Prospect Road Surgery Advanced Access

1. Prospect Road SurgeryAdvanced Access HOW YOU COULD GET HERE !! Chris Nicholls chris.nicholls@wakeha.nhs.uk 01924 274 123

2. Prospect Road Surgery • Practice Population = 7,288 • 3.5 WTE GPs • 1.75 WTE Nurses • 5 Receptionists – all part time • GMS Practice • Large population increase over the last two years

3. Why Advanced Access? • GP 3rd Available Appointment 14 days! • Nurse 3rd Available Appointment 16 days! • Stress, Stress, Stress • Unhappy Patients = Unhappy Staff • Senior Partner Retiring (October 2002) • How would we cope with no extra capacity? • Advanced Access????

4. What Happened Next? • Presentation by Access Facilitator • Committed to working with the Collaborative • Capacity Demand Measuring (two weeks August 2002)

5. August2002 • Total GP Demand 540 appointments per week (Follow Ups 15%) • Total Nurse Demand 165 appointments per week (Follow Ups 32%) • GP Backlog 1512 Appointments • Nurse Backlog 462 Appointments • GP DNAs – 64 per month • Nurse DNAs – 55 per month • Shortfall in GP appointments only 3 per week • Shortfall was going to jump to 100 per week in October

6. Practice Wide Data

7. Where did we start? • Plan to clear the backlog when Senior Partner replaced • Changed Monday Working • Mondays booked on the day only (except 1st hour) • No follow up appointments on a Monday • After two weeks extended to Fridays • GP 3rd available appointment dropped from 14 days to 3.9 days • Nurse 3rd available appointment dropped from 16 days to 1.2 days

8. Gloomy October • Dr. Brad Retired • Mid - week wait went back up to 14 days • Practice became disillusioned • Had anything changed? • Ray of Light……………. • Dr. G’s Telephone Consultations • Potential to save 10 appointments per week per GP

9. Telephone Consultations • 14, 5 minute appointments per week (7 on Mondays, 7 on Fridays) • Mainly for discussion of labs/ X-ray results/ hospital letters • Very clear guidelines for reception about who is suitable • Telephone consultations taking 5 minutes as opposed to 10 • Only 1 in 20 is resulting in a face to face consultation as well • The patients like them!

10. Clearing the Backlog • No replacement for retired partner to be found • Locums difficult to find • Appointments booked on the day only over Christmas • Started the New Year with a clean slate

11. New Year New Start • Mondays booked on the day only (except 1st 1/2 hour) • Follow up appointments kept to the middle of the week • Patients educated to ring the day they want to be seen • Patients educated to ring after 10.30am for anything other than an appointment • Roughly 40% appointments can be pre - booked • Introduced GP led Clinics • Extending telephone consultations to other GPs • New appointment slips • Contingency Planning

12. Problems • Selling it to the rest of the Practice • Gaining the patients trust in the new system • Clarifying the system to Reception • Getting Reception to use it! • Change is scary - what if it doesn’t work!

13. Success • GP 3rd available appointment 0.42 days (from 14) • Nurse 3rd available appointment 3.13 days (from 16) • Happy Patients • Happy Staff • Happier GPs - well you can’t please everyone! • FREE APPOINTMENTS!

14. Where Now • Practice nurse starting minor illness training April 03 • Receptionist training to be Health Care Assistant April 03 • Out of Hours usage reduced • DNA’s reduced • Practice moved to all 10 minute appointments • Staff and patient questionnaire to assess impact of work April 03 • Identified need to increase the amount of pre-booking