1. Berkley Practice What is it like to be a patient? Jo Newton jo.newton@patient-access.org.uk

2. “How To Get Your Life Back, Save More Money and Have Happier Patients Within The Next 12 Weeks”

3. Familiar?

4. Before Patient Access GPs, PMs and receptionists said… I’m embarrassed when I see rows of patients waiting We’re going to have to get another GP in at a cost of £100,000.00 We all feel totally drained & I know that patients aren’t happy either I’m annoyed by the huge number of DNAs I dread the inevitable phone blitz at 8 every morning I can’t take the aggression from frustrated patients anymore. I can’t magic up an appointment

5. Not To Mention The Patients… I’m frustrated that I can’t speak to my GP when I need to. I’m very tempted to change surgeries A lot of the time I don’t even need to see the GP, so why can’t I just phone, save the travel cost, hassle & my GP’s time? We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8. It’s a joke! We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8. It’s a joke! Why do I have a 3- week wait at my surgery & yet I hear of others who see their doctor the same day?

7. Reception takes call GP sees patient 10-min slot GP sees patient 10-min slot Problem solved 70% “routine” 30% “urgent” “All gone, call back tomorrow” 3 week wait High DNAs Repeat booking See any GP/locum Poor continuity Repeat booking Patient pressure

10. Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 20% 10% 30% 60% How Patient Access Works

11. 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

12. 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.

13. 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.

14. 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

15. What do patients think of our service? Administrative staff views – Not very happy – wait to see GP & opening hours – ‘Patients satisfied with system – can get to see GP at their demand whatever day or time’ Clinical staff views – Wait too long but then receive a good service – Can’t get through, access, inconvenient times, can’t book ahead – Can’t see doctor so offered nurse triage which helps

16. My daily work at present Administrative staff views – Work very stressful – Can’t get work done, feel dissatisfied Clinical staff views – Face to face triage – Busy busy busy

17. My ideal work Administrative staff views – Want to help patients – Happy in current role – Would like to meet patients demands Clinical staff views – ‘Would like less stress and improved access’ – ‘Would like to start at 9am, be in control and finish on time’ – ‘Would like to continue to do telephone triage’

18. Fear losses if changes are made? Administrative staff views – What will the effects be long term? – Will we lose control of GP appointments? – ‘Staff sanity and loss of control of appointments’ Clinical staff views – How will my role be effected? (nurse) – None

19. Consultations all face to face, 6.5% of list per week, avg

20. Average wait to see a GP is 7 days. Imagine just 1.

21. Wide variety of demands on reception (NB many in “other” are GP or nurse requests)

22. Monday is MUCH busier than other days

23. High demand at 8-9am, but reasonable spread through the day. 97% of requests agreed – high!

24. One third of patients are walk-ins. This is high, again suggests it’s hard to get through.

25. 45% of patients request a named doctor

26. Vast majority of patients want to see the doctor today- that’s why they called today.

27. Consultations – more on Mondays, good

28. 55% of consults are acute or exacerbations, ie best dealt with today.

29. Very few phone consults at present, 97% f2f, but of the 4 phone consults, all resolved.

30. In your view, 38% did not need a face to face. Even more will be evident.

31. Continuity: despite patient views, yours is that it matters only 27% of consultations

32. 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

33. 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%

34. Phone consults take about 3 minutes Four practices, 17,000 patients, 9 months to May 2011 Traditionally, all patients take ten minutes. Why?

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

36. Within 12 weeks, response time median 30 minutes (now 19min)

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

38. 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

39. 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

40. 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)

41. “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.

42. 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

43. Evidence now links method with outcomes Access & Continuity Transformed, measured, understood. Access & Continuity Transformed, measured, understood. Patient safety & satisfaction GP control of work load, staff job satisfaction 20% reduction from faster response Lower costs within practice Lower A&E attendance Lower OP referrals and emergency admissions GP service innovation - new thinking GP service innovation - new thinking 20% reduction through improved continuity & management “I can see my own GP” “Stress has melted away” “We’re saving GP sessions”

44. Matching supply with demand coming in hour by hour enables outstanding patient service and the sense of flow. Loadmaster chart shows variation by day and hour.

45. Changing to demand led planning: the volume ranges of patient requests ranges from 5.5 to 10% of list per week. Note: 1. Practices have effectively unlimited access 2. Coding and data quality issues may affect comparisons

46. Safety: either doctor or patient can call for a face to face. Conversion rate falls through the day, and varies by GP. Calls after 1700 result in only 7% conversion to ftf Data from Thurmaston HC, 25/7/11 – 3/2/12. n = 10,367 calls Bubble chart: area of circle in proportion to number of GP calls made by hour Assumptions: all GP appts booked following GP phone call, at time of call 1 in 3 called in at 8am, falling to 1 in 5 before 11

47. Over time, your patients are 20% less likely to attend A&E At mean deprivation, line shows 21% saving Best fit line for 31 Patient Access practices Best fit line for 8,000 practices Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH

48. Crucial to match demand & capacity We know that clinically urgent demand is about 23% of consultations (blue) Offering an urgent only service means a daily work profile with only around ¼ demand at weekends Hence lower requirement for sessions OOH one GP for approx 8,000 patients

49. When service is all day, by 1800 it drops off