Berkley Practice What is it like to be a patient?

1. Berkley PracticeWhat is it like to be a patient?

2. “How To Get Your Life Back, Save More Money and Have Happier Patients Within The Next 12 Weeks”

3. Familiar? Familiar?

4. Before Patient Access GPs, PMs and receptionists said… I’m embarrassed when I see rows of patients waiting We’re going to have to get another GP in at a cost of £100,000.00 I’m annoyed by the huge number of DNAs I dread the inevitable phone blitz at 8 every morning I can’t take the aggression from frustrated patients anymore. I can’t magic up an appointment We all feel totally drained & I know that patients aren’t happy either

5. Not To Mention The Patients… Why do I have a 3-week wait at my surgery & yet I hear of others who see their doctor the same day? I’m frustrated that I can’t speak to my GP when I need to. I’m very tempted to change surgeries A lot of the time I don’t even need to see the GP, so why can’t I just phone, save the travel cost, hassle & my GP’s time? We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8. It’s a joke!

7. “All gone, call back tomorrow” 3 week wait High DNAs Repeat booking Reception takes call GP sees patient 10-min slot 70% “routine” Problem solved Patient pressure 30% “urgent” See any GP/locum Poor continuity Repeat booking

10. How Patient Access Works Come and see GP Admin question 30% 20% Reception takes call GP phones patient 60% 60% Problem solved 10% 20% Come andsee nurse

11. A Typical Receptionist Day With Patient Access Admin question 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 20% solve Reception takes call Just 60% list for GP 20% book to see nurse Nurse

12. 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 minsplus 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. Come and see GP 30% GP phones patient 60% Problem solved 10% Come and see nurse

13. 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.

14. The Relief of Working Efficiently • 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 • 7% list increase with no extra GP sessions needed at Oak Tree Health Centre We’re now saving20% of GP working hoursand A&E attends are 50% below Liverpool average- DrChris Peterson, GP at The Elms & Liverpool CCG Urgent Care Lead

15. What do patients think of our service? • Administrative staff views • Not very happy – wait to see GP & opening hours • ‘Patients satisfied with system – can get to see GP at their demand whatever day or time’ • Clinical staff views • Wait too long but then receive a good service • Can’t get through, access, inconvenient times, can’t book ahead • Can’t see doctor so offered nurse triage which helps

16. My daily work at present • Administrative staff views • Work very stressful • Can’t get work done, feel dissatisfied • Clinical staff views • Face to face triage • Busy busybusy

17. My ideal work • Administrative staff views • Want to help patients • Happy in current role • Would like to meet patients demands • Clinical staff views • ‘Would like less stress and improved access’ • ‘Would like to start at 9am, be in control and finish on time’ • ‘Would like to continue to do telephone triage’

18. Fear losses if changes are made? • Administrative staff views • What will the effects be long term? • Will we lose control of GP appointments? • ‘Staff sanity and loss of control of appointments’ • Clinical staff views • How will my role be effected? (nurse) • None

19. Consultations all face to face, 6.5% of list per week, avg

20. Average wait to see a GP is 7 days. Imagine just 1.

21. Wide variety of demands on reception (NB many in “other” are GP or nurse requests)

22. Monday is MUCH busier than other days

23. High demand at 8-9am, but reasonable spread through the day. 97% of requests agreed – high!

24. One third of patients are walk-ins. This is high, again suggests it’s hard to get through.

25. 45% of patients request a named doctor

26. Vast majority of patients want to see the doctor today- that’s why they called today.

27. Consultations – more on Mondays, good

28. 55% of consults are acute or exacerbations, iebest dealt with today.

29. Very few phone consults at present, 97% f2f, but of the 4 phone consults, all resolved.

30. In your view, 38% did not need a face to face. Even more will be evident.

31. Continuity: despite patient views, yours is that it matters only 27% of consultations

32. Launch programme - just 12 weeksto a happier, less stressful practice Detailed planning Staff survey Patient comms Whole team meeting New deal for patients Predicting demand & matching capacity. Patient & staff feedback Review Launch day Preparation Routine New measures help tuning. Build confidence Affirmation Consensus Yes. Pledge to each other and to patients

33. Simple, but the whole system changes Come and see GP Admin question 40% 10% Reception takes call GP phones patient 70% 50% Problem solved 10% 20% Come and see nurse PA Navigator measures the flows, which vary by GP & practice.

34. Phone consults take about 3 minutes Traditionally, all patients take ten minutes. Why? Four practices, 17,000 patients, 9 months to May 2011

35. Clarendon, a training and teaching practice in Salford.Previously drowning in demand, now feelingon top of workload Before After Reduced stress! Abuse of reception staff gone All patients who need it are seen Saving one clinical session • Frustrated, stressed doctors • Miserable reception staff • Unhappy patients • Reputational issues • List size effect

36. Within 12 weeks, response time median 30 minutes(now 19min)

37. Golden Rules • If telephone lines open 9am, so do Dr callbacks • All patients are called back – no Doctors appointments made by receptionists • Call back within the hour • All Drs on telephone call backs (exception Duty Dr or locum/trainee) • Call patients in for face to face from mid morning (and mid/late afternoon)

38. You lead. We guide you through the change. • Work on the whole practice system with the whole team. • Change is hard. We make the process easy and fast. • 5 stages over 8-12 weeks, knowing how you are doing • Every practice differs. You make the decisions. “Patient Access has given us a new lease of life” Dr. Kam Singh

39. Launch programme - just 12 weeksto a happier, less stressful practice Detailed planning Staff survey Patient comms Whole team meeting New deal for patients Predicting demand & matching capacity. Patient & staff feedback Review Launch day Preparation Routine New measures help tuning. Build confidence Affirmation Consensus Yes. Pledge to each other and to patients

40. Evidence now links method with outcomes Lower costs within practice GP control of work load, staff job satisfaction “We’re saving GP sessions” “Stress has melted away” “I can see my own GP” Access & Continuity Transformed, measured, understood. GP service innovation - new thinking Patient safety & satisfaction 20% reduction from faster response 20% reduction through improved continuity & management Lower A&E attendance Lower OP referrals and emergency admissions

41. Matching supply with demand coming in hour by hour enables outstanding patient service and the sense of flow. Loadmaster chart shows variation by day and hour.

42. Changing to demand led planning: the volume ranges of patient requests ranges from 5.5 to 10% of list per week. Note: 1. Practices have effectively unlimited access 2. Coding and data quality issues may affect comparisons

43. Safety: either doctor or patient can call for a face to face. Conversion rate falls through the day,and varies by GP. 1 in 3 called in at 8am, falling to 1 in 5 before 11 Calls after 1700 result in only 7% conversion to ftf Data from Thurmaston HC, 25/7/11 – 3/2/12. n = 10,367 calls Bubble chart: area of circle in proportion to number of GP calls made by hour Assumptions: all GP appts booked following GP phone call, at time of call

44. Over time, your patients are 20% less likely to attend A&E At mean deprivation, line shows 21% saving Best fit line for 8,000 practices Best fit line for 31 Patient Access practices Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH

45. Crucial to match demand & capacity We know that clinically urgent demand is about 23% of consultations (blue) Offering an urgent only service means a daily work profile with only around ¼ demand at weekends Hence lower requirement for sessions OOH one GP for approx 8,000 patients

46. When service is all day, by 1800 it drops off