Transcript Slide 1

Little London Surgery
What is it like to be a patient?
Harry Longman
[email protected]
Launch programme - just 12 weeks
to a happier, less stressful practice
Detailed planning
Staff survey
Patient comms
Whole team
meeting
Preparing
Deciding
Yes.
Pledge to
each other
and to patients
New deal for patients
Predicting demand &
matching capacity.
Patient & staff
feedback
Launch day
Affirming
Adapting
“Bringing the baby home”
New measures help tuning.
Adapt to local needs
Continuous improvement
What do patients think of our service?
• Administrative staff views
– Frustrated at the lack of available appts and the difficulty getting
through on the phones.
– Not happy about only being able to book on the day...appts go so
quickly.
– Not happy that they cannot see the doctor they want.
– Not happy, having to wait too long for everything!
• Clinical staff views
– I would have always said patients were quite positive about our service
but of late...it has changed greatly...from my own perspective...speaking
to patients in my own clinic.
– Some do understand and use appropriately...but most of the time is
inappropriate use of service....
My daily work at present – admin views
•
•
•
•
We are at rock bottom.
Fed up of being shouted at by patients.
Very difficult patients want everything now....
I seem to be fire fighting everyday with constant grumbles from
both staff and patients about the appointment system and
availability of Drs
My daily work at present – clinician views
• Always busy, never having a full, if any, lunch break.
• Extra patients squeezed in, never time for admin.
• Very long days averaging 14 hours most weekdays.
Frustrated.....
• Stress...not enough time in the day...pressure...demand.
• Too busy to spend full time with patients when required.
• Everyone is so consumed with their own workloads...difficult to
run an effective service.
• Although enjoy seeing patients...work has become (a) burden.
• Reduced job satisfaction...not enough time to...manage
patients well.
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
My ideal work
• Administrative staff views
–
–
–
–
–
–
To be able to help all patients.
To be busy but be able to cope, not stressed out.
To help the surgery run more smoothly and efficiently.
Patients can access the services more appropriately.
A reduction in DNA's.
A happy environment.
• Clinical staff views
– Time to deal with patients properly...remember why we became
clinicians.
– More team cohesion where everyone feels valued and values everyone
else...
– Atmosphere happy, less stressful...proud of what our practice is
achieving.
– Continuity...work for the good of the patient...achieve best outcomes.
– Manageable.
– More personal development professionally and work life balance.
– Start 8.20, finish 6.30...and finish the paperwork.
Fear losses if changes are made?
• Administrative staff views
–
–
–
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(Loss of) patient contact...missed diagnosis.
Nothing more to lose!
Access to doctors
Moving away from (being a) friendly GP Practice
• Clinical staff views
– Changes being made far too quickly without adequate time and resources
being put in place.
– Loss of our reputation for compassionate care amongst our patients.
– Spending too much time on phone.
– Not opportunistically dealing with...face-to-face advice/continuity.
– (Loss of) patient contact.
– Service descending into even more chaos.
– Worried about the patients who cannot speak English and the patients we
want to follow up, how will they fit in the system.
A new simpler system
Admin question
Come and see GP
30%
20%
Reception
takes call
20%
60%
GP phones patient
10%
Come and see
nurse
60%
Problem
solved
Receptionists’ day
Admin question
20% solve
Reception
takes call
60% list
for GP
20% book
to see nurse
For a patient list of 8,000:
10-12% call per week
Monday is 28% of the week
220 – 270 calls, at 2 mins each
7 – 9 hours of calls.
Other days 4.5 – 6 hours.
NB many more calls will come in
the morning, but will spread as a
result of good service.
GPs’ day
For a patient list of 8,000:
6-8% call for GP per week
Monday is 28% of the week
130 – 180 calls, other days 80-120
Plan for 40 each per GP per day.
40 x 5 mins, plus 16 x 10 mins
Total consulting time 6 hours/day
Availability of nurse consultations
will reduce this by ≈ 40 mins/day
Mornings more phone calls,
becoming more face to face late
morning and into afternoon.
Come and see GP
30%
GP phones patient
10%
Come and see
nurse
60%
Problem
solved
Half the patients calling want a doctor
Monday is MUCH busier than other days
A spike of demand at 8am, a small one at 4pm?
Suggests people are struggling to get in.
Most patients do get an appt, but 9% told to call
another time – rework means taking the call again
One third of patients are walk-ins. This is high,
again suggests it’s hard to get through.
79% of patients request a named doctor – very
high, and shows how much this matters.
Vast majority of patients want to see the doctor
today- that’s why they called today.
Consultations – more on Mondays, good, but
not so many more.
63% of consults are acute or exacerbations, ie
best dealt with today.
And new/follow up ratio is 63%
Very few phone consults at present, 94% f2f, but
of the 7 phone consults, 6 resolved.
In your view, 24% did not need a face to face this always changes!
Continuity: despite patient views, yours is that
it matters only 30% of consultations
Language in consultations: although some have
difficulties, 88% are native or adequate English
Demographics: more children and young parents than
average. Rapid response very important to these groups.
A practice in the Patient Access community…
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
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
A new simpler system
Admin question
Come and see GP
30%
20%
Reception
takes call
20%
60%
GP phones patient
10%
Come and see
nurse
60%
Problem
solved
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
“Bringing the baby home”
New measures help tuning.
Build confidence
Affirmation
We are with you every step of the way
Dr Kam Singh, “It’s given me a new lease of life”
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