Tudor House & Rectory Road Medical Practice Review

1. Tudor House & Rectory Road Medical Practice Review Harry Longman Harry.Longman@patient-access.org.uk 01509 81629307939 148618 Thoreya Swage Thoreya.Swage@patient-access.org.uk 07970 848573

2. What is it like to be a patient now? 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. They are now measuring the time to speak to me in minutes. The median is 30. I can ask for a later time.

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

5. Well, I have a choice but 93% of the time I’ll say today

6. The whole practice seems to operate on the idea of today, now. Previous spread of bookings - gone

7. I can call any time. Quite often it’s early, but not like the old days when you had to call at 8am. That spike has flattened a good deal

8. They are plotting the demands we make 6.4% pw, ringing us up, and only around 35% have to go in.

9. Apparently they have worked out which day we are going to call, and adjust rotas to suit.

10. They even know what time we’ll ring. It’s easier to predict this than get the GPs to sit at their desks.

11. They can track volumes by day, so they know Monday is a peak, other days lower.

12. They even know the chance of me seeing my usual doctor. It’s getting a little better at 82%.

13. Reception data capture: increasingly patients are asking to speak to the GP

14. About 87% of requests we get a GP phonecall, not what I wanted in 6% of calls, and 8% still asked to call back

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

16. 65% of demands are acute, another 10% acute exacerbations, so the best day to be seen is today

17. While 71% of “new” consults are by phone, this rises to 83% of “follow ups” – the GP has the notes

18. From a phone consult, 45% are resolved if acute, rising to 70% for chronic routine conditions.Usually the doctor who sees me is the one who phoned.

19. From the GPs point of view, are the consults appropriate? For 89%, yes. Only 4% “should have been self care”, more misdirected within practice.

20. In GP view, continuity matters in only 36% of consults, and is usually achieved. (other practices say up to 60%)

21. Where achieved, continuity means phone call more likely to resolve the problem (70%)

22. Before - Patients’ views of our service • Fed up with having to phone again and again…can never get through at 8am…appts gone by 8.10 a.m. • Frustration with not being able to get a routine appointment as soon as they would like. • Not enough access to their own GP. • Patients who work have difficulty turning around to come back for an appt we could have given the day they phoned.

23. How has the new system changed things? Come and see me Admin question 30% 20% Reception takes call GP phones patient 60% 60% Problem solved 10% 20% Come and see the nurse PA Navigator measures the flows, which vary by GP & practice.

24. Patient Survey – post launch • Happy with the new system, it’s a sensible idea • Has 3 children so very happy that the problem was solved without her having to come in • I think it is great. I don’t go to the dr very often and when I do I need to see them, now I can, whereas before I had to ring every day for three weeks to get an appointment to see my dr • Better than having to wait hours for a dr, I get to see and speak to them on the same day • Worked really well, got the reassurance I needed. Have used the system twice now and think it is brilliant • The service is better in respect that you don’t always want to see a doctor face-to-face, you may just need advice

25. Very high approval of change, 80% say better

26. 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 • Will at some point have to change dr as the system doesn’t work for me as I work full time and can’t just pop in • Would like the ability to email doctor too • Very quick, very good • Very efficient service

28. Before - My daily work here • Stress…phone is constantly ringing. • Frustrating to tell patients we don’t have any appts • Patients booked in at inappropriate times. • Fear a mistake may be made because we are so busy. • Frustrations with patient demand and political decisions beyond our control. • 14-hour days…often can be as late as 23.00!!! yet not enough time in the working day for admin tasks. • Frustrating when patients booked in…could have easily have been dealt with over the phone.

29. My ideal work • More appointments available on the day. • No phones on front desk so can deal with patients in person…designated phone areas and admin areas. • To give a friendly efficient service to patients. • Time in day to read letters, look at path results, plan. • A cheerful, enjoyable place to work, where people work together as a team…where all staff appreciated. • Some way of advising patients re self care v when they actually need to be seen. • I would like a lunch hour (or half hour).

30. Staff Survey after • 24 responses (14 reception/admin, 7 doctors, 3 nurses) • Have you achieved what you wanted? 11 – yes, 6 – not sure, 1 - no • Is the change for the better? 17 – yes, 4 – same, 3 – worse • Effect on patients – 20 – happy, 3 – mixed, 1 – not happy

31. Staff Survey after • What next? • More staff to cope with increased number of telephone calls • ‘need more staff to cope with the increase in telephone calls’ • ‘ adequate staffing to man 6 incoming lines’ • More phones • ‘need more phones to deal with the constant amount of calls coming in’ • Need to consider what to do with patients who can’t use phones • ‘bear in mind that phoning is not for everyone, especially the hard of hearing, elderly’ • Need to change the admin/nursing organisation to support the change • ‘this system needs to supported by wholesale back office change’ • ‘need slot times for the phone conversations so doctors have a rough idea of how behind /on time they are’ • Need to plan for when doctors go on leave/holidays • ‘ see how things are when in busier periods and when docs on leave’ • ‘ need to look at doctor cover for holidays etc’

32. How can we help all our patients, all day, every day?