Vanbrugh Group 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 v telephone consultations

70% face to face but a significant minority are by phone

Already 78% of phone consults are resolved over the phone

And 7% of consults seen as “face to face not needed”

Most requests for appointments are made between 8.00am and 9.00am

Large spike in demand at 8am

Significant numbers don’t get what they want, 12% told to call back (rework). No wonder they call early.

No of days wait to see a GP is increasing

Some appointments are up to two weeks ahead

Most want to be seen same day, though a few booking ahead 7 or even 14 days. Why?

Continuity is about 73%

Continuity: 43% of patients name a doctor, and in 42% of consults, seen as important by GPs, key to new design

Acuity: 66% acute or exacerbations, best dealt with today

What do patients think of our service? Administrative staff views – There are many that complain about long delays getting through on the phone. – Find it frustrating getting through on the telephone and on many occasions the 'same day' appointments have been used shortly after 8am. – Hard to get through on the phones, scripts not ready on time. GP's/clinics running late – Unable to get appt that suits them or with a particular GP Clinical staff views – Possibly concerns about getting appointments, particularly with their preferred doctor & frustration with clinics running late. – Sometimes complain can't get an appointment. – Clinical service is good and the staff very friendly but that access is frustrating, especially by phone

My daily work at present Administrative staff views – My frustration is the telephones continually ringing, there never seems to be enough people to deal with the demand. – It is difficult explaining to patients that the 'same day' appointments have been used, which can be as early as just after 8am. – Quite constant with calls – Not being able to offer apps sooner – Not enough appointments on certain days and often only a duty doctor on in the afternoon Clinical staff views – Very pressured, stressed – Would like more continuity of care – Sometimes I feel a bit overloaded when I have extra patients and phone calls booked in and this leads to stress. Sometimes I finish late due to extras.

My ideal work Administrative staff views – I would like to have less stress, trying to juggle workload, and be able to deal with patients queries more quickly and efficiently – Being able to offer patients an appointment or telephone call back at a date and time which suits them, and with a doctor of their choice would be ideal! – To have more appointments that we could offer to patients – To have the time to deal with patient queries and get back to them when you say you will. Clinical staff views – More time to complete admin work – would like slightly less pressure, to be more in control – Enough time for each patient and patients seen by one doctor for most problems or at least for complex ongoing problems. – Patients’ access to be made easier – Ensure time available to see the patients that need to be seen and to avoid pt that don't need to be seen.

A Typical Receptionist Day With Patient Access Reception takes call Admin question 20% solve 20% book to see nurse 20% book to see nurse Just 60% list for GP Just 60% list for GP Nurse Per Week, Patient List Of 8, % of patients call 28% on Monday 220 – mins 7 to 9 hours of calls Other days 4.5 to 6 hrs Many more calls will come in the morning, but will spread as a result of good service

GP phones patient Problem solved Come and see GP Come and see nurse 10% 30% 60% A Typical GP Day With Patient Access Per Week, Patient List of 8, % call for GP Mon - 28% of the week 130 to 180 calls on Mon calls on other days Plan for 40 each per GP per day 40 x 5 mins plus 16 x 10 mins Total consulting time 6 hrs/day Availability of nurse consultations can reduce this by ≈ 40 mins/day Mornings more phone calls, becoming more face-to-face late morning & into afternoon.

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