1. SunnyBank Medical Centre
Moving Towards Advanced Access
Dr Graham Hillary & Susan Dawrant

2. Dr Graham Hillary & Susan Dawrant
Organisation at April 2000
6 Doctors 4 Full Time
2 Part Time
Locum Cover
4 Practice Nurses (2.3wte) Recruiting:
Treatment Room Nurse
HCA
Phlebotomist
List Size increasing
Clinical Appointments 10minutes
Full Time GP hours surgery per week
24.25 hours surgery per week at holiday time
Fully Computerised Paperless
Dr Graham Hillary & Susan Dawrant

3. Dr Graham Hillary & Susan Dawrant
Demands on Time
8 Weeks Holiday 2 weeks Study leave
No Bank holiday work Closed Wednesday Lunchtime
In-house Diabetic Clinic Outreach Diabetic Session
ENT Outreach Minor Surgery Sessions
Undergraduate Teaching Training
Acupuncture PCT Meetings
Collaborative Core Training Session
Management Meeting
Dr Graham Hillary & Susan Dawrant

4. Dr Graham Hillary & Susan Dawrant
April 2000
Appointments booked up to 8weeks ahead
Held appointments (Routine/Reserved/Urgent)
Long queue for routine appointments
3rd Available appointment - Average 9days
Up to DNA’s per month
Low staff morale - constant pressure for limited availability
Patient satisfaction poor
Duty Doctor always very pressured
Duty GP always coping with demand in excess of availability.
Average 3rd available appointment measured at 12noon was 9 days - more popular GPs booked up several weeks in advance for routine bookings/reviews
Dr Graham Hillary & Susan Dawrant

5. Matching Capacity to Demand
Understand Daily Demand
Measure requests for Appointments over a one week period.
Tally Sheet.
Analyse results
Average of 20% - 30% shortfall
Tally sheet - Staff asked to record every request for an appointment for either a GP or PN. Daily record over a one week period compared against actual appointments available.
% shortfall dependant on day.
Monday 30% shortfall
Dr Graham Hillary & Susan Dawrant

6. Review Workload/Systems PDSA Cycles
Maximise manpower on days of high demand.
Monitor follow-up
Delegate to the most appropriately trained clinical member of the team.
Length of appointments/type of consultation
Reduce DNA rate
All GPs available on Monday to maximise capacity available.
Monitor reviews - frequency - could review be delegated to another member of the team - telephone consultation.
Review appointment timings - clinic sessions to ensure maximising use. Interchange routine appointments/telephone consultation slots as required
DNA - patient contacted by phone day before appointment to remind/confirm attendance when booking for longer than 10mins.
Dr Graham Hillary & Susan Dawrant

7. Working Smarter not Harder
Match the Team to the work
Expand the role of the Nursing Team
Nurse led Specialist Clinics
Treatment Room Nurse
HCA’s
Phlebotomist
Salaried GP
Locum Cover
Locum to cover GP absences
Salaried GP to cover workload - due to GP taking clinical sessions from timetable due to outside commitment.
Dr Graham Hillary & Susan Dawrant

8. Increasing alternative forms of Access
Telephone Consultation
Trialing the System (PDSA Cycles)
Evaluation & Review
Implement & Trial New System
Re-Evaluate
Monitor
Dr Graham Hillary & Susan Dawrant

9. Increasing alternative forms of Access
Telephone Consultation.
Routing patient to other healthcare professional where appropriate
Group Consultation (Smoking Cessation Clinics).
Outside Agencies Clinics - Benefit Advice/Cancer Support Team
NHS Direct
Self-help - other agencies
Video/Leaflets/Booklets for patient use.
Dr Graham Hillary & Susan Dawrant

10. Appointment System for GP Bookings
Highest Demand/Maximum Capacity
Monday - No pre-bookable appointments.
Tuesday - Friday
50% of appointments are bookable up to 3 working days in advance.
A GP can override the booking policy
Telephone Consultations
Duty GP would triage request for appointment once availability exceeded.
Dr Graham Hillary & Susan Dawrant

11. Advertising the Changes
Communication Across the Team
Reception Team inform patient when taking appointments.
Practice Leaflet
Handouts available in reception
Flyer included in routine correspondence
Call Display
Dr Graham Hillary & Susan Dawrant

12. Unblock Future Capacity
Commenced New Appointment Booking System from Jan2001.
Diary Planned and New Appointment System implemented.
Existing Diary not extended beyond Christmas.
Over Christmas & New Year no prebookable appointments for any GP.
Dr Graham Hillary & Susan Dawrant

13. Evaluation - PDSA Cycle
Initially no appointments may be booked more than 3 days in advance.
Concerned about creating an artificial backlog.
Evaluate after a 6 month period
Increase the booking time to 7 days in advance.
Unequal spread of demand across clinicians
Dr Graham Hillary & Susan Dawrant

14. Appointment Availability 2001
March-Spare Capacity in the System 92% of the time.
September-Spare Capacity in the System 97.5% of the time
Spare availability not always utilised
patients’ preferred time option
choice of clinician
timeframe available to book appointments
Initially a small number of appointments weren’t booked due to booking timeframe. However, as the patient have become familiar with the appointment booking system unbooked appointment due to booking time frame are virtually nil.
Occasionally unequal demand spread across GPs. Popular GPs never have any free appointment slots.
Dr Graham Hillary & Susan Dawrant

15. Organisation at October 2001
6 Doctors 4 Full Time
2 Part Time
1 Salaried GP 8 Sessions per week
Long-Term Locum 4 Sessions per week
6 Practice Nurses (3wte) 3 G Grade 2 F Grade 1 D Grade
2 HCA (1.5wte)
Phlebotomist (Extended Role of Receptionists)
Training Reception Members to undertake HCA Role
List Size increasing
Clinical Appointments 10minutes
Full Time GP 18 hours surgery per week
21 hours surgery per week at holiday time
Fully Computerised Paperless
Dr Graham Hillary & Susan Dawrant

16. DNA’s Previously 160 - 200 per month
March 38
29% GP Booked Reviews
26% booked on same day
5% booked 1 day in advance
24% booked 2 days in advance
16% booked 3 days in advance
September 40
8% GP Booked Reviews
53% booked on same day
13% booked 1 day in advance
6% booked 2 days in advance
3% booked 3 days in advance
6% booked 6 days in advance
20% booked 7 days in advance
Dr Graham Hillary & Susan Dawrant

17. Dr Graham Hillary & Susan Dawrant
Conclusion
It Works
Match manpower to demand (holiday/sickness)
Routing the patient to the most appropriate member of the team.
Increased accessibility
Reduced DNA’s
Less harassed staff
Patients have stopped playing the system
Positive feedback from patients/staff/clinical team
Empty slots
Increased Capacity but a restriction on patient choice
DNA’s same day appointment - increased
New problem
Complacency - unbooked slots appearing in routine surgeries
Duty GP can become grumpy when underworked/overworked
Dr Graham Hillary & Susan Dawrant

18. Dr Graham Hillary & Susan Dawrant
Sunnybank Medical Centre
National Primary Care Development Team
Dr Graham Hillary & Susan Dawrant