1. Conway PMS What is it like to be a patient? Thoreya Swage thoreya.swage@patient-access.org.uk thoreya.swage@patient-access.org.uk

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

3. 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

4. What do patients think of our service? (small sample – 5) Administrative staff views – NOT VERY HAPPY AT THE MOMENT RE APPOINTMENTS – patients seem to be happy with telephone triage but feel they have to wait a while to prebook an appointment – I only really get to speak to patients about access when they are not happy. There has been a reduction in complaints about access since we started a form of tel triage in the practice. – SOME GOOD SOME BAD Clinical staff views – None recorded

5. Already, many patients ask for a GP phone call

6. Monday has much higher demand

7. Very heavy demand 8-9am. Little left later on.

8. Most phone, but 17% walk-ins suggest it can be hard to get through, or they think this will beat the queue

9. A large number of requests are turned down. 17% “call again”, a lot of rework

10. Just over half request a named doctor

11. The vast majority who call want the doctor today.

12. Just 18 GP consults recorded – but mixture of phone, f2f

13. Telephone outcomes – views of GPs from daily work? (sample is only 5 calls so analysis only illustrative)

14. Small sample but this is typical, continuity important in around half of consults in GP view.

15. My ideal work Administrative staff views – happy working environment is essential which we are lucky to have and helping patients and making them feel comfortable is our top priority – More time for clinicians to see patients. Less frantic approach to healthcare leading to a safer service. Clinical staff views – None recorded

16. 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 8,000 10-12% of patients call 28% on Monday 220 – 270 calls @ 2 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

17. 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 8,000 6-8% call for GP Mon - 28% of the week 130 to 180 calls on Mon 80-120 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.

18. 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.

19. 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

20. 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%

21. 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

22. 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)

23. 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)

24. 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

25. “Patient Access has given us a new lease of life” Dr. Kam Singh Work on the whole practice system with the whole team. Change is hard. We make the process easy and fast. 5 stages over 8-12 weeks, knowing how you are doing Every practice differs. You make the decisions. You lead. We guide you through the change.

26. Which is the best pancake? Cold and soggy Hot, fresh and crispy