1. City Walls: demand steady or declining a little at about 7% of list. Patient contacts 20% higher but face to face 40% lower.

2. Wait to see a GP, average days, has dropped 60% from 5 to 2

3. 75% of patients are now seen on the same day, a big improvement on 40% before, but evidence that some are pushed into next day. Expect 80-90%.

4. Still some 10% of telephone callbacks are pushed into the next day. This is blocking the flow, and making patients phone early to get a call. Best to get all phonecalls dealt with on same day

5. Pattern of demand still shows a very high peak at 8am and unusually low bookings later in the day. The two unhelpful effects of capping calls. Afternoon bulge is from calls made long after the peak demand

6. Having enough capacity at the start of each day will put you in control, and the peaks will flatten. Every day shows an unwelcome peak. This can change.

7. Need to match GP availability by day to expected demand – fairly flat, Mondays in most practices are higher.

8. Continuity (face to face) has remained high through the change. Well worth preserving or enhancing. Phone continuity is lower as patients given less choice?

9. Summary findings Service greatly improved since launch, waiting days cut by 60% and now 75% of patients seen same day. Pattern of work changed, with 20% more patient demand dealt with and 40% less f2f. Continuity holding up well, has been known to improve but starting from a high base through personal lists. Still very high peak at 8am, probably because sense of scarcity as later in the day, some calls and some f2f pushed to the following day. Unless patients have confidence they will be dealt with swiftly, they will continue to call early, which itself disrupts the flow. Use Loadmaster chart to plan rotas and get on top of demand for good. Then life will get easier.