South Axholme Practice PathfinderWhat is it like to be a patient?

Harry Longman harry.longman@patient-access.org.uk

Pathfinder – for informed consensus on change

Analysis

• You know you have a problem and something must change• You’ve seen the evidence that this works elsewhere• But you want to see the picture with your own data

Within two weeks, and without any paperwork, you find out. Now you have the basis for consensus on change.

Meeting with partners Decision

Leadership questionnaire

Navigator6 m history

DatalogReception, GP

Staff survey

Over two years there has been a slight fall in face to face consults and rise in telephone consults. Patient contacts are about 5% of list pw.

Looked at by time of day, opening at 8.30 is a bit busy.

Monday has about 50% more demand than other days

About 68% of appointments are booked same day

But the average wait to see a GP is about 3 days.

Phone consults are responded to, over a variable time up to 4 hours

Continuity is flat around 65%. Reflects frustrations.

What do patients think of our service?• Administrative staff views

– (Patients) become frustrated when they cannot get appointments straight away.

– Seem to get more demanding about who they will and won’t see. – Often want to see one GP on the day and will not accept that this is not

possible– Some have unrealistic expectations...and...this seems to be on the increase

• Clinical staff views– Hard to get appointment with specific doctor when they want one.– Some (perceive) rudeness from practice...also feel some of us don't listen. – Frequently complain that they cannot see the same doctors which in some

situations is important. Makes it difficult for follow up and continuity of care.

– Complain about having to disclose information to reception staff when trying to book appointments.

– Patients (want) a time that suits them.

My daily work at present• Administrative staff views

– More and more stressful with everchanging goal posts – Patients unable to have appointments with their GP of choice.

• Clinical staff views– Often very busy, non-stop, frustrated by rude patients. – Patients come in and demand their prescriptions on the spot (ie they

have run out completely). It puts us under pressure to work faster which can lead to errors.

– Workload heading out of control. – Patients (regularly) booked inappropriately. Could have been dealt

with over the phone...or by the nursing team. – Some of our patients openly admit that they lie to the reception team

in order to get the appt...the time...the clinician they want.– I find it frustrating that we remain too doctor centered!

My ideal work

• Administrative staff views– Peaceful– For the GPs to be happy with service the receptionists are providing– For receptionists to be happy with what they can offer– For patients to be happy with the service they are given

• Clinical staff views– Where the system works without having to interrupt the doctor too often– To use the phone and email more...a reduction in consultation numbers– Patients would benefit from using more telephone consultations– Would prefer to use my time more effectively with the patients who

really need to see a doctor rather than wasting time dealing with prescription requests, patients who come in just to complain...and patients who have refused to see our nurse practitioners when it would have been appropriate for them to do so.

– I would like to focus my time on complex patients and our older patients.

Any fears in the face of change?

• Fear not working in a safe and efficient environment• Loss of my job, loss of wages• Patient welfare if appointments/hours are reduced• Open to change if there is a benefit i.e. time saving, more

economical etc. • As long as I can see a point to the change I’m all for it! I don’t like

change for change sake. • No. The situation is so busy that I have nothing to lose. I feel care is

less thorough caused by the ongoing increasing pressure on the service.

Reception data capture – 47% of requests are for GP, of which 1/3 are for named GP. Others mostly nurse or admin.

Monday is the busiest by a long way.83% of bookings are by phone, 17% walk-ins quite high.

And everything seems to happen at 8am.

But although 79% are given agreed clinician and date, others are not and 10% have to call again – rework.

Outside a traditional surgery

People waiting on the phone, the same, unseen

The traditional model

Reception takes call

GP sees patient10 min slot

Problem solved

70% “routine”

30% “urgent”

“All gone.Call backtomorrow”

3 week wait,high DNAs,repeat booking

See any GP/locumPoor continuity,repeat booking

Patientpressure

Rework

Vast majority of patients want an appointment today, with a few others booking one or two weeks ahead.

56% of GP patients are acute, a further 9% exacerbations. People need help on the day.

Over 87% of GP consults are face to face, only 12% by phone

But of these, 73% are solved over the phone

While your view is that currently under 10% did not need a face to face

Clue to a practical solution…“How can we help all our patients, all day, every day?”

The traditional model

Reception takes call

GP sees patient10 min slot

Problem solved

70% “routine”

30% “urgent”

“All gone.Call backtomorrow”

3 week wait,high DNAs,repeat booking

See any GP/locumPoor continuity,repeat booking

Patientpressure

Rework

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 reality.

A new principle is at work

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 4 minutes

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

Traditionally, all patients take ten minutes.

Why?

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

20%

20% 10%

30%

60%

60%

Clarendon Practice, Salford,

turns round

Dr Jeremy Tankel, GP PrincipalHarry Longman, Patient Access

harry.longman@patient-access.org.uk

Average days wait to see a GP falls off a cliff.

All data from Clarendon, charts by PA Navigator

They now measure the wait in minutes. Median is about 30.

All data from Clarendon, charts by PA Navigator

Patients are more likely to see the same doctor. Continuity, so precious to both, is up 15%

This means that on multiple consultations, a patient has about 85% chance of same

GP

All data from Clarendon, charts by PA Navigator

Clarendon, a deprived population of 10,000, 3 partners, 3 sal GPs Why change and for what?

Before• Rising demand – falling

morale• Waiting room stress• Grumbling patients• All pre-books gone• Mad rush on phones at 8am

After• Demand high but stable• A “no-waiting” room• Free slots in most sessions• Patients love it• No need for 8am rush

A training and teaching practice, with a new NP.Previously drowning in demand, now feeling on 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 pts who need it are seen• Saving one clinical session

They know when the patients are going to call, by day, by hour, and the GPs are ready

All data from Clarendon, charts by PA Navigator

Rock steady 90% of patients are seen the same day – the other 10% chose to wait for their own convenience.

All data from Clarendon, charts by PA Navigator

As response has improved over time, the proportion of patients saying the service is “better” has risen to 76%, while those saying “worse” are now 8%.

All data from Clarendon, charts by PA Navigator

“How are we going to help all our patients, all day, every day?”

Consensus

Preparation

Staff surveyPatient surveyData captureTrainingSystem setupWhole team

New deal for patientsFeedback wallTest & learnBuild confidence

Launch day

Routine

ReviewEvidence:New measuresNew staff surveyNew patient surveyYour decision

Yes.Pledge toeach otherand to patients

Launch programme12 weeks to a different practice

• Work on the whole practice system with the whole team• Change is hard. We make the process easy and fast• 5 stages over 12 weeks, knowing how you are doing• Every practice differs. You make the decisions

You lead. We guide you through the change