little london surgery what is it like to be a patient? harry longman...
TRANSCRIPT
Deciding
Preparing
Detailed planningStaff surveyPatient commsWhole team meeting
New deal for patientsPredicting demand & matching capacity.Patient & staff feedback
Launch day Adapting
Affirming
“Bringing the baby home”New measures help tuning.Adapt to local needsContinuous improvement
Yes.Pledge toeach otherand to patients
Launch programme - just 12 weeksto a happier, less stressful practice
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
Reception takes call
GP sees patient10 min slot
Problem solved
70% “routine”
30% “urgent”
“All gone.Call backtomorrow”
3 week wait,high DNAs,repeat booking
See any GP/locumPoor continuity,repeat booking
Patientpressure
Rework
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
– (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
Reception takes call
GP phones patient
Problem solved
Come and see GPAdmin question
Come and see nurse
20%
20% 10%
30%
60%
60%
Receptionists’ day
Reception takes call
Admin question
20% solve
20% bookto see nurse
60% list for GP
For a patient list of 8,000:10-12% call per weekMonday is 28% of the week220 – 270 calls, at 2 mins each7 – 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
GP phones patient
Problem solved
Come and see GP
Come and see nurse
10%
30%
60%
For a patient list of 8,000:6-8% call for GP per weekMonday is 28% of the week130 – 180 calls, other days 80-120Plan for 40 each per GP per day.40 x 5 mins, plus 16 x 10 minsTotal 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.
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…
Monday morning 8.30, Busy day, going full tilt.All carefully worked out.
Dr Chris Barlow of Quorn, oneof the earliest pioneers in 2000
The traditional view of general practice
One tiny problemPerfect service
• We help all our patients, all day, every day• The Patient Access method makes this a reality.
A new principle is at work
Magic 1: Over half need only the call
Call fulfils demand See doctor Seenurse
Two practices, 8,000 patients, 9 months to May 2011
Magic 2: The call takes about 4 minutes
Four practices, 17,000 patients, 9 months to May 2011
Traditionally, all patients take ten minutes.
Why?
A new simpler system
Reception takes call
GP phones patient
Problem solved
Come and see GPAdmin question
Come and see nurse
20%
20% 10%
30%
60%
60%
Consensus
Preparation
Detailed planningStaff surveyPatient commsWhole team meeting
New deal for patientsPredicting demand & matching capacity.Patient & staff feedback
Launch day Routine
Review
“Bringing the baby home”New measures help tuning.Build confidenceAffirmation
Yes.Pledge toeach otherand to patients
Launch programme - just 12 weeksto a happier, less stressful practice
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 PrincipalHarry Longman, Patient Access
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