Eltham Palace Surgery What is it like to be a patient? Thoreya Swage

Outside a traditional surgery People waiting on the phone, the same, unseen

Reception takes call GP sees patient 10-min slot GP sees patient 10-min slot Problem solved 70% “routine” 30% “urgent” “All gone, call back tomorrow” 3 week wait High DNAs Repeat booking See any GP/locum Poor continuity Repeat booking Patient pressure

Why do patients call? 63% GP, many for nurse, admin, repeat prescription, test results

Requests for GP by day, Monday much higher demand

Requests: a problem: huge rush at 8am

Outcome of requests – 41% not offered what they want, of whom 8% told to call back, making rework

Vast majority of requests are for same day.

49% specified a named doctor, GPs say continuity important in 37%, though achieved only 28%.

Volume of consults per day, as submitted, very different from pattern of patient demand per day.

35% of cases acute, unusually low. Any reason for this?

At present, very few consults are by phone

Sample very small, but 5/7 resolved over the phone. We typically see 60% resolved.

Your view is only 20% more consults could have been by phone – though this often changes!

Key points Demand variable by day, supply volume match looks OK with Mondays much higher. Patients ring the day they want to be seen, but most have to wait. Continuity (choice of doctor) appears more valued by GPs than patients – this can be improved with better access Currently some consults by phone, but resolve rate is on the low side at 45% which will mean a higher workload. The average is around 60%, saving time and increasing capacity.

What do patients think of our service? Administrative staff views – No one answers the phones, never no appointments for about 2 weeks. – Not able to get through on the phones. Complaints that they are too few appointments available. Problems with scripts. – Patients complaint that they cannot get an appointment with a GP for over 2 weeks, – Patients can wait for up to 10 minutes to be answered by telephone even though we have appointed extra staff to answer these calls. Clinical staff views – Long waiting times, frustration with this – Good, helpful but has trouble getting through on the phone at busy times. waiting times, frustration with this

My daily work at present Administrative staff views – Answering the phone, dealing with patients. Get very stressed as no appointments and gets upset that I’ve got nothing to offer them. Embarrassment too with it. – I have experienced very upset patients that have had difficulty getting through on the telephone lines which we fully understand must be very frustrating. – It's hard talking to patients on the appointments line when you can't offer any appointments. Clinical staff views – Extremely busy regularly working over 12 hours a day – QOF, Results, Workflow, Docman, Prescriptions, helping with Reception. Feel stressed most days with the workload & the backlog of work that i cannot catch up with, angry patients who are rude when you try to help them.

My ideal work Administrative staff views – Be able to offer a more better service – Time to do daily work without having a backlog of paperwork. A system that allows the surgery to run efficiently with the patients feeling that they don't need to complain. – Content and happy patients with lots of appointments – It would be great to have two spaces on the front desk of reception so at busy times we can get through patients quicker. It would great to have more phones upstairs for our appointment line. Clinical staff views – More structured working day with time to go through letters/results within the working day rather than coming in on days off or staying v late at night – To have enough time to do my daily work. Less/No home visits

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. 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

Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 20% 10% 30% 60% How Patient Access Works

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)

Consensus Preparation Detailed planning Staff survey Patient comms Whole team meeting New deal for patients Predicting demand & matching capacity. Patient & staff feedback Launch day Routine Review New measures help tuning. Build confidence Affirmation Yes. Pledge to each other and to patients Launch programme - just 12 weeks to a happier, less stressful practice

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