Welland Medical Practice

What is it like to be a patient?

Harry Longman, Bill Howlett [email protected] [email protected]

Your Patient Access Launch Programme Just 5 Simple Steps To Your Happier, Efficient, More Profitable Practice Within The Next 12 Weeks

5 Affirm 4 Adapt 2 Preparation 3 Launch Day!

1 Consensus

Wk 1 Wks 1-3 Wk 3-4 Wks 5-11 Wk 12

What do patients think of our service?

• • • Admin and Receptionists’ view – Disappointment with appointment system by patients – Some patients happy with help they get – and let us know – Patients happy with level of care, but do complain about appointment system & lack of availability – Patents say we have poor access – Good apart from not enough appointments – Appointment system not good enough, (patients) want to access service same day Doctors’ view – Difficulty getting appointments Nurses’ view – Never had to face complaints – Patients often complain – unable to get appointment and being unable to see the doctor/nurse of choice – Long waits on the phone – then no appointments available – Often unhappy at seeing a nurse when wanted to see a doctor

My daily work at present

• • • Admin and Receptionists’ view – Difficult patients cause most stress, “talk down to us” when we help – 8.30 – 9.00 – stressful if not enough appointments – Staff get on with one another – good – Daily appointment bookings, Rx requests, patient queries assisting GP’s and nurses, daily admin tasks – Hardworking, stressful but rewarding – Frustration of not being able to offer a service I would be proud to shout about – Demanding job, enjoy all, never stressed even when patients are demanding Doctors’ view – GP Nurses’ view – Practice Nurse duties – Very busy & stressful environment – Often deal with patients who should have seen a doctor – Time wasted outside Dr’s room – when already short of time

My ideal work

• • • Admin and Receptionists’ view – Full time admin work (no reception) – To give patients access to a clinician within 24 hours and offer an appointment time that suits them – – – More appointments to give patients Better accessibility, more efficient service Patient call practice, access advice re medical condition, promote preventative medicine – Patients leaving Happy Doctors’ view – Patients getting appropriate and timely service Nurses – Less patients, more time – Enough time to spend with patients – so not rushing – Feeling well supported by colleagues

“All gone, call back tomorrow” Reception takes call 3 week wait High DNAs Repeat booking

70% “routine” Patient pressur GP sees patient 10-min slot

See any GP/locum Poor continuity Repeat booking Problem solved

• • •

If changes are made, do you fear the loss of anything?

Admin and Receptionists’ view – Depends what kind of change – only fear is job loss – No (4) – Changes can be for the better, change needed for appointment system – Changes made and explained properly will promote practice & encourage more to join – Can take getting used to, but change does improve running of practice Doctors’ view – (no comments) Nurses’ view – Face to Face contact – No, I think things need to change

Why do patients call? 59% for a GP, also 24% for repeat prescription

Calls by day, Monday much higher – how should this affect capacity planning?

Calls by time of day – heavy weighting at 8am suggests little available later on

This is how it looks on SystmOne.

Outcome of requests - 12% told to call back another time, generating rework.

Vast majority of requests are for same day.

Only 21% specified a named doctor, similar views from GP, continuity important for just 28% of consults, lower than many

GP consultations – not much variation cf demand, need to match whole week. Loadmaster will help planning.

63% of cases acute, clinically best dealt with today.

At present, only 5% of consults are by phone

Via Navigator, we can see how long it takes to respond

Your view is only 11% of consults could have been by phone – though this often changes!

Language is native or adequate for 81% of consultations, but 19% is a significant proportion where difficult.

Key points

• • • • • Demand is quite variable by day of week, much heavier on Monday.

Demand is stacked at the start of the day, suggesting anxiety for patients – 12% are turned away, while almost all want “same day” Continuity (choice of doctor) is mentioned less often than with many patients and GPs.

Currently very few consults are by phone so a change will feel very different.

While language is an issue for some (around 19%) for the great majority it will be OK.

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.

How Patient Access Works Admin question 20% Reception takes call 60% 30%

GP phones patient

60% Come and see GP 20% 10% Problem solved Come and see nurse

A Typical Receptionist Day With Patient Access Admin question 20% solve Reception takes call 20% book to see nurse Nurse Just 60% list for GP

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

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.

30% GP phones patient 10% Come and see nurse 60% Come and see GP Problem solved

Average wait time to see a GP drops dramatically

All data from Clarendon, charts by PA Navigator

How can we help all our patients, all day, every day?

Turns out, you can rely on the patients

The thinking goes like this… • • • • •

NO

No targets No tick boxes No compulsion No “incentivisation” No substitute for the GP patient relationship • • • • •

YES

Helping patients Enhancing professional practice Evidence based Measurement for improvement Saving effort and time

The Relief of Working Efficiently 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 always offered the same day  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 Patient Access Launch Programme Eight ways we support you in leading change and avoiding the pitfalls 1. Your personal training partner 2. Key actions checklist week by week 3. Datalog paperless data capture 4. Unique Navigator analysis suite 5. Private online resources portal 6. Easy to use video tutorials & FAQs 7. Patient communication materials customised for you, video & leaflet 8. Expert helpline and rapid response throughout the programme

Step 1 – Consensus This step equips you to secure the all-important agreement of your partners  Explaining the process so that you’re fully informed to make the right decision  Leading Change questionnaire to assess your readiness for change  Working with you to identify the Change Leader within your practice.

Step 2 - Preparation Equips you to transition smoothly to your new system  Your Own Training Support Partner is with you step-by-step, including:  Manager planning by reviewing your rotas and current processes  Advising on scheduling, process-changes & your go live date  Training on the steps and actions to inform your staff and patients.

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Staff and patient survey

 Real Time Paperless Data Capture input by you interpreted by our Navigator software  Whole Team Induction led by your Training Support Partner  Bespoke Online Resource Portal including Video Tutorials, FAQs and Key Actions Checklist  Customised Patient Communication - Video, Leaflet, Poster produced for you.

Step 3 – Launch Day!

The exciting, agreed day where you transition to your new system.

 Your Training Support Partner attends your Launch Day to:  Offer support and guidance on the first day you fully implement telephone triage  Monitor and advise on controlled face-to-face appointment-setting 

Answer staff and patient questions

 Feedback Wall and Patient Survey

Step 4 – Adapt

The daily process of becoming embedding the system, building confidence and adjusting it so that it works beautifully for you.

 Real Time Online Data Capture continues to be input by you  Navigator software continues to analyse your activity  Your Training Support Partner advises you on emerging patterns so that you can adjust accordingly  On-hand help continues from your Training Support Partner to answer your questions and overcome any challenges.

Step 5 – Affirm

Review and refine your activity and results.

 Real Time Data Capture continues to be input by you to equip us to monitor your activity and advise you 

New Staff and Patient Survey

 Bespoke Before and After Report produced using Navigator software and presented by your Training Support Partner to review key learnings, maintain progress, discuss next steps  Option of on-going monitoring and support with our Accelerator Programme.

Your step by step guide to a happier practice Start today Call 01509 816 293 | email [email protected] “Patient Access has given us a new lease of life” Dr. Kam Singh