Survival – ‘managing demand’ A Stowhealth solution
Dec 17, 2015
Options and Decision
Do nothing - people would have walked! Pour in more resource – not an attractive or
sensible option Try and manage demand better?......
Our Methodology
Look at the options Get an external review - choke on the next step price Do it ourselves
What were we doing?
"Hybrid system":
- Pre-booked routine surgeries
- On The Day Team: staffed by 2 Drs/session, NP am + limited Minor Illness support
Separate LTMC clinic: LTC reviews/QOF delivery
External review
"Patient Access"
www.patient-access.org.uk
Facilitated in-house survey of:
Reception: How often were you able to give people what they wanted?
Clinicians:
New/follow up
Acute/Acute-on-Chronic/Chronic
Continuity important?
Continuity achieved?
Duration of face to face consults around 12 minutes, and telephone stable at 4 minutes is on the fast end.
Continuity: judged important mostly for chronic conditions, also many acute, 42% overall, and 8% gap where not achieved.
Where continuity matters, and is achieved, 62% of consultations are resolved, cf only 39% where not achieved.
What next?
Balked at £13K + quoted for further input Do it ourselves! Working party - Doctor, Business Manager,
Nurses, HCAs "Suck it & see" Regular review Constant tweaking
How will the new system change things?
Reception takes call
GP phones patient
Problem solved
Come and see meAdmin question
Come and see the nurse
10%
20% 10%
30%
60%
PA Navigator measures the flows, which vary by GP & practice.
70%
Principles
Triage all Doctor appointment requests Ask patient if there is a specific Dr that they
wish to speak to - if not, allocate in turn Use Minor Illness clinic where appropriate Clinicians can book future appointments -
beware tomorrow's demand! Never refuse an appointment if patient wishes
to be seen
Unchanged
Bloods LTMC Learning disability reviews Mental health reviews Postnatals Baby checks Baby immunisations
Outcomes - September 2013
Average number of telephone calls/Dr/session - 17.7 (range 15.0 - 21.3)
Average number of face-to-face appointments/Dr/session - 4.4 (range 3.2 - 6.3)
Average conversion rate - 25% (range 18.2 - 36.3%)
Other findings
Demand is predictable (& finite!)
3/4 of daily phone demand received by 1pm
2/3 of total daily work (phone + face-to-face) dealt with by 1pm
Activity has fallen since outset, but now stable
How does it feel? Patients and Staff
Patient survey 300 questionnaires sent Ratio - 2 telephone only: 1 face-to-face 110 responses received
Staff survey 26 responses received
PATIENT - Did you find it convenient to receive a call back from the clinician
during surgery hours?
YesYes 89%
NoNo 11%
PATIENT - Were you satisfied with the outcome of your telephone
consultation?
YesYes 88%
NoNo 9%
BlanBlankk
3%
PATIENT - If required, were you given an appointment on the day that you wished
to be seen?
YesYes 87%
NoNo 13%
PATIENT - How was your experience of our new appointment system compared
to our previous system?
BetteBetterr
50%
SameSame 31%
WorsWorsee
17%
BlanBlankk
2%
STAFF - How would you rate your ability to meet your patients needs? (n=26)
BetteBetterr
73%
SameSame23%
WorsWorsee
4%
STAFF - As a result of our new appointment system, do you feel more
in control of your working day?
YesYes 54%
NoNo 19%
BlanBlankk
27%
STAFF - What is your experience of our new appointment system compared to
our previous system?
BetteBetterr
80%
SameSame 20%
WorsWorsee
0%
Pros
See the patients that need to be seen, not just those willing to wait
Better continuity Better understanding of demand Better able to match capacity to demand Clinicians feel more in control of their working day Fewer late finishes Little needs cancelling if absence/sickness All demand dealt with at end of day - the phones do
stop ringing!
Cons
Hard, intense work - timely call backs important Difficult for some people to receive call backs whilst
at work Very sensitive to "bums on seats" - can't restrict
demand! Requires stricter holiday planning Half days Needs telephone triage confidence Need good LTC/QOF systems