1. Parkside Surgery What is it like to be a patient
Parkside Surgery What is it like to be a patient? Harry Longman, Patient Access

2. “How are we going to help all our patients, all day, every day?”
Consensus
Yes.
Pledge to
each other
and to patients
Preparation
Launch day
Staff survey
Patient survey
Data capture
Training
System setup
Whole team
Routine
New deal for patients
Feedback wall
Test & learn
Build confidence
Review
Evidence:
New measures
New staff survey
New patient survey
Your decision
Launch programme
12 weeks to a different practice

3. What do patients think of our service?
Administrative staff views
Some patients get frustrated that they can’t have what they want
Mainly seen on the day they request...if ring before will get in the same morning with a GP
A few patients don’t like...new systems, and have booked appts earlier so they have a time and date
Some patients don’t like to volunteer information
Clinical staff views
Appreciate being able to see the docs quickly...surprised to be offered an "on the day" appointment.
Easy to get in when wanted but not always with the GP they want
Appointments waiting time recently 4/52
"Like the continuity “ (provided they get it of course)
Like ease of access...flexibility
We are generally liked personally and patients seem to appreciate that we try to get things right. Reception held in very high regard by patients (some that have transferred from other practices.)

4. My daily work at present
Administrative staff views
My (phone) duties are...often non stop!
Stresses are generated from the number of patients the GPs need to see every day to keep on top of the workload.
Clinical staff views
30-45 patients, some trivial, 11 hour days routinely, often more, feel drained...some features of burn-out. No time for meetings/management stuff, quality beginning to slip as a result.
Getting busier, lot of inefficiencies in how we work, on call surgeries 'abused'
A lot of the time is spent on "paperwork" type issues...arising from telephone and face to face consultations...overflows into my days off... at least 2hrs remote working...every day off and Saturday and Sunday.
Long surgeries...Non-stop stress
Overwhelmed..12.5/day hours here...and at least 4-5 hours...from home on days off. Current system fragile...no space for unexpected... burnout a real possibility.... On some days I hardly speak to anyone else in the team...pinned to the computer/ phone or seeing patients.

5. Outside a traditional surgery
Many practices pride themselves on good access, and they are working hard. But with scenes like this, I began to see how good intentions are not enough. They need a method.
People waiting on the phone, the same, unseen

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

7. Evidence of busy times at 8am, and not much later.

8. My ideal work Administrative staff views Clinical staff views
Flexibility...upbeat...positive...friendly
To be able to offer more appts as this is sometimes difficult. To always be polite and helpful to patients.
Workload...more manageable.
Clinical staff views
Manageable lists.... Fewer inappropriate attendances.
More efficiency and not feeling...risk of missing the really important ones
Less of the "paperwork" element.
Variety of clinical problems. Time to have regular clinical meetings so the standards at the practice are maintained, time to manage elderly frail people better. The partners need time to be ahead of changes in the NHS, to manage the practice in a planned way and have time to communicate changes properly with all of the team.

9. Fear losses if changes are made?
Administrative staff views
Patients will be wary...if can’t get what they need at the time they need.
Need to be kept aware of the changes and know how to deal with them
Alteration in working hours/days...reduction
New service may generate more complaints and lower satisfaction scores
Wary of breaching patient confidentiality
Clinical staff views
Worried that patients may not like new system, patient satisfaction may drop...clinical risk may increase. (Loss of) eye contact/body language etc.
(Loss of) income...(less) efficient
Patients may be at work or on there way when GP calls to triage them.
That the process may disadvantage the less assertive and people with poor communication skills or who are depressed.
(Will not be able to) notice the incidental (symptoms) over the phone.
Older patients...have been used to a different system.
Changes may limit continuity
That it will be very intense...then won't have enough slots to see patients.
(Clinical) risks; PSQ will suffer, more complaints.

10. Reception data capture: Monday the highest

11. It’s very busy at 8am. By afternoon, little to offer.

12. 77% of patient requests agreed. 10% told to call back

13. Continuity: 40% of patients name a doctor

14. Vast majority of requests are for same day

15. About 16% of requests are walk in – is it hard to get through on the phone?

16. Reception dealing with wide variety, high repeat scripts

17. GP volume is highest on Friday

18. Acuity is typical of most practices, majority acute, and new to follow up is 58%

19. Urgency also typical: most demand is acute & routine

20. Today, only about 20% of GP consults are by phone

21. But 80% of them are resolved over the phone (small number of NP telephone consults, 33% resolved, not sure about nurse?)

22. Nevertheless, you consider only 20% were “face to face not needed”

23. Continuity: GPs view, 30% important, lower than average

24. Navigator: GP consultation rate up 24% over 2 years. Wow
Navigator: GP consultation rate up 24% over 2 years. Wow. But current consults weekly rate 6.4% - moderate

25. Weekly pattern shows most on Fridays. Hmm.

26. We’ll be tracking phone response times, currently 2 hours

27. And days wait to see GP, currently 4 to 5 (though 40% are same day)

28. An interesting feature – your consults are much longer than most

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

30. A practice in the Patient Access community looks a little different
Dr Chris Barlow of Quorn, one
of the earliest pioneers in 2000
The evidence led me here. Simple. Patient calls in. Doctor calls them back. Deal with the problem today. Brilliant. The thinking is to understand patient demand, and respond simply and appropriately.
Monday morning 8.30,
Busy day, going full tilt.
All carefully worked out.

31. The traditional view of general practice, every problem requires 10 minutes face to face with the GP
Traditional thinking says one size fits all patients: whatever the problem, the answer is 10 minutes face to face with the GP. We all recognise that patients and problems are not like that. The new thinking is to accept the infinite variety coming in, and respond to each demand in the simplest, most effective way. The telephone response from a GP is the current most practical way we have found to do that.
The effects are: professional service (the most qualified, best informed clinician is the GP with your notes), faster service (contact typically under an hour) and lower costs (evidence from many practices of time freed up, often over 3,000 patients per GP fte).
Perfect service
One tiny problem

32. A new principle is at work
We help all our patients, all day, every day
The Patient Access method makes this a reality.
Well, after 6 we might suggest the patient will get a call back in the morning.

33. Magic 1: Over half need only the call
Call fulfils demand
See doctor
See
nurse
How does the magic work? Common ratios seen among all Patient Access practices – only about a third need to see the doctor.
Two practices, 8,000 patients, 9 months to May 2011

34. Magic 2: The call takes about 4 minutes
Traditionally, all patients take ten minutes. Why?
Patient demands are infinitely varied in shape. Patient Access allows the GP to fit the response just right around the patient. Calls are mostly short, but can vary, as can appointments.
Four practices, 17,000 patients, 9 months to May 2011

35. Simple, but the whole system changes
Reception takes call
GP phones patient
Problem solved
Come and see GP
Admin question
Come and see nurse
20%
10%
30%
60%
PA Navigator measures the flows, which vary by GP & practice.

36. Clarendon Practice, Salford, turns round Dr Jeremy Tankel, GP Principal Harry Longman, Patient Access

37. Average days wait to see a GP falls off a cliff.
All data from Clarendon, charts by PA Navigator

38. They now measure the wait in minutes. Median is about 30.
All data from Clarendon, charts by PA Navigator

39. Patients are more likely to see the same doctor
Patients are more likely to see the same doctor. Continuity, so precious to both, is up 15%
This means that on multiple consultations, a patient has about 85% chance of same GP
All data from Clarendon, charts by PA Navigator

40. Clarendon, a deprived population of 10,000, 3 partners, 3 sal GPs Why change and for what?
Before
After
Rising demand – falling morale
Waiting room stress
Grumbling patients
All pre-books gone
Mad rush on phones at 8am
Demand high but stable
A “no-waiting” room
Free slots in most sessions
Patients love it
No need for 8am rush

41. A training and teaching practice, with a new NP
A training and teaching practice, with a new NP. Previously drowning in demand, now feeling on top of workload
Before
After
Frustrated, stressed doctors
Miserable reception staff
Unhappy patients
Reputational issues
List size effect
Reduced stress!
Abuse of reception staff gone
All pts who need it are seen
Saving one clinical session

42. They know when the patients are going to call, by day, by hour, and the GPs are ready
All data from Clarendon, charts by PA Navigator

43. Rock steady 90% of patients are seen the same day – the other 10% chose to wait for their own convenience.
All data from Clarendon, charts by PA Navigator

44. As response has improved over time, the proportion of patients saying the service is “better” has risen to 76%, while those saying “worse” are now 8%.
All data from Clarendon, charts by PA Navigator

45. You lead. We guide you through the change
Work on the whole practice system with the whole team
Change is hard. We make the process easy and fast
5 stages over 12 weeks, knowing how you are doing
Every practice differs. You make the decisions