know how to deal with them– Alteration in working hours/days...reduction – New service may generate more complaints and lower satisfaction scores– Wary of breaching patient confidentiality

• Clinical staff views– Worried that patients may not like new system, patient satisfaction may

drop...clinical risk may increase. (Loss of) eye contact/body language etc. – (Loss of) income...(less) efficient– Patients may be at work or on there way when GP calls to triage them. – That the process may disadvantage the less assertive and people with

poor communication skills or who are depressed. – (Will not be able to) notice the incidental (symptoms) over the phone. – Older patients...have been used to a different system. – Changes may limit continuity – That it will be very intense...then won't have enough slots to see patients.– (Clinical) risks; PSQ will suffer, more complaints.

Reception data capture: Monday the highest

It’s very busy at 8am. By afternoon, little to offer.

77% of patient requests agreed. 10% told to call back

Continuity: 40% of patients name a doctor

Vast majority of requests are for same day

About 16% of requests are walk in – is it hard to get through on the phone?

Reception dealing with wide variety, high repeat scripts

GP volume is highest on Friday

Acuity is typical of most practices, majority acute, and new to follow up is 58%

Urgency also typical: most demand is acute & routine

Today, only about 20% of GP consults are by phone

But 80% of them are resolved over the phone(small number of NP telephone consults, 33% resolved, not sure about nurse?)

Nevertheless, you consider only 20% were “face to face not needed”

Continuity: GPs view, 30% important, lower than average

Navigator: GP consultation rate up 24% over 2 years. Wow.But current consults weekly rate 6.4% - moderate

Weekly pattern shows most on Fridays. Hmm.

We’ll be tracking phone response times, currently 2 hours

And days wait to see GP, currently 4 to 5 (though 40% are same day)

An interesting feature – your consults are much longer than most

The traditional model

Reception takes call

GP sees patient10 min slot

Problem solved

70% “routine”

30% “urgent”

“All gone.Call backtomorrow”

3 week wait,high DNAs,repeat booking

See any GP/locumPoor continuity,repeat booking

Patientpressure

Rework

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 reality.

A new principle is at work

Magic 1: Over half need only the call

Call fulfils demand See doctor Seenurse

Two practices, 8,000 patients, 9 months to May 2011

Magic 2: The call takes about 4 minutes

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

Traditionally, all patients take ten minutes.

Why?

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

20%

20% 10%

30%

60%

60%

Clarendon Practice, Salford,

turns round

Dr Jeremy Tankel, GP PrincipalHarry Longman, Patient Access

harry.longman@patient-access.org.uk

Average days wait to see a GP falls off a cliff.

All data from Clarendon, charts by PA Navigator

They now measure the wait in minutes. Median is about 30.

All data from Clarendon, charts by PA Navigator

Patients are more likely to see the same doctor. Continuity, so precious to both, is up 15%

This means that on multiple consultations, a patient has about 85% chance of same

GP

All data from Clarendon, charts by PA Navigator

Clarendon, a deprived population of 10,000, 3 partners, 3 sal GPs Why change and for what?

Before• Rising demand – falling

morale• Waiting room stress• Grumbling patients• All pre-books gone• Mad rush on phones at 8am

After• Demand high but stable• A “no-waiting” room• Free slots in most sessions• Patients love it• No need for 8am rush

A training and teaching practice, with a new NP.Previously drowning in demand, now feeling on 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 pts who need it are seen• Saving one clinical session

They know when the patients are going to call, by day, by hour, and the GPs are ready

All data from Clarendon, charts by PA Navigator

Rock steady 90% of patients are seen the same day – the other 10% chose to wait for their own convenience.

All data from Clarendon, charts by PA Navigator

As response has improved over time, the proportion of patients saying the service is “better” has risen to 76%, while those saying “worse” are now 8%.

All data from Clarendon, charts by PA Navigator

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

You lead. We guide you through the change