Blackheath PMS Woodland SurgeryWhat 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

Reception 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

Why do patients call? 65% for a GP, many for nurse, admin, repeat

prescription

When do they call? Monday much higher

Requests: a problem: huge rush at 8am, a few more at 10.

Outcome of requests – 12% told to call back. Rework.

Vast majority of requests are for same day.

39% specified a named doctor, interestingly more often important to GPs at 52%.

GP consultations by day – compare fairly flat line with much higher demand on Mondays

50% of cases acute, clinically best dealt with today. This usually rises to around 60%

At present, 21% of consults are by phone

Of these, 73% were resolved on the phone.

Your view is only 21% more consults could have been by phone – though this often changes!

What do patients think of our service?• Administrative staff views

– On the whole, pretty good– normally excellent with us able to give same

day appointments or telephone triage calls with GP

– normally always good• Clinical staff views

– we provide enough same day appointments telephone advise & triage

– very good service, able to get appointment or speak to doctor with in a day

My ideal work• Administrative staff views

– I would like the time to be able to finish one task before being several others. I like interacting with the patients on a friendly basis. I think this helps patients to feel more relaxed as they wait to see the Doctor

– being able to be of help to all patients and clinicians when called upon. Improving my IT skills.

• Clinical staff views– need more time for face to face consultation &

telephone triage– more time to have face to face and paper work

Key points

• Demand variable by day, supply volume match looks OK with Mondays much higher.

• Patients ring the day they want to be seen, but most have to wait.

• Continuity (choice of doctor) appears more valued by GPs than patients – this can be improved with better access

• Currently some consults by phone, but resolve rate is on the low side at 45% which will mean a higher workload. The average is around 60%, saving time and increasing capacity.

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 saving20% 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

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

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)

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

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