Transcript Slide 1
Lockfield Surgery
Willenhall
9th May 2014
Launching Patient Access
Jonathan Ratcliff
[email protected]
Agenda
• Current Model
• Surveys from Lockfield Staff
– Patient’s View
– Current Workload
– Ideal Work
• Your Performance Data
• A New Way Of Working
• Summary / Questions
Familiar?
“All gone,
call back
tomorrow”
3 week wait
High DNAs
Repeat booking
Reception
70% “routine”
takes call
Patient
pressur
e
30% “urgent”
See any GP/locum
Poor continuity
Repeat booking
GP sees
patient
10-min slot
Problem
solved
What do patients think of our service?
• Admin and Receptionists’ view
•
If they want a certain Dr and have to wait for an appointment they moan an
say the service is crap
• Some patients are very abusive and patronising and GP staff are unable to
respond because there is no one to back them up
• Fed up with the wait for appointments, Fed up with not being able to see
their preferred doctor, Fed up with wait on telephones
• Too many patients having to be put for triage due to lack of GP
appointments. Need more commitment from the partners.
• Nurses’ view
• Majority generally satisfied. Few verbally complain unable to get
appointment when want to or unable to get appointment with GP of their
choice.
• Doctors’ view
• never enough appts, can't get to see the GP of choice
• Don’t know
My daily work at present
• Admin and Receptionists’ view
• I get very stressed when patients have been on triage and waiting over 2
hours or more for something as simple as a urine result to be looked at.
• Frustrated with the whole of the appointment system. Really fed up with
being complained at by patients because there are no appts available.
• GP's screaming they are stressed but they need to be on the front line and
deal with the abuse we have to tolerate. Its a very stressful job.
• Nurses’ view
• Patients attending with multiple/list of problems but not given time to
cover everything. Patient expectation is to still have everything done.
• Doctors’ view
• There’s an unfair distribution of workload. Some Doctors spend time
troubleshooting patient’s problems whilst others sort problems
superficially with poor patient satisfaction who then return.
• Don’t know
My ideal work
• Admin and Receptionists’ view
• More appointments. Continuity of care. Educate our patients on our service
and their expectations. Better service makes happier staff and happier
patients. No complaints regarding the service or the staff.
• "happy staff will make happier patients", Overall a more stress free
environment and happier staff that want to come to work and not feel as if
they have to!!!!!
• Nurses’ view
• Interruption free with sufficient time given for the appointment. I don't like
to feel rushed as I then have concerns that I may have missed something.
• Doctors’ view
• 12 face to face consultations and 12 telephone consultations per session
• Fair distribution of work. Ability to spend more time with patients for
mutual benefit.
If changes are made, do you fear losing anything?
• Admin and Receptionists’ view
• No fears, I am up for the change if it will make things better, it cant make it
worse!!!!! LESS STRESS PLEASE!!!!!
• I feel in the first few weeks I might struggle . If system makes things easier
and stress free I am up for the change.
• I don't fear the loss of anything but it will be nice to want to come into
work instead of dreading it, having no headaches, no verbal abuse from
patients or doctors and less stress
• Nurses’ view
• No, I only hope that things can improve thus reducing stress levels, and
increasing job and patient satisfaction.
• Doctors’ view
• PATIENTS MAY NOT ACCEPT CHANGES AND THEN LEAVE THE PRACTICE.
• Practice should change if its not effective. I fear it wont.
Why do patients call? 52% for a GP, many for nurse,
admin, test results (repeat prescriptions additional to this)
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
Outcome of requests - 22% told to call back another time,
generating rework.
Vast majority of requests are for same day.
You are seeing about 45% the same day. This usually
rises to over 80%
38% specified a named doctor, similar views from GP,
continuity important for 41% of consults, about average.
GP consultations – highest on Tuesdays, low Weds. Need
to think how to match demand – highest on Mondays.
66% of cases acute, clinically best dealt with today.
At present, just 22% of consults are by phone
But of those, 66% are resolved on the phone – good.
Your view is only 6% more consults could have been by
phone – though this often changes!
Navigator shows your demand is going up week by week
this year – does it feel like this?
Key points
• Demand heavier on Monday, but not supply. Demand
rising fast – any idea why?
• Patients ring the day they want to be seen, but most
have to wait.
• Demand is high at the start of the day, though it could
be worse. Will spread as patients gain confidence.
• Continuity (choice of doctor) is agreed on by patients
and GPs, though not achieved on many occasions
• Currently some consults by phone, and a good
proportion of them are resolved, should work well but
with many more calls.
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
Come and
see GP
30%
20%
Reception
takes call
20%
60%
GP phones
patient
10%
Come and
see nurse
60%
Problem
solved
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
3
2
Preparation
1
Launch
Day!
Consensus
Wk 1
Wks 1-3
Wk 3-4
Wks 5-11
Wk 12
A Typical Receptionist Day With Patient Access
Admin question
Per Week,
Patient List Of 8,000
20% solve
10-12% of patients call
Just 60%
list
for GP
Reception
takes call
28% on Monday
220 – 270 calls @ 2 mins
7 to 9 hours of calls
Other days 4.5 to 6 hrs
20% book
to see nurse
Many more calls will come in
the morning, but will spread as
Nurse
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
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 GPpatient 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.
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