What is it like to be a patient?

1. Manor Drive Surgery PathfinderWhat is it like to be a patient?Thoreya Swage, Patient Accessthoreya.swage@patient-access.org.uk07946 559132

2. What is it like to be a patient? Patient wants the doctor • When do I have to call? • Will I be seen? • Will they see me when I want to come? • Who will I see?

3. The average wait to see a GP is around 7 days at present, though it has been over 12, and for a phone call it is about one day.

4. Although just over 50% of f2f bookings are made the same day.

5. The average wait is pulled up by the large proportion booked two weeks or more ahead.

6. Each week about 400 f2f consults and 200 by telephone are offered. The combined effective rate is around 4.6% of patient list pw, on the low end.

7. Pattern of booking through the day: a large spike at 8.45 when telephone slots are booked, while f2f are booked throughout the day, more morning.

8. Balance of workload through the week: f2f higher on Monday and Friday, phone highest on Thursday.

9. What do patients think of our service? • Receptionists’ view • ‘Whole spectrum of satisfaction’ • ‘Not good enough’ ‘pretty bad’ • ‘Patients think waiting too long for appointments – is a big concern’ • Doctors’ view • ‘Hard to get through on the phone and make an appt’ • ‘Some find it hard to get appt but on the whole they are happy with current system as patients allowed to leave messages in out baskets at reception and we get back to them the same day or day after or call duty doctor’ • Nurse/HCA view • ‘Half think good/half think bad. Not happy with appointments’ • ‘Sometimes difficult to get appointments’ • Admin • ‘Not happy, takes too long for phones to be answered, then can’t give an appointment’ • ‘Not enough appointments’

10. Continuity GP-patient is around 85% for f2f, a good level for a large practice, phone lower about 70%. Important to preserve and enhance.

11. Reception data capture: most patient requests are for GP appt or phone, many for nurses, other admin, repeat Rx and test results.

12. When do patients call for GP, and what is the outcome?Vast majority are morning 9-11, mostly agreed.

13. The daily pattern: Mondays more than double other days.About 12% don’t get what they want, of which 8% are call again.

14. How far ahead do patients want to book? Phone requests same day, f2f appear to be spread out – this is unusual. Are they asking for 2 weeks?

15. GP consultations recorded – partial only, mostly face to face

16. Acuity: you judge 64% of presentations to be acute, mean best seen and dealt with as soon as possible. (Often see more than this)

17. Most of those recorded are face to face, whether acute or routine

18. Are they appropriate? You judge only 4% should have been self care, but 18% could have been by phone.

19. Actual outcomes of phone consults – sample size is small, and resolution rate below expected but clear pattern, more resolved for chronic routine than acute

20. 53% of consultations are new, 47% follow up.Close to average, often see higher new/FU ratio.

21. Continuity: you judge this to be important in 68% of consultations, and almost always achieved. Both figures are higher than average.

22. My daily work at present • Receptionists’ view • ‘Not able to give pts appts within the time scale that they want’ • ‘My job is to help patients, so it is frustrating that I cannot give them what they want’ • Generally quite happy, sometimes when very busy pats can be impatients whilst waiting ‘to be seen’ • ‘Patient anger at non appts/stressful’ • Doctors’ view • ‘Frustrating when you want to see a patient and have no where to put them’ • ‘Lot of paperwork, and messages patients leave- can take 2 -3 hours in a day ... I often feel completely drained at the end of the day because of stress.’ • Nurse/HCA view • ‘Pressure at time to meet targets’ • ‘Not enough time allocated for some appts, wrong patients booked, lots of patients squeezed in’ • Admin • ‘No stresses’ • ‘Very stressful with the amount of patients we have at the surgery’ • ‘Too much of everything at the moment, patients expect things to be done straight away. Think they are the only patient’

23. My ideal work • Receptionists’ view • ‘Having a booking system that is easy for patient to understand, will give the majority of the patients what they want’ • ‘To be more helpful to the pt by giving them an appt when needed’ • ‘Another GP to accommodate the overflow of patients’ • ‘Be able to offer the patients appts within a week’ • Doctors’ view • ‘Ideally I prefer routine and I like seeing a set number of patients daily’ • ‘Be able to match patient supply with demand without killing myself’ • Nurse/HCA view • ‘Prevent overloading’ • Admin • ‘Quite happy as I am’ • ‘Less stressful’ • ‘More capacity all round for GPs’

24. Summary • A mixed system of on the day phone triage, with prebooked face to face 2 weeks plus ahead. • Demand is very high for phone calls early in the day, suggesting a perceived shortage, but f2f are booked throughout the day. Overall demand is on the low end. • Waiting time to see a GP f2f is on average very high at 7 days. Suggests pressure on the system, as do pt comments • Continuity is highly valued and usually achieved for f2f but not for phone calls. • You don’t judge much demand to be inappropriate, but significant numbers could be by phone. It’s interesting to see how this changes with experience. • Staff want to help patients but not enough appointments are available.

25. Problem solved Admin question Come and see the nurse GP phones patient Come and see me Reception takes call How will the new system change things? 30% 10% 70% 60% 10% 20%

26. TH surgery - Since waiting times to see the GP have dropped 80%, I’ll be seen same day

27. TH Surgery - The whole practice seems to operate on the idea of today, now.

28. TH Surgery - I can call any time. Quite often it’s early, but not like the old days when you had to call at 8am.

29. TH Surgery The main mode has switched from face to face to phone, but visits have also dropped a lot.

30. TH Surgery - Patient Survey – post launch • ‘Really beneficial as it doesn’t waste my time or the drs. I love it.’ • ‘It works for me as I get to see my own dr as I don’t normally get to see her’ • ‘Amazed, very sceptical before but it is amazing’ • ‘Would like to talk to someone face-to-face’ • ‘Very quick, very good’ • ‘Very efficient service’