Welland Medical PracticeWhat is it like to be a patient?

Harry Longman, Bill Howlettharry.longman@patient-access.org.uk william.howlett@patient-access.org.uk

Your Patient Access Launch Programme

1Consensus

2Preparation

3Launch Day!

4Adapt

5Affirm

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

What do patients think of our service?

• Admin and Receptionists’ view– Disappointment with appointment system by patients– Some patients happy with help they get – and let us know– Patients happy with level of care, but do complain about appointment system & lack of

availability– Patents say we have poor access– Good apart from not enough appointments– Appointment system not good enough, (patients) want to access service same day

• Doctors’ view– Difficulty getting appointments

• Nurses’ view– Never had to face complaints– Patients often complain – unable to get appointment and being unable to see the

doctor/nurse of choice– Long waits on the phone – then no appointments available– Often unhappy at seeing a nurse when wanted to see a doctor

My daily work at present

• Admin and Receptionists’ view– Difficult patients cause most stress, “talk down to us” when we help– 8.30 – 9.00 – stressful if not enough appointments– Staff get on with one another – good– Daily appointment bookings, Rx requests, patient queries assisting GP’s and nurses, daily

admin tasks– Hardworking, stressful but rewarding– Frustration of not being able to offer a service I would be proud to shout about– Demanding job, enjoy all, never stressed even when patients are demanding

• Doctors’ view– GP

• Nurses’ view– Practice Nurse duties– Very busy & stressful environment– Often deal with patients who should have seen a doctor– Time wasted outside Dr’s room – when already short of time

My ideal work

• Admin and Receptionists’ view– Full time admin work (no reception)– To give patients access to a clinician within 24 hours and offer an appointment time

that suits them– More appointments to give patients– Better accessibility, more efficient service– Patient call practice, access advice re medical condition, promote preventative

medicine– Patients leaving Happy

• Doctors’ view– Patients getting appropriate and timely service

• Nurses– Less patients, more time– Enough time to spend with patients – so not rushing– Feeling well supported by colleagues

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

If changes are made, do you fear the loss of anything?

• Admin and Receptionists’ view– Depends what kind of change – only fear is job loss– No (4)– Changes can be for the better, change needed for appointment system– Changes made and explained properly will promote practice &

encourage more to join– Can take getting used to, but change does improve running of practice

• Doctors’ view– (no comments)

• Nurses’ view– Face to Face contact– No, I think things need to change

Why do patients call? 59% for a GP, also 24% for repeat prescription

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

This is how it looks on SystmOne.

Outcome of requests - 12% told to call back another time, generating rework.

Vast majority of requests are for same day.

Only 21% specified a named doctor, similar views from GP, continuity important for just 28% of consults,

lower than many

GP consultations – not much variation cf demand, need to match whole week. Loadmaster will help

planning.

63% of cases acute, clinically best dealt with today.

At present, only 5% of consults are by phone

Via Navigator, we can see how long it takes to respond

Your view is only 11% of consults could have been by phone – though this often changes!

Language is native or adequate for 81% of consultations, but 19% is a significant proportion

where difficult.

Key points

• Demand is quite variable by day of week, much heavier on Monday.

• Demand is stacked at the start of the day, suggesting anxiety for patients – 12% are turned away, while almost all want “same day”

• Continuity (choice of doctor) is mentioned less often than with many patients and GPs.

• Currently very few consults are by phone so a change will feel very different.

• While language is an issue for some (around 19%) for the great majority it will be OK.

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

A Typical Receptionist Day With Patient Access

Reception takes call

Admin question

20% solve

20% bookto see nurse

Just 60% list

for GP

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

GP phones patient

Problem solved

Come and see GP

Come and see nurse

10%

30%

60%

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 harry.longman@patient-access.org.uk

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