Lockfield Surgery

Willenhall

9th May 2014

Launching Patient Access

Jonathan Ratcliffjonathan.ratcliff@patient-access.org.uk

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?

Receptio

n takes

call

GP sees patient10-min

slot

Problem solved

70% “routine”

30% “urgent”

“All gone,call backtomorrow”

3 week waitHigh DNAsRepeat booking

See any GP/locumPoor continuityRepeat booking

Patientpressure

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.

Reception takes call

GP phones patient

Problem solved

Come and see GP

Admin question

Come and see nurse

20%

20% 10%

30%

60%

60%

How Patient Access Works

Your Patient Access Launch Programme

Wk 1 Wks 1-3 Wk 3-4 Wks 5-11 Wk 12

Just 5 Simple Steps To

Your Happier, Efficient,

More Profitable Practice

Within The Next 12 Weeks

A Typical Receptionist Day With Patient Access

Nurse

Per Week, Patient List Of

8,000

10-12% of patients call

28% on Monday

220 – 270 calls @ 2

mins

7 to 9 hours of calls

Other days 4.5 to 6 hrs

Many more calls will come

in the morning, but will

spread as a result of good

service

A Typical GP Day With Patient Access

Per Week,

Patient List of 8,000

6-8% call for GP

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

40 x 5 mins plus 16 x 10 mins

Total consulting time 6

hrs/day

Availability of nurse

consultations can reduce this

by ≈ 40 mins/day

Mornings more phone calls,

becoming more face-to-face

late morning & into afternoon.

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 GP-

patient relationship

YES• Helping patients• Enhancing professional

practice• Evidence based• Measurement for

improvement• Saving effort and time

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 Relief of Working Efficiently

The Patient Access Launch Programme

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

Eight ways we support you in leading change and avoiding the

pitfalls

Step 1 – Consensus

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.

This step equips you to secure the all-important agreement of your partners

Step 2 - Preparation

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.

Equips you to transition smoothly to your new system

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

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 4 – Adapt

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.

Step 5 – Affirm

Your step by step guide to a happier practice

Start todayCall 01509 816 293 | email jonathan.ratcliff@patient-access.org.uk

“Patient Access has given us a new lease of life” Dr. Kam Singh