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