1. Supporting You Through Access Janet Harris -Service Improvement Manager

2. Train the Trainers Aim To provide participants with the knowledge and skills required for planning and delivering a facilitated session on Access Learning outcomes Apply the principles of adult learning theory to facilitate learning in the workplace Provide delegates with an understanding on how to use the forms and the tools Plan an inter-professional learning session that promotes an effective learning environment

3. Teaching a practical skill 1.Demonstrate the skill with no words 2.Demonstrate and explain what you are doing 3.The learner explains what you should do as you follow their instructions 4.The learner performs the skill whilst explaining to you what they are doing

4. Introductions

5. Lunch time… Breaks… Fire alarms and exits… Mobiles … Toilet location… Housekeeping

6. Supporting You to Review Access Lots of Gain- No Pain

7. Learning outcomes Be aware of benefits to practice Be aware of benefits to patients Describe what planning is needed Describe and explain the process Guide your team through use of the materials. Identify when help may be needed Increase understanding of what support practice managers may need and where to find it

8. Fewer unwarranted interruptions Less stressful environment for staff Information to help you create the right solutions to the right problems Increased team knowledge, skills and working More patients being seen by right person in right place at the right time Benefits to Practice

9. Better experience Better information to help you with what matters to you When you need to see someone you see the right person, in the right place, at the right time Benefits to Patients

10. What you should get from this exercise Have we created demand? Does demand mirror capacity? Therefore is it a safe process? Does unscheduled demand unacceptably exceed scheduled demand? Do we have to focus on patient education more? What resources do we have? Are our staff surviving?

11. Key Findings Discuss and analyse your key findings Do we have higher demand on some days than others? When do we receive the majority of demand - in the morning or afternoon? By what time do we have no urgent appointments left? What proportion of same day and pre-bookable appointment requests do we receive? What is the demand for different healthcare professionals? What are the reasons for appointment requests (eg, new or follow-up or acute or multiple problems)? Do we know how many patients got the appointment they requested? Are there certain days of the week that have a higher demand than capacity? Are there certain days of the week that have a higher capacity than demand? Do we have the right split between the number of available appointments for same day and pre-bookable appointments? Why is there so much variation between nurses in clinical time Do we have higher demand on some days than others? When do we receive the majority of demand - in the morning or afternoon? By what time do we have no urgent appointments left? What proportion of same day and pre-bookable appointment requests do we receive? What is the demand for different healthcare professionals? What are the reasons for appointment requests (eg, new or follow-up or acute or multiple problems)? Do we know how many patients got the appointment they requested? Are there certain days of the week that have a higher demand than capacity? Are there certain days of the week that have a higher capacity than demand? Do we have the right split between the number of available appointments for same day and pre-bookable appointments? Why is there so much variation between nurses in clinical time

12. The Improvement Cycle Plan the work, communi cate with team and set date Draw out and analyse high level patient flow map Record incoming queries and requests from all routes Record appointment requests from all routes Collect appointment activity data and lost activity and extras Record appropri ateness of consulta tion Record staff and partner time availabl e Analyse the data (Demand, Capacity and Activity) Discuss the analyses and additional information, e.g. annual access survey, patient and carer views Complete Practice Action Step 1 Step 2 Step 3

13. http://www.psd.scot.nhs.uk/professionals/m edical/qof.html Accessing Material

14. Any Questions ?

15. Planning the work Agree how to proceed Consider how patients can be involved Understand and agree how tailor forms Agree which GP’s and nurses to be observed Agree timeline for completing data collection

16. Patient OOH NHS24 NHS Inform Optician Web Phone In person Letter Receptionist Triage/Advice Nurse Practitioner Doctor Healthcare Assistant Practice Nurse Pharmacy Secondary Care Admit OPD Investigations Patient Flow Map Decision to contact GP

17. Group Exercise 10 minutes

18. Queries Time Taken on Query Query NumberMinutesSecondsReason for QueryComment 1 30Prescription 2220Access to Medical Report 3145Lost appointment card Face to Face 4310Lost Prescriptions at Chemist Scripts in chemist already 5122Lost umbrella patient left item in surgery yesterday 6230Hospital Letter Waiting too long 7110Waiting on hospital appointments 8 50Wanting appointment None available 9110Test result 10 35Test result 11 12 13 14

19. Queries Tool

20. Reception Queries

21. Availability of Appointments

22. How productive are we? This is Capacity Available appointments Ensure you record what appointments were available and not what appointments have already been booked – ie: your capacity The person responsible for managing rotas will be best placed to record this – usually practice manager or lead receptionist

23. ost Activity Recording

24. How productive are we? Lost and extra appointments DNAs (did not attends) Patient cancellations Practice cancellations (eg: meetings, training) Unused slots Extra patients seen *Be clear on definitions for cancellations This data should be available on the GP Information System

25. Demand

26. Tailor the form to meet your practice needs

28. Analysing your data Use simple run charts Compare capacity and demand Use activity against capacity

29. Reasons why inappropriate consultation Out of 14 patients seen, only eight were appropriate to see the GP.

30. Group Exercise 15 Mins

31. Any Questions ?

32. Additional Observations

33. How to collect the data One template per person per day using the clinic template screen. Complete one for each day the person works each week. Every minute of the working day much be accounted for whether it appears on screen or not.

34. Clinic Template Tool

35. GP and Nurse Percentage time Variation in Actual Patient Facing Time

36. Coffee break….

37. Resource as a Capacity

42. 2.8

43. Know What Improvements to Prioritize Agree priorities, key actions and timelines Prepare Practice Access Action Report Use and share Practice Access Action Report

44. Agree Priorities, Key Actions and Timelines Step 1 – Agree areas for improvement Step 2 – Prioritise areas for improvement Step 3 – Identify Key Actions Step 4 - Set clear timelines Step 5 - Agree responsible person for action Review ideas that have worked elsewhere Ask staff for their ideas 'Initially everybody was a bit change-happy: we can do this we can do that; but we've calmed down and started to look at things properly and look at things in-depth. 'We have workshop meetings and staff are more vocal with suggestions and bringing ideas forward which is great. People are more willing to speak up.’ Stephanie Bond, senior receptionist

45. Practice Access Report Prepare Use and Share

46. Completing Access Plan the work Identify and analyse reception queries Identifying and analyse capacity, demand and activity ( Including resource capacity) Identifying and analyse capacity, demand and activity ( Including resource capacity) Define and Scope Pilot & Implement Monitor & Sustain Patient Journey Map Agree and prioritise areas for improvement Complete and submit report 1 1 3 3 4 4 5 5 6 6 2 2 © NHS Institute for Innovation and Improvement 2011

47. Action Report

48. Summary Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand. Confucius (approx 450 BC) Learning takes place through the active behaviour of the student: it is what he does that he learns, not what the teacher does. Tyler (1949)