Transcript Slide 1

Berkley Practice
What is it like to be a patient?
Jo Newton
[email protected]
“How To Get Your Life Back,
Save More Money
and Have Happier Patients
Within The Next 12 Weeks”
Familiar?
Before Patient Access GPs, PMs and receptionists said…
I’m
embarrassed
when I see rows
of patients
waiting
I dread the
inevitable phone
blitz at 8 every
morning
I’m annoyed
by the huge
number of
DNAs
We’re going to
have to get
another GP in
at a cost of
£100,000.00
I can’t take the
aggression from
frustrated patients
We all feel totally
anymore. I can’t magic
drained & I know that
up an appointment
patients aren’t happy
either
Not To Mention The Patients…
Why do I have a 3-
I’m frustrated that I can’t
week wait at my
speak to my GP when I
surgery & yet I hear of
need to. I’m very
others who see their
doctor the same day?
tempted to change
surgeries
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!
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?
“All gone,
call back
tomorrow”
Reception
takes call
3 week wait
High DNAs
Repeat booking
70% “routine”
Patient
pressure
30% “urgent”
See any GP/locum
Poor continuity
Repeat booking
GP sees
patient
10-min slot
Problem
solved
How Patient Access Works
Admin question
Come and
see GP
30%
20%
Reception
takes call
20%
60%
GP phones
patient
10%
Come and
see nurse
60%
Problem
solved
A Typical Receptionist Day With Patient Access
Per Week,
Patient List Of 8,000
Admin question
10-12% of patients call
20% solve
28% on Monday
Just 60%
list
for GP
Reception
takes call
220 – 270 calls @ 2 mins
7 to 9 hours of calls
Other days 4.5 to 6 hrs
Many more calls will come in
20% book
to see nurse
Nurse
the morning, but will spread as
a result of good service
A Typical GP Day With Patient Access
Per Week,
Come and see GP
Patient List of 8,000
6-8% call for GP
30%
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
GP phones patient
60%
40 x 5 mins plus 16 x 10 mins
Total consulting time 6 hrs/day
Availability of nurse consultations
10%
can reduce this by ≈ 40 mins/day
Mornings more phone calls,
becoming more face-to-face late
morning & into afternoon.
Come and see nurse
Problem
solved
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.
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
 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
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
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
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’
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
Consultations all face to face, 6.5% of list per week, avg
Average wait to see a GP is 7 days. Imagine just 1.
Wide variety of demands on reception
(NB many in “other” are GP or nurse requests)
Monday is MUCH busier than other days
High demand at 8-9am, but reasonable spread through the
day. 97% of requests agreed – high!
One third of patients are walk-ins. This is high, again
suggests it’s hard to get through.
45% of patients request a named doctor
Vast majority of patients want to see the doctor todaythat’s why they called today.
Consultations – more on Mondays, good
55% of consults are acute or exacerbations,
ie best dealt with today.
Very few phone consults at present, 97% f2f,
but of the 4 phone consults, all resolved.
In your view, 38% did not need a face to face.
Even more will be evident.
Continuity: despite patient views, yours is that it matters
only 27% of consultations
Launch programme - just 12 weeks
to a happier, less stressful practice
Detailed planning
Staff survey
Patient comms
Whole team
meeting
Preparation
Consensus
Yes.
Pledge to
each other
and to patients
New deal for patients
Predicting demand &
matching capacity.
Patient & staff
feedback
Launch day
Review
Routine
New measures help tuning.
Build confidence
Affirmation
Simple, but the whole system changes
Admin question
Come and see GP
40%
10%
Reception
takes call
20%
70%
GP phones patient
10%
Come and see
nurse
PA Navigator measures the flows, which vary by GP & practice.
50%
Problem
solved
Phone consults take about 3 minutes
Traditionally, all
patients take ten
minutes. Why?
Four practices, 17,000 patients, 9 months to May 2011
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
Within 12 weeks, response time median 30 minutes
(now 19min)
Rules
• 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)
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 8-12 weeks, knowing how you are doing
Every practice differs. You make the decisions.
“Patient Access has given us a new lease of life” Dr. Kam Singh
Launch programme - just 12 weeks
to a happier, less stressful practice
Detailed planning
Staff survey
Patient comms
Whole team
meeting
Preparation
Consensus
Yes.
Pledge to
each other
and to patients
New deal for patients
Predicting demand &
matching capacity.
Patient & staff
feedback
Launch day
Review
Routine
New measures help tuning.
Build confidence
Affirmation
Evidence now links method with outcomes
Lower costs
within practice
“We’re saving
GP sessions”
GP control of work load,
staff job satisfaction
“Stress has melted
away”
“I can see my own GP”
GP service innovation
- new thinking
Access & Continuity
Transformed, measured,
understood.
20% reduction from
faster response
Lower A&E
attendance
Patient safety &
satisfaction
20% reduction through
improved continuity
& management
Lower OP referrals and
emergency admissions
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.
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
Safety: either doctor or patient can call for a face to
face. Conversion rate falls through the day,
and varies by GP.
1 in 3 called in at
8am, falling to 1 in
5 before 11
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
Calls after 1700 result
in only 7% conversion
to ftf
Over time, your patients are 20% less likely to attend A&E
At mean
deprivation, line
shows 21% saving
Best fit line for
8,000 practices
Best fit line for
31 Patient
Access
practices
Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH
Crucial to match demand & capacity
We know that clinically urgent demand
is about 23% of consultations (blue)
25%
Offering an urgent only service
means a daily work profile with only
around ¼ demand at weekends
20%
15%
10%
5%
Hence lower requirement for sessions
OOH one GP for approx 8,000 patients
0%
When service is all day, by 1800 it drops off