Survival – ‘managing demand’

A Stowhealth solution

Aim

Explain where we were Options and decisions Our methodology Our conclusion

Where were we

Fraught Working 0800 – 1930 and not finishing Unhappy and unsustainable

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

Our system

Others changes

Increase in Minor Illness clinic capacity

Move more Treatment Room activity to HCAs

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%)

Reduction in DNAs

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

Monday AM

Tuesday PM

Thursday PM

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 able to speak to/see the clinician of your choice?

YesYes87%

NoNo13%

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

The future?