berkley practice what is it like to be a patient? jo newton [email protected]
TRANSCRIPT
“How To Get Your Life Back,
Save More Money
and Have Happier Patients
Within The Next 12 Weeks”
Familiar?
Familiar?
Before Patient Access GPs, PMs and receptionists said…I’m
embarrassed when I see
rows of patients waiting
We’re going to have to get
another GP in at a cost of
£100,000.00
We all feel
totally drained
& I know that
patients aren’t
happy either
I’m annoyed by the huge number of
DNAsI dread the inevitable
phone blitz at 8 every
morning
I can’t take the
aggression from
frustrated patients
anymore. I can’t magic
up an appointment
Not To Mention The Patients…
I’m frustrated that I
can’t speak to my GP
when I need to. I’m
very tempted to
change surgeries
A lot of the time I
don’t even need to
see the GP, so why
can’t I just phone,
save the travel cost,
hassle & my GP’s
time?
We’re told to ring at
8 but can never get
through because
they’ve told
everyone to call at
8.
It’s a joke!
Why do I have a 3-
week wait at my
surgery & yet I hear
of others who see
their doctor the
same day?
Receptio
n takes
call
GP sees patient10-min
slot
Problem solved
70% “routine”
30% “urgent”
“All gone,call backtomorrow”
3 week waitHigh DNAsRepeat booking
See any GP/locumPoor continuityRepeat booking
Patientpressure
Reception takes call
GP phones patient
Problem solved
Come and see GP
Admin question
Come and see nurse
20%
20% 10%
30%
60%
60%
How Patient Access Works
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
What do patients think of our service?
• Administrative staff views– Not very happy – wait to see GP & opening hours– ‘Patients satisfied with system – can get to see GP at
their demand whatever day or time’
• Clinical staff views– Wait too long but then receive a good service– Can’t get through, access, inconvenient times, can’t
book ahead– Can’t see doctor so offered nurse triage which helps
My daily work at present
• Administrative staff views– Work very stressful– Can’t get work done, feel dissatisfied
• Clinical staff views– Face to face triage– Busy busy busy
My ideal work
• Administrative staff views– Want to help patients– Happy in current role– Would like to meet patients demands
• Clinical staff views– ‘Would like less stress and improved access’– ‘Would like to start at 9am, be in control and finish on
time’– ‘Would like to continue to do telephone triage’
Fear losses if changes are made?
• Administrative staff views– What will the effects be long term?– Will we lose control of GP appointments?– ‘Staff sanity and loss of control of appointments’
• Clinical staff views– How will my role be effected? (nurse)– None
Consultations all face to face, 6.5% of list per week, avg
Average wait to see a GP is 7 days. Imagine just 1.
Wide variety of demands on reception (NB many in “other” are GP or nurse requests)
Monday is MUCH busier than other days
High demand at 8-9am, but reasonable spread through the day. 97% of requests agreed – high!
One third of patients are walk-ins. This is high, again suggests it’s hard to get through.
45% of patients request a named doctor
Vast majority of patients want to see the doctor today- that’s why they called today.
Consultations – more on Mondays, good
55% of consults are acute or exacerbations, ie best dealt with today.
Very few phone consults at present, 97% f2f, but of the 4 phone consults, all resolved.
In your view, 38% did not need a face to face. Even more will be evident.
Continuity: despite patient views, yours is that it matters only 27% of consultations
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
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
10%
20% 10%
40%
50%
70%
Phone consults take about 3 minutes
Four practices, 17,000 patients, 9 months to May 2011
Traditionally, all patients
take ten minutes. Why?
Clarendon, a training and teaching practice in Salford.
Previously drowning in demand, now feelingon 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 patients who need it are
seen• Saving one clinical session
Within 12 weeks, response time median 30 minutes(now 19min)
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)
“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.
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
Evidence now links method with outcomes
Access & ContinuityTransformed, measured,
understood.
Patient safety & satisfaction
GP control of work load, staff job satisfaction
20% reduction fromfaster response
Lower costs within practice
Lower A&E attendance
Lower OP referrals and emergency admissions
GP service innovation- new thinking
20% reduction through improved continuity
& management
“I can see my own GP”
“Stress has melted away”
“We’re saving GP sessions”
Matching supply with demand coming in hour by hour enables outstanding patient service and the sense of
flow.
Loadmaster chart shows variation by day and hour.
Changing to demand led planning: the volume ranges of patient requests ranges from 5.5 to 10% of
list per week.
Note: 1. Practices have effectively unlimited access 2. Coding and data quality issues may affect comparisons
Safety: either doctor or patient can call for a face to face. Conversion rate falls through the day,
and varies by GP.
Calls after 1700 result in only 7% conversion
to ftf
Data from Thurmaston HC, 25/7/11 – 3/2/12. n = 10,367 callsBubble chart: area of circle in proportion to number of GP calls made by hourAssumptions: all GP appts booked following GP phone call, at time of call
1 in 3 called in at 8am, falling to 1 in
5 before 11
Over time, your patients are 20% less likely to attend A&E
At mean deprivation, line
shows 21% saving
Best fit line for 31 Patient
Access practices
Best fit line for 8,000 practices
Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH
Crucial to match demand & capacity
Monday Tuesday WednesdayThursday Friday Saturday Sunday0%
5%
10%
15%
20%
25%
We know that clinically urgent demandis about 23% of consultations (blue)
Offering an urgent only servicemeans a daily work profile with only around ¼ demand at weekends
Hence lower requirement for sessions
OOH one GP for approx 8,000 patients
When service is all day, by 1800 it drops off