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Survival – ‘managing demand’

Learn how Stowhealth successfully managed demand to improve patient satisfaction and clinician control. Our methodology includes triage, minor illness clinics, and continuous review. Find out the pros and cons of our new appointment system.

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Survival – ‘managing demand’

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  1. Survival – ‘managing demand’ • A Stowhealth solution

  2. Aim • Explain where we were • Options and decisions • Our methodology • Our conclusion

  3. Where were we • Fraught • Working 0800 – 1930 and not finishing • Unhappy and unsustainable

  4. Options and Decision • Do nothing - people would have walked! • Pour in more resource – not an attractive or sensible option • Try and manage demand better?......

  5. Our Methodology • Look at the options • Get an external review • - choke on the next step price • Do it ourselves

  6. What were we doing? • "Hybrid system": • - Pre-booked routine surgeries • - On The Day Team: staffed by 2 Drs/session, NP am + limited Minor Illness support • Separate LTMC clinic: LTC reviews/QOF delivery

  7. External review • "Patient Access" • www.patient-access.org.uk • Facilitated in-house survey of: • Reception: How often were you able to give people what they wanted? • Clinicians: • New/follow up • Acute/Acute-on-Chronic/Chronic • Continuity important? • Continuity achieved?

  8. Duration of face to face consults around 12 minutes, and telephone stable at 4 minutes is on the fast end.

  9. Continuity: judged important mostly for chronic conditions, also many acute, 42% overall, and 8% gap where not achieved.

  10. Where continuity matters, and is achieved, 62% of consultations are resolved, cf only 39% where not achieved.

  11. What next? • Balked at £13K + quoted for further input • Do it ourselves! • Working party - Doctor, Business Manager, Nurses, HCAs • "Suck it & see" • Regular review • Constant tweaking

  12. 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% PA Navigator measures the flows, which vary by GP & practice.

  13. Principles • Triage all Doctor appointment requests • Ask patient if there is a specific Dr that they wish to speak to - if not, allocate in turn • Use Minor Illness clinic where appropriate • Clinicians can book future appointments - beware tomorrow's demand! • Never refuse an appointment if patient wishes to be seen

  14. Our system

  15. Others changes • Increase in Minor Illness clinic capacity • Move more Treatment Room activity to HCAs

  16. Unchanged • Bloods • LTMC • Learning disability reviews • Mental health reviews • Postnatals • Baby checks • Baby immunisations

  17. Outcomes - September 2013 • Average number of telephone calls/Dr/session - 17.7 (range 15.0 - 21.3) • Average number of face-to-face appointments/Dr/session - 4.4 (range 3.2 - 6.3) • Average conversion rate - 25% (range 18.2 - 36.3%)

  18. Reduction in DNAs

  19. Other findings • Demand is predictable (& finite!) • 3/4 of daily phone demand received by 1pm • 2/3 of total daily work (phone + face-to-face) dealt with by 1pm • Activity has fallen since outset, but now stable

  20. Monday AM

  21. Tuesday PM

  22. Thursday PM

  23. How does it feel? Patients and Staff • Patient survey • 300 questionnaires sent • Ratio - 2 telephone only: 1 face-to-face • 110 responses received • Staff survey • 26 responses received

  24. PATIENT - Did you find it convenient to receive a call back from the clinician during surgery hours?

  25. PATIENT - Were you able to speak to/see the clinician of your choice?

  26. PATIENT - Were you satisfied with the outcome of your telephone consultation?

  27. PATIENT - If required, were you given an appointment on the day that you wished to be seen?

  28. PATIENT - How was your experience of our new appointment system compared to our previous system?

  29. STAFF - How would you rate your ability to meet your patients needs? (n=26)

  30. STAFF - As a result of our new appointment system, do you feel more in control of your working day?

  31. STAFF - What is your experience of our new appointment system compared to our previous system?

  32. Pros • See the patients that need to be seen, not just those willing to wait • Better continuity • Better understanding of demand • Better able to match capacity to demand • Clinicians feel more in control of their working day • Fewer late finishes • Little needs cancelling if absence/sickness • All demand dealt with at end of day - the phones do stop ringing!

  33. Cons • Hard, intense work - timely call backs important • Difficult for some people to receive call backs whilst at work • Very sensitive to "bums on seats" - can't restrict demand! • Requires stricter holiday planning • Half days • Needs telephone triage confidence • Need good LTC/QOF systems

  34. The future?

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