Reedyford Health Care What is it like to be a patient?

1. Reedyford Health CareWhat is it like to be a patient?

2. “How are we going to help all our patients, all day, every day?” Consensus Yes. Pledge to each other and to patients Preparation Launch day Staff survey Patient survey Data capture Training System setup Whole team Routine New deal for patients Feedback wall Test & learn Build confidence Review Evidence: New measures New staff survey New patient survey Your decision Launch programme 12 weeks to a different practice

3. What do patients think of our service? • Administrative staff views • Lack of appointments to offer to patients • Great clinical service, but poor appointment service • Patients complain about lack of appts • Clinical staff views • Good practice reputation but poor access • Easier to get an audience with the Queen, than an appt with me • Patients feel they are being ‘fobbed off’ • Struggle to get appt with Dr of choice on the day • patients don’t like phoning in the morning to be told no appts available

4. My daily work at present • Administrative staff views • phones are very busy in the mornings esp at 8.30 am • Feel positive when we have appts to offer to patients. Feel really bad when we don’t • Can get lot of abuse from patients when no appts to offer • Clinical staff views • Get to work 30 mins earlier to fit in admin • Working at full pace all day • Dealing with various queries all day, sometimes worry that may have missed something • Lots of pressures to meet targets and meet patient needs • Never have enough time, always running late due to lack of time • No time for lunch

5. Outside a traditional surgery People waiting on the phone, the same, unseen

6. Rework The traditional model “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

7. My ideal work • Administrative staff views • Stagger opening of appts so patients don’t have to ring at 8.30 am • Be able to book appt for patient with Dr of choice. This would cut down repeat phone calls and I would feel more positive about picking up the phone! • Steady phone calls all day • Enough appts to meet demand • Clinical staff views • Being able to assign slots of different lengths to patients with different categories of problems, but then it is difficult for some of them to know what is serious and what is not. • Reception staff to take better note of patient screen alerts which ask for double appointment slots for patients who are known to take up time. • Better service, more appts • would like to be able to run on time, have enough appointments, not see patients who are wasting time, encourage patients to take responsibility in looking after themselves where appropriate

8. My ideal work - Clinical staff views (cont) • Being able to devote the time needed to more complex patients - includes a lot of the diabetic patients I see. • Having time to process post and lab links the day they arrive. • Also having satisfied patients that I don't have to spend valuable minutes in the consultation apologising for their difficulty getting an appt

9. Fear losses if changes are made? • Administrative staff views • fear of losing job • It can only be better if patients offered more appts • Changes may be made without proper planning or consultation • Clinical staff views • It can only get better! • Role of the triage nurse could change – if GPs on triage all the time • Open to change but sceptical after 25 years of change as have tried other systems before • worry more patients will be brought in to be seen anyway due to the threat of litigation. There will be an inequality of patients wishing to see certain GPs; the threat to continuity

10. Why do patients call?65% of calls are for a GP, others for nurse, a few admin

11. 92% of demand is by phone. A good place to start

12. GP demand much higher on Monday

13. GPs: days similar, few on Thursday?

14. But is everyone really sick only at 8am?

15. 30% of requests for clinician not met, of which 11% told to call back. This creates rework

16. Examples of comments show more rework • Chasing x-ray referral, asked to ring back in morn to speak to secretary • Apptcanx and rebooked • Pt chasing phone call from GP, Advised will be this afternoon sometime • Requested female GP, none available, advice phone call from nurse booked • Visit request, phone call arranged from triage nurse • Requested female, could not find a female gp that was convenient for her, plenty of male appts though! • Patient wanted to change appointment but decided to keep original • Didn't specify how long he wanted to wait to see requested GP • Patient only wanted to see Dr Ashworth next Fri or Mon, non available, she will try back later

17. Vast majority want to be seen today, some a week away, even though (inset) clinically 78% routine, just 22% urgent

18. But 62% acute or exacerbations, ie best dealt with now.

19. 40% request a named GP, 60% don’t mind.Typical, and useful thinking of new system.

20. GPs’ view, continuity matters for just 30%. A little lower than most?

21. 64 telephone consults, just 15% of total.

22. Of the telephone consults, 89% resolved over the phone.

23. GPs’ view, only about 15% “face to face not needed”Amazing how this changes (day 1 Derbyshire practice 30%)

24. Rework The traditional model “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

25. A practice in the Patient Access community looks a little 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.

26. The traditional view of general practice, every problem requires 10 minutes face to face with the GP One tiny problem Perfect service

27. A new principle is at work • We help all our patients, all day, every day • The Patient Access method makes this a reality.

28. Magic 1: Over half need only the call See nurse Call fulfils demand See doctor Two practices, 8,000 patients, 9 months to May 2011

29. Magic 2: The call takes about 4 minutes Traditionally, all patients take ten minutes. Why? Four practices, 17,000 patients, 9 months to May 2011

30. A whole new system, all work in a new way Come and see GP Admin question 30% 20% Reception takes call GP phones patient 60% 60% Problem solved 10% 20% Come and see nurse PA Navigator measures the flows, which vary by GP & practice.

31. Measurement is crucial to good performance– patient service Always offer same day, 80% choose this Come and see GP Admin question 30% 20% Reception takes call GP phones patient 60% 60% Rapid response critical, often also choice of GP. Problem solved 10% 20% Prompt answer Come and see nurse PA Navigator measures the flows, which vary by GP & practice.

32. Measurement is crucial to good performance – working efficiently Come and see GP High solve rate saves GP time Admin question 30% 20% Consult durations flexible, appropriate Reception takes call GP phones patient Below 50% saves no time. Maximum safe level? 60% 60% Predict demand volume & timing to plan supply Problem solved 10% 20% Adequate nurse capacity for balanced workload Come and see nurse PA Navigator measures the flows, which vary by GP & practice.

33. Clarendon Practice, Salford, turns roundDr Jeremy Tankel, GP PrincipalHarry Longman, Patient Accessharry.longman@patient-access.org.uk

34. Average days wait to see a GP falls off a cliff. All data from Clarendon, charts by PA Navigator

35. They now measure the wait in minutes. Median is about 30. All data from Clarendon, charts by PA Navigator

36. Patients are more likely to see the same doctor. Continuity, so precious to both, is up 15% This means that on multiple consultations, a patient has about 85% chance of same GP All data from Clarendon, charts by PA Navigator

37. Clarendon, a deprived population of 10,000, 3 partners, 3 sal GPs Why change and for what? Before After Demand high but stable A “no-waiting” room Free slots in most sessions Patients love it No need for 8am rush • Rising demand – falling morale • Waiting room stress • Grumbling patients • All pre-books gone • Mad rush on phones at 8am

38. A training and teaching practice, with a new NP.Previously drowning in demand, now feeling on top of workload Before After Reduced stress! Abuse of reception staff gone All pts who need it are seen Saving one clinical session • Frustrated, stressed doctors • Miserable reception staff • Unhappy patients • Reputational issues • List size effect

39. They know when the patients are going to call, by day, by hour, and the GPs are ready All data from Clarendon, charts by PA Navigator

40. Rock steady 90% of patients are seen the same day – the other 10% chose to wait for their own convenience. All data from Clarendon, charts by PA Navigator

41. As response has improved over time, the proportion of patients saying the service is “better” has risen to 76%, while those saying “worse” are now 8%. All data from Clarendon, charts by PA Navigator

42. 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 12 weeks, knowing how you are doing • Every practice differs. You make the decisions