Conway PMS What is it like to be a patient? Thoreya Swage [email protected] [email protected].

Conway PMSWhat is it like to be a

patient?

Thoreya [email protected]

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

What do patients think of our service?(small sample – 5)

• Administrative staff views– NOT VERY HAPPY AT THE MOMENT RE APPOINTMENTS– patients seem to be happy with telephone triage but feel

they have to wait a while to prebook an appointment– I only really get to speak to patients about access when

they are not happy. There has been a reduction in complaints about access since we started a form of tel triage in the practice.

– SOME GOOD SOME BAD

• Clinical staff views– None recorded

Already, many patients ask for a GP phone call

Monday has much higher demand

Very heavy demand 8-9am. Little left later on.

Most phone, but 17% walk-ins suggest it can be hard to get through, or they think this will beat the

queue

A large number of requests are turned down. 17% “call again”, a lot of rework

Just over half request a named doctor

The vast majority who call want the doctor today.

Just 18 GP consults recorded – but mixture of phone, f2f

Telephone outcomes – views of GPs from daily work? (sample is only 5 calls so analysis only illustrative)

Small sample but this is typical, continuity important in around half of consults in GP view.

My ideal work

• Administrative staff views– happy working environment is essential which we are

lucky to have and helping patients and making them feel comfortable is our top priority

– More time for clinicians to see patients. Less frantic approach to healthcare leading to a safer service.

• Clinical staff views– None recorded

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%

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

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)

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

“Patient Access has given us a new lease of life” Dr. Kam Singh

• Work on the whole practice system with the whole team.

• Change is hard. We make the process easy and fast.• 5 stages over 8-12 weeks, knowing how you are doing• Every practice differs. You make the decisions.

You lead. We guide you through the change.

Which is the best pancake?

Cold and soggy

Hot, fresh and crispy