H85116 Manor Practice What is it like to be a patient? Thoreya Swage

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

The traditional model Reception takes call GP sees patient 10 min slot GP sees patient 10 min slot Problem solved 70% “routine” 30% “urgent” 60% “All gone. Call back tomorrow” 3 week wait, high DNAs, repeat booking See any GP/locum Poor continuity, repeat booking Patient pressure

Face-to face vs telephone consultations

Already, some 28% of consultations are by phone

Half of the telephone consultations are resolved there and then

And 18% face to face consultations are seen as ‘not needed’

Most requests for appointments are in the morning

Calls by time of day – well spread

BUT - outcome of requests – fewer than half agreed, 23% told to call back another time, generating rework

Average no of days wait to see a GP is 6 days

Some appointments are up to 3 weeks ahead (or more)

Vast majority of requests are for same day

Continuity is about 65%

Only 28% specified a named doctor, similar views from GP, continuity important for just 30% of consults, lower than many

55% of cases acute, clinically best dealt with today.

What do patients think of our service? Administrative staff views – Cannot get an appointment – Patients generally happy with service but frustrated holding on to speak to the Doctor during 'on call‘ sessions. Plus time waiting to get an appointment sometimes over 2 weeks wait! – on the whole good, although somewhat frustrated about waiting times – there are never enough appointments and patients complain that there is always difficulty in getting through on the telephones Clinical staff views – Happy with the service although complain they usually have to wait 3 weeks to see me. – They are happy when they get to see the Doctor but getting that far can be a real trial for some – Good overall service but difficulty getting appointments – Have difficulty getting an appointment to see nurses apparently dont want to go to other site for appts if they are used to one. Want to book ahead but appt aren’t made up 12w ahead as before

My daily work at present Administrative staff views – Have to deal with patients complaining that they can't get appointments. Doctors not completing paperwork in timely manner due to stresses of seeing patients. The whole practice seems to be working in a stressful and frustrating environment due to workload, including the Practice Manager!!! – Dealing with pt over phone in person, filing, scaning booking appt, printing prescriptions, faxing, dealing with medical staff post and all other ad hoc duties – Extremely busy and full on – Very busy on the telephone and bearing the brunt of the patient's complaints regarding appointments is very stressful on a daily basis Clinical staff views – I like my work and enjoy patient contact - good or bad. The only stress I get is that the patients do complain all the time about other members of staff and waiting times. I know that this is just frustration. – There is never enough time in the day. Things that would normally take 5minutes to do now take 8mins. – Patients that are late and still expect to be seen despite no time. And moan when they have to wait when you fit them in later!. Current rule is still see them even if they ar 9 mins late for 10min appt. Pressure of work means that consultations have to be rushed or truncated to stay on time. Baby clinic no appts. Sit and wait varied work load nothing to unmanageable. Patients have to wait with fractious children on 1st come 1st served basis.

My ideal work Administrative staff views – Patients able to see a Doctor at their convenience, complaints reduced, streamlined processes as regards workload – Less demanding, more time to deal with things – More telephone lines, prescriptions being taken from the desk (although this will be in place shortly). – receptionist to nice people Clinical staff views – Get most things done and go home without worrying about unfinished business. – To have sufficient time to deal with patients and not to have to rush with their care, – Appts for baby clinic. 20min appts for diabetic clinic. 40mns new diabetics and asthmatics. Doctors that take notice and act upon pop ups so it isn’t a mad rush every march.

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

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 GP Admin question Come and see nurse 10% 20% 10% 40% 50% 70%

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