vanbrugh group practice what is it like to be a patient? thoreya swage...
TRANSCRIPT
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 v telephone consultations
70% face to face but a significant minority are by phone
Already 78% of phone consults are resolved over the phone
And 7% of consults seen as “face to face not needed”
Most requests for appointments are made between 8.00am and 9.00am
Large spike in demand at 8am
Significant numbers don’t get what they want, 12% told to call back (rework). No wonder they call
early.
No of days wait to see a GP is increasing
Some appointments are up to two weeks ahead
Most want to be seen same day, though a few booking ahead 7 or even 14 days. Why?
Continuity is about 73%
Continuity: 43% of patients name a doctor, and in 42% of consults, seen as important by GPs, key to
new design
Acuity: 66% acute or exacerbations, best dealt with today
What do patients think of our service?
• Administrative staff views– There are many that complain about long delays getting
through on the phone.– Find it frustrating getting through on the telephone and
on many occasions the 'same day' appointments have been used shortly after 8am.
– Hard to get through on the phones, scripts not ready on time. GP's/clinics running late
– Unable to get appt that suits them or with a particular GP
• Clinical staff views– Possibly concerns about getting appointments,
particularly with their preferred doctor & frustration with clinics running late.
– Sometimes complain can't get an appointment.– Clinical service is good and the staff very friendly but
that access is frustrating, especially by phone
My daily work at present
• Administrative staff views– My frustration is the telephones continually ringing, there
never seems to be enough people to deal with the demand.
– It is difficult explaining to patients that the 'same day' appointments have been used, which can be as early as just after 8am.
– Quite constant with calls– Not being able to offer apps sooner– Not enough appointments on certain days and often only
a duty doctor on in the afternoon
• Clinical staff views– Very pressured, stressed– Would like more continuity of care– Sometimes I feel a bit overloaded when I have extra
patients and phone calls booked in and this leads to stress. Sometimes I finish late due to extras.
My ideal work
• Administrative staff views– I would like to have less stress, trying to juggle workload, and
be able to deal with patients queries more quickly and efficiently
– Being able to offer patients an appointment or telephone call back at a date and time which suits them, and with a doctor of their choice would be ideal!
– To have more appointments that we could offer to patients– To have the time to deal with patient queries and get back to
them when you say you will.• Clinical staff views
– More time to complete admin work– would like slightly less pressure, to be more in control– Enough time for each patient and patients seen by one doctor
for most problems or at least for complex ongoing problems.– Patients’ access to be made easier– Ensure time available to see the patients that need to be seen
and to avoid pt that don't need to be seen.
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
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%
40%
50%
70%
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