Transcript Slide 1
Parkside Surgery
What is it like to be a patient?
Harry Longman, Patient Access
[email protected]
“How are we going to help all our patients, all day, every day?”
Consensus
Yes.
Pledge to
each other
and to patients
Preparation
Staff survey
Patient survey
Data capture
Training
System setup
Whole team
Launch day
New deal for patients
Feedback wall
Test & learn
Build confidence
Launch programme
12 weeks to a different practice
Routine
Evidence:
New measures
New staff survey
New patient survey
Your decision
Review
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 11.00 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.)
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.
Outside a traditional surgery
People waiting on the phone, the same, unseen
The traditional model
“All gone.
Call back
tomorrow”
3 week wait,
high DNAs,
repeat booking
Reception
takes call
70% “routine”
Patient
pressure
GP sees patient
10 min slot
30% “urgent”
See any GP/locum
Poor continuity,
repeat booking
Problem
solved
Evidence of busy times at 8am, and not much later.
My ideal work
• Administrative 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.
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.
Reception data capture: Monday the highest
It’s very busy at 8am. By afternoon, little to offer.
77% of patient requests agreed. 10% told to call back
Continuity: 40% of patients name a doctor
Vast majority of requests are for same day
About 16% of requests are walk in – is it hard to get
through on the phone?
Reception dealing with wide variety, high repeat scripts
GP volume is highest on Friday
Acuity is typical of most practices, majority acute, and
new to follow up is 58%
Urgency also typical: most demand is acute & routine
Today, only about 20% of GP consults are by phone
But 80% of them are resolved over the phone
(small number of NP telephone consults, 33% resolved, not sure about nurse?)
Nevertheless, you consider only 20% were “face to face not needed”
Continuity: GPs view, 30% important, lower than average
Navigator: GP consultation rate up 24% over 2 years. Wow.
But current consults weekly rate 6.4% - moderate
Weekly pattern shows most on Fridays. Hmm.
We’ll be tracking phone response times, currently 2 hours
And days wait to see GP, currently 4 to 5 (though 40% are same day)
An interesting feature – your consults are much longer than most
The traditional model
“All gone.
Call back
tomorrow”
3 week wait,
high DNAs,
repeat booking
Reception
takes call
70% “routine”
Patient
pressure
GP sees patient
10 min slot
30% “urgent”
See any GP/locum
Poor continuity,
repeat booking
Problem
solved
A practice in the Patient Access community
looks a little 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 traditional view of general practice, every problem
requires 10 minutes face to face with the GP
Perfect service
One tiny problem
A new principle is at work
• We help all our patients, all day, every day
• The Patient Access method makes this a reality.
Magic 1: Over half need only the call
Call fulfils demand
See doctor
Two practices, 8,000 patients, 9 months to May 2011
See
nurse
Magic 2: The call takes about 4 minutes
Traditionally, all
patients take
ten minutes.
Why?
Four practices, 17,000 patients, 9 months to May 2011
Simple, but the whole system changes
Admin question
Come and see GP
30%
20%
Reception
takes call
20%
60%
GP phones patient
10%
Come and see
nurse
PA Navigator measures the flows, which vary by GP & practice.
60%
Problem
solved
Clarendon Practice,
Salford,
turns round
Dr Jeremy Tankel, GP Principal
Harry Longman, Patient Access
[email protected]
Average days wait to see a GP falls off a cliff.
All data from Clarendon, charts by PA Navigator
They now measure the wait in minutes. Median is about 30.
All data from Clarendon, charts by PA Navigator
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
Clarendon, a deprived population of 10,000, 3 partners, 3 sal GPs
Why change and for what?
Before
• Rising demand – falling
morale
• Waiting room stress
• Grumbling patients
• All pre-books gone
• Mad rush on phones at 8am
After
• Demand high but stable
• A “no-waiting” room
• Free slots in most sessions
• Patients love it
• No need for 8am rush
A training and teaching practice, with a new NP.
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 pts who need it are seen
• Saving one clinical session
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
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
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
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