Threeways Surgery What is it like to be a patient? Thoreya Swage, Patient Access [email protected] [email protected].

Threeways SurgeryWhat is it like to be a patient?

Thoreya Swage, Patient [email protected]

Outside a traditional surgery

People waiting on the phone, the same, unseen

The traditional model

Reception takes callReception takes call

GP sees patient10 min slot

GP sees patient10 min slot

Problem solved

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

80% of consults are face to face, but quite a few by phone

Of those, 56% resolved over the phone

Though when asked if consultation was appropriate, only 10% said it could have been by phone.

Hourly demand, slopes downward, good service implied here

GPs see continuity as important in 38% of consultations.

57% of patients ask for a named doctor. Significantly more than GPs. Something that needs to be addressed, and can be.

Vast majority of requests are for same day

But still 10% of requests told to call back another time - rework

30% of requests from walk ins suggest that patients find it difficult to get through on the phone.

Patients’ views of our service• ‘Difficulty in getting appointments/lack of appointments’• ‘Patients like the continuity of seeing the same doctor but we

have to have locums in and they are not always happy to see them as an alternative’

• ‘many new patients have left their old surgeries to join Threeways because they have heard such good things about it’

• ‘Most people seem happy about the quality of the consultation but are always fed up with me running late’

• ‘Excellent. Only frustration can be getting through at 8-9am on the phone and 2-3pm i.e. peak call times

My daily work at present

• ‘on commencement of shift there are rarely enough appointments available’

• ‘Gaining more patients and no more appointments’• ‘would prefer to have any visits assigned as soon as

they come in to aid time management/planning’• ‘very stressful and the feeling is that all members of

staff are being stretched to the limit’• ‘lack of appointments with particular GPs’• ‘very long hours, most days 12-13 hours

My ideal work• ‘more flexibility in working hours and more late

appointments for people who work’• ‘having enough appointments’• ‘a surgery where all streams of work are seen and dealt

with by the appropriate staff member. Time in the day to check results and paperwork and may be even have a cup of tea and see other staff members’

• ‘To be able to give patients appointments at the times they would like and to generally have more appointments’

• ‘seeing only those patients who really need to see a doctor’

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 daily reality.

A new principle is at work

Simple, but the whole system changes

PA Navigator measures the flows, which vary by GP & practice.

Reception takes callReception takes call GP phones patientGP phones patient

Problem solved

Problem solved

Come and see GPCome and see GPAdmin questionAdmin question

Come and see nurse

Come and see nurse

10%

20% 10%

30%

60%

70%

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 3 minutes

Four practices, 17,000 patients, 9 months to May 2011

Traditionally, all patients

take ten minutes. Why?

“How are we going to help all our patients, all day, every day?”You answer, over five stages of the programme.

ConsensusConsensus

PreparationPreparation

Staff surveyPatient surveyData captureTrainingSystem setupWhole team

New deal for patientsFeedback wallTest & learnBuild confidence

Launch dayLaunch day

RoutineRoutine

ReviewReviewEvidence:New measuresNew staff surveyNew patient surveyYour decision

Yes.Pledge toeach otherand to patients

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