Transcript Survival – ‘managing demand’

Survival – ‘managing demand’
A Stowhealth solution
Aim
Explain where we were
 Options and decisions
 Our methodology
 Our conclusion

Where were we
Fraught
 Working 0800 – 1930 and not finishing
 Unhappy and unsustainable

Options and Decision
Do nothing - people would have walked!
 Pour in more resource – not an attractive or
sensible option
 Try and manage demand better?......

Our Methodology
Look at the options
 Get an external review
 - choke on the next step price
 Do it ourselves

What were we doing?
"Hybrid
system":
- Pre-booked routine surgeries
- On The Day Team: staffed by 2 Drs/session, NP am +
limited Minor Illness support
Separate
LTMC clinic: LTC reviews/QOF delivery
External review
"Patient Access"
www.patient-access.org.uk
Facilitated in-house survey of:
Reception:
How often were you able to give people what they
wanted?
Clinicians:
New/follow up
Acute/Acute-on-Chronic/Chronic
Continuity important?
Continuity achieved?
Duration of face to face consults around 12 minutes, and
telephone stable at 4 minutes is on the fast end.
Continuity: judged important mostly for chronic conditions, also
many acute, 42% overall, and 8% gap where not achieved.
Where continuity matters, and is achieved, 62% of
consultations are resolved, cf only 39% where not achieved.
What next?
Balked at £13K + quoted for further input
 Do it ourselves!
 Working party - Doctor, Business Manager,
Nurses, HCAs
 "Suck it & see"
 Regular review
 Constant tweaking

How will the new system change things?
Admin question
Come and see me
30%
10%
Reception
takes call
20%
70%
GP phones
patient
10%
Come and see the
nurse
PA Navigator measures the flows, which vary by GP &
60%
Problem
solved
Principles
Triage all Doctor appointment requests
 Ask patient if there is a specific Dr that they
wish to speak to - if not, allocate in turn
 Use Minor Illness clinic where appropriate
 Clinicians can book future appointments beware tomorrow's demand!
 Never refuse an appointment if patient wishes
to be seen

Our system
Others changes

Increase in Minor Illness clinic capacity

Move more Treatment Room activity to HCAs
Unchanged
Bloods
 LTMC
 Learning disability reviews
 Mental health reviews
 Postnatals
 Baby checks
 Baby immunisations

Outcomes - September 2013

Average number of telephone calls/Dr/session 17.7 (range 15.0 - 21.3)

Average number of face-to-face
appointments/Dr/session - 4.4 (range 3.2 - 6.3)

Average conversion rate - 25% (range 18.2 36.3%)
Reduction in DNAs
Other findings

Demand is predictable (& finite!)

3/4 of daily phone demand received by 1pm

2/3 of total daily work (phone + face-to-face)
dealt with by 1pm

Activity has fallen since outset, but now stable
Monday AM
Tuesday PM
Thursday PM
How does it feel? Patients and Staff
Patient survey
 300 questionnaires sent
 Ratio - 2 telephone only: 1 face-to-face
 110 responses received

Staff survey
 26 responses received

PATIENT - Did you find it convenient to
receive a call back from the clinician during
surgery hours?
Yes 89%
No
11%
PATIENT - Were you able to speak to/see the
clinician of your choice?
Yes 87%
No 13%
PATIENT - Were you satisfied with the
outcome of your telephone consultation?
Yes
88%
No
9%
Blank 3%
PATIENT - If required, were you given an
appointment on the day that you wished to be
seen?
Yes 87%
No 13%
PATIENT - How was your experience of our
new appointment system compared to our
previous system?
Better 50%
Same
31%
Worse 17%
Blank
2%
STAFF - How would you rate your ability to
meet your patients needs? (n=26)
Better 73%
Same 23%
Worse 4%
STAFF - As a result of our new appointment
system, do you feel more in control of your
working day?
Yes
54%
No
19%
Blank 27%
STAFF - What is your experience of our new
appointment system compared to our
previous system?
Better 80%
Same
20%
Worse
0%
Pros

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See the patients that need to be seen, not just those
willing to wait
Better continuity
Better understanding of demand
Better able to match capacity to demand
Clinicians feel more in control of their working day
Fewer late finishes
Little needs cancelling if absence/sickness
All demand dealt with at end of day - the phones do
stop ringing!
Cons




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Hard, intense work - timely call backs important
Difficult for some people to receive call backs whilst
at work
Very sensitive to "bums on seats" - can't restrict
demand!
Requires stricter holiday planning
Half days
Needs telephone triage confidence
Need good LTC/QOF systems
The future?