skewen medical centre what is it like to be a patient? jo newton, harry longman...
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Skewen Medical CentreWhat is it like to be a patient?
Jo Newton, Harry Longman [email protected]
01509 816293 07939 148618
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What do patients think of our service?
• Receptionists’ view– Workload can be frustrating and stressful – especially first 45mins– Many patients getting used to phone triage, but frustrated if can’t see Dr
they want to see, or if delay in call back
• Doctors’ view– ‘Patients generally happy with service & easy access to GPs’– ‘Mixed – some like triage, others can’t get through, lines engaged,
appointment times when on school run / commute to work’
• Nurses– Patients happy with service except when..– Can’t get through on phone, no appointments for 2 days, can’t see Dr of
choice
• Admin– Patients complain about engaged phone / no appointments / no choice
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My daily work at present
• Receptionists’ view– ‘busy stressful putting up with complaints’– Phone constantly ringing disrupts ability to do other work– ‘Drs don’t always follow system & block lines to phone for coffee’
• Doctors’ view– ‘not too bad on non on call days – on call is busy & stressful’– ‘I am miserable & get frustrated because I see flaws in the system but
can’t correct them’
• Nurses– ‘some patients book with us thinking we can make appt with GP’
• Admin– When answering phones some patients get frustrated
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My ideal work• Receptionists’ view
– ‘no pre-bookable appts just open access all day every day with all Drs’– Less stress: patients to take complaints eg timekeeping to Dr not us
• Doctors’ view– ‘I want the happy team we had back (we lost it in 2012)’– ‘it is important to have a patient centred service but not at detriment
of doctor’s working day’– Retired.
• Nurses /Admin– ‘to be able to assist everyone and find an appt asap without any
problems’– ‘have enough available appts without feeling agitated or stressed’
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Demand is fairly steady at about 550 phone and 250 f2f consults per week, total new contacts estimated around 600 or 7.5% of list pw, medium.
Prescriptions recorded as GP consults shown separately at 200 pw.
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A problem is revealed looking at the time of booking. Almost all f2f is booked in a mad rush at 8am – though phone consults are booked all through the
day.Prescriptions mainly afternoon.
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Response times to telephone calls: median 62 minutes. This could easily be halved, improving satisfaction and flow.
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The average wait to see a GP appears to be one day and rising, but more like two days to speak to a GP. Scripts are all same day.
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In truth almost all appear to be booked on the same day, though a number of phone consults are booked a week or two in advance, which skews the mean.
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It appears that 82% of GP f2f appts are booked on the day, but we don’t know how many requests are rework from previous days.
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Duration of appointments, mean f2f 8 mins and phone below 4 mins, on the low end. Prescription requests shown as short consults.
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Average response time is consistently around 100 minutes. Tracking this week by week will be important feedback.
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Continuity within the month is stable around 80%. This is the chance that a patient will see the same doctor on each visit – it can move higher.
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Your consultation data over two weeks, by mode of consultation
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Consultation mode is 62% face to face, 37% phone and a few visitsIf all demand is triaged, this is 60% bring in rate – higher than expected 40%?
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About 55% of consultations are new vs 45% follow up
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57% of consultations are acute conditions, a further 8% exacerbations.
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Phone consultations: 50% of acutes resolved by phone, rising to 80% of chronic routine calls
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Your view, was the consultation appropriate? Almost all yes, with about 5% could have been phone, almost none “self care”
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Continuity: considered important in 58% of consults, achieved 90% of the time, and unimportant in 42% of cases
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Reception: 60% of requests are for a GP appt or phone call.
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Requests are about 50% higher on Mondays than other days. Many requests for appts are “downgraded” to phonecall, some offered later date.
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Looked at by hour of the day, requests for GP come in one manic rush at 8am
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Almost all requests for a GP are for the same day.
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Almost all are reported as “first time” calls, although comments made…eg, “chasing a call made earlier for a phone call”
“will call another day for a specific doctor”
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Summary – something not working?
• In many ways the service looks good– Almost all same day service– Total demands about expected level of 7.5% pw– Mostly phone initially, plenty of f2f– Continuity looks OK
• Data reveals problems– 8am rush is very pronounced and hard work– Response time is high because of the rush
• People feel under pressure– Doctors not happy with situation– Receptions feel stress from patients– It’s difficult to see the doctor you want to
• Looks like a hybrid system, and fixable
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How? A new system. Simple, but different
PA Navigator measures the flows, which vary by GP & practice.
Reception takes call
GP phones patient
Problem solved
Come and see GPAdmin question
Come and see nurse
10%
20% 10%
30%
60%
70%