threeways surgery what is it like to be a patient? thoreya swage, patient access...
TRANSCRIPT
Outside a traditional surgery
People waiting on the phone, the same, unseen
The traditional model
Reception takes callReception takes call
GP sees patient10 min slot
GP sees patient10 min slot
Problem solved
Problem solved
70% “routine”
30% “urgent”
60%
“All gone.Call backtomorrow”
3 week wait,high DNAs,repeat booking
See any GP/locumPoor continuity,repeat booking
Patientpressure
80% of consults are face to face, but quite a few by phone
Of those, 56% resolved over the phone
Though when asked if consultation was appropriate, only 10% said it could have been by phone.
Hourly demand, slopes downward, good service implied here
GPs see continuity as important in 38% of consultations.
57% of patients ask for a named doctor. Significantly more than GPs. Something that needs to be addressed, and can be.
Vast majority of requests are for same day
But still 10% of requests told to call back another time - rework
30% of requests from walk ins suggest that patients find it difficult to get through on the phone.
Patients’ views of our service• ‘Difficulty in getting appointments/lack of appointments’• ‘Patients like the continuity of seeing the same doctor but we
have to have locums in and they are not always happy to see them as an alternative’
• ‘many new patients have left their old surgeries to join Threeways because they have heard such good things about it’
• ‘Most people seem happy about the quality of the consultation but are always fed up with me running late’
• ‘Excellent. Only frustration can be getting through at 8-9am on the phone and 2-3pm i.e. peak call times
My daily work at present
• ‘on commencement of shift there are rarely enough appointments available’
• ‘Gaining more patients and no more appointments’• ‘would prefer to have any visits assigned as soon as
they come in to aid time management/planning’• ‘very stressful and the feeling is that all members of
staff are being stretched to the limit’• ‘lack of appointments with particular GPs’• ‘very long hours, most days 12-13 hours
My ideal work• ‘more flexibility in working hours and more late
appointments for people who work’• ‘having enough appointments’• ‘a surgery where all streams of work are seen and dealt
with by the appropriate staff member. Time in the day to check results and paperwork and may be even have a cup of tea and see other staff members’
• ‘To be able to give patients appointments at the times they would like and to generally have more appointments’
• ‘seeing only those patients who really need to see a doctor’
A practice in the Patient Access community looks a little different
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, every problem requires 10 minutes face to face with the GP
One tiny problemPerfect service
• We help all our patients, all day, every day• The Patient Access method makes this a daily reality.
A new principle is at work
Simple, but the whole system changes
PA Navigator measures the flows, which vary by GP & practice.
Reception takes callReception takes call GP phones patientGP phones patient
Problem solved
Problem solved
Come and see GPCome and see GPAdmin questionAdmin question
Come and see nurse
Come and see nurse
10%
20% 10%
30%
60%
70%
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 3 minutes
Four practices, 17,000 patients, 9 months to May 2011
Traditionally, all patients
take ten minutes. Why?
“How are we going to help all our patients, all day, every day?”You answer, over five stages of the programme.
ConsensusConsensus
PreparationPreparation
Staff surveyPatient surveyData captureTrainingSystem setupWhole team
New deal for patientsFeedback wallTest & learnBuild confidence
Launch dayLaunch day
RoutineRoutine
ReviewReviewEvidence:New measuresNew staff surveyNew patient surveyYour decision
Yes.Pledge toeach otherand to patients
What happens next?• All to agree to a change• Change leader• Decide on a launch date• Do not book any appointments from launch
date onwards• Workforce planning (GPs and reception staff)
What happens next?
• Inform the patients– e.g. flyer, PPG, website, media, answerphone
message etc
• Train staff– Procedure for reception staff to follow
• Support provided by Patient Access training partner – before, at launch and afterwards
Which is the best pancake?
Cold and soggy
Hot, fresh and crispy