After an initial rise demand has dropped over 10%. 25% drop in face to face saves time All data from The Elms, charts by PA Navigator Through the winter, demand has drifted down

A year of two halves. Launch 16/4/12, something happened to the average wait to see a GP since then. All data from The Elms, charts by PA Navigator From launch date, drop in waiting days to see GP from 6 to 1

Drilling down to the wait for a GP to respond to a patient call, the median is 15 minutes. Response time 200 times faster than government 48 hour target. All data from The Elms, charts by PA Navigator

Elms has low A&E attendance, the system helping to maintain this by rapid access to a GP The Elms A&E attends are 40% below average for Liverpool. Liverpool CCG figures

Fast gets faster. With better matched supply and demand, average response times continue to fall. A change to GP rotas enables the practice to stay right on top of demand, feeling in control all day. All data from The Elms, charts by PA Navigator

Pattern of demand by hour of the day is predictable and can then be matched by GP availability for rapid response. Understanding the daily predictable pattern of demand is crucial to matching GP time All data from The Elms, charts by PA Navigator

Prediction is the secret for capacity planning. Based on a moving four week view, we can see how many GPs are needed by day and by hour Read off the number of GPs needed per hour responding to new calls All data from The Elms, charts by PA Navigator Later in the day, less new demand and more time to see face to face

If they need to be seen, patients choose which day to come. For a mere 90%, it’s the same day. 90% choose same day, giving the lie to theories pre-allocating 1/3 on the day versus 2/3 “routine” slots. There is no such distinction here. All data from The Elms, charts by PA Navigator

Are patients being rushed? No, average consultation times are slightly higher than many, over 5 mins for phone, 12 for f2f. Telecons times stable near 6 mins All data from The Elms, charts by PA Navigator Face to face have lengthened to 12 mins avg

GPs are able to give appropriate time to each patient, unconstrained by 10 minute appointment slots, and they do. Most telephone cons are 2-4 minutes, with a longer tail. But the spread for face to face consults is strikingly broad All data from The Elms, charts by PA Navigator

Recent audit by GPs shows 72% of demand is acute. Only 2% “should have been self care”: access has not increased demand All data from The Elms, charts by PA Navigator Very small, only 2%, considered by GPs as “self care”. Floodgates have not opened.

With largely acute demand, continuity considered by GPs as important in only 35% of cases and achieved in 32%. All data from The Elms, charts by PA Navigator

Continuity has remained stable through the change. Measured statistically, % of patients seeing same GP. All data from The Elms, charts by PA Navigator This means that on multiple consultations, a patient has about 60% chance of same GP

Does this practice have unusually undemanding patients? No, in deprived Liverpool 8 it is on the high end at over 8% pw All these practices have unconstrained demand, same model.

What do patients think? Chat outside the school gates… Trying to get through before taking the kids to school was a nightmare, and even worse ringing back after 9am and all the appointments had gone and told to ring the next day. Now you can get through anytime and get sorted the same day I love it! You always get seen now Don’t always need to see a doctor. Can get a prescription for problem

And the doctors? Partners at Elms say “Under the old system we would have been dead” “It has been life saver” “First three months were hard. Now we have reduced doctor sessions, saving the practice £37k per year” “This is the future of primary care” – Dr Chris Peterson

70% of patients rate the new system as better, 3.7% worse (note: n = 27) Independent qualitative research for Liverpool PCT by GfK shows what matters most to patients is speed and continuity.