Workflow Optimisation Workflow Optimisation hereweare.org.uk

Workflow Optimisation Who we are: Jonathan Serjeant Lewis Smith Workflow Optimisation

About Here About Here Here is a not-for-profit, social enterprise, membership organisation delivering NHS services. Our members are local GPs, Practice Managers, Practice Nurses and our own staff. We believe these things to be true: Care is something we can choose to show for ourselves for each other at any time. Care is not exclusive to an appointment or a medical intervention. We have a right to take control of our lives. It takes courage to step forward and effect change. The capacity to lead is within us all. Every interaction can be powerful if we choose to engage consciously. We know the ripples from these movements can go on to create profoundly positive change. True care is a way of living that creates meaning between us all. Care Unbound. To create more possibilities for care in every moment.

About Workflow Optimisation http://www.workflowoptimisation.co.uk/

Summary Workflow Optimisation is a new approach to administration entering a General Practice It saves up to 40mins per day per GP Data quality is enhanced in the medical record The patient journey is facilitated Robust governance structures supported by MDOs We have now trained in excess of 80 practices and have further training planned for more than 200 practices

Origins of Workflow Optimisation Extended Integrated Primary Care (EPiC) Prime Ministers Challenge Fund April 2014 Dr Robert Varnam – Head of General Practice Development NHS England came to visit as initial data stood out 5 Workstreams Access fund to develop further 40 practices in 3 months Extended modes of access Community Navigators Community Pharmacy Extended Hours Redirection of Workflow 11 practices trained 1:1 training

Process development 1 practice – Benfield Valley Healthcare Hub 1 GP – Dr Jonathan Serjeant 1 Administrator – Jayne Williams 4 months to develop working through a variety of letters Dr Jonathan Serjeant – 1 hour per week for governance 11 practices trained 1:1 training

I have never been involved in a change programme that has led to such a dramatic improvement in service so quickly. In one week the surgery was transformed Dr Naz Khan – Chief of Clinical Leadership and Engagement Brighton and Hove CCG

Our Purpose Our purpose is to help people make informed decisions about their care with their clinician. How we achieve what matters to the person is by processing their clinical correspondence in a timely, safe and efficient manner and ensuring that their medical record is up to date when they need it. This is achieved through a comprehensive training package and supporting materials.

Our training journey

Our training journey Significant shift in how we trained people Went from 1:1 to classroom based Initial Challenges Time Constraints Clinical System and IT issues Lack of Docman installed on our systems Releasing the “right” staff Developing the training model after EPiC

Our training journey Training sessions developed Group working Feedback from students “…I thoroughly enjoyed the course. It has given me the confidence to push forward the final stages of implementing workflow redirection. As a result of the course I am going to recommend the additional actions as advised. I think you have done a marvellous job in training a group of people with very different skill levels. Thank you very much...” Chapel Street Surgery “This has proved to be more than worth the initial investment in time required to train the admin team. There has been a very noticeable reduction in the number of letters. The quality of coding of information improved in terms of both consistency and coverage - Dr Peter Devlin “…It is a very relaxed atmosphere. It didn't matter how many questions you asked. The trainers were always happy to help. It would have been good if the venue was a little nearer! I will take back all the info to the surgery and become more efficient in coding and helping GPs to have more time to see patients. I can't think of anything I would like more help with, it will be nice to have the follow up visits, where I am sure there will be lots of questions…” Norton Brook Medical Centre

Our training journey Current model Learning Backlog busting Robust practice protocol in advance of training GP Champion identified and fully engaged – separate half day course Administrator time agreed to implement/process workflow Backlog busting

Learning Intention To understand the purpose of Workflow Optimisation. To be able to recognise clinically relevant information contained in the clinical correspondence. To be able to process and action a letter to completion or to forward to the correct recipient. To begin to implement the Workflow Optimisation process in practice.

Learning Outcomes To be able to process a letter to completion in a safe, efficient and timely way To move a person through their journey in a safe, efficient and timely way To provide an accurate and up to date record for the patient when they need it, allowing them, with their clinician, to make an informed decision as to their care

Clinical Governance

Clinical Governance How to do this safely? The structure GP Champion Medication Protocol Audit and Feedback tool Significant event collection Medicolegal assurance .

GP Champion Fundamental requirement 1:1 support Initially support, audit and feedback on weekly basis Interval stretched over time Collate feedback from clinicians Helps form practice policies Schedule requirements 10-12 hours GP input over first 3/12 in this role .

Medication protocol Our learning shaped the protocol High risk DMARDS Anticoagulation HIV Medication Drugs prescribed outside of primary care Enhanced patient safety when implemented Role of pharmacist supporting? .

Audit and Feedback Medication Under-coding Mis-coding Over-coding Incorrect action RAG Status

Audit and Feedback   PCCPA GP Audit Date: Print Name: Audit by: Signature: Feedback Date: Date: RAG Status: R = Red (Unallowable), A = Amber (Allowable), G = Green (Perfect). Patient ID Date of Letter Letter Type / Speciality Medication Over-Coding Under-Coding Mis-Coding Incorrect Action RAG Status Other Notes  

MDU Underwriting

Benefits - At a practice level Timely updating of medical record Accurate and consistent information entered Stewardship of the patient journey DNA Check Blood test booked there and then Follow up appointment resolved Etc. Clinician time saving Epic pilot data 40 mins per day per full time GP Data from wave two of training 63 practices 30 mins per day per full time GP Consistent 80% letters, read, coded, actioned and completed when fully implemented by trained practices Assumptions underpinning time saving Upskilling of team Increased resilience Ability to review back office functions and better practice sharing .

At a CCG level Change management programme successfully implemented AND maintained Data quality Greater impact for risk stratification, risk modeling etc. Consistent data entry across the geographical footprint Ability to adapt Read code use to local requirements ?Read code formulary Easier audit potential re chosen clinical areas Local practice resilience increased Skill to train Workflow Optimisations remains within your local team .

Initial Structure – Gaining Maximum Early Benefit .

Initial Structure – Gaining Maximum Early Benefit .

Initial Structure – Gaining Maximum Early Benefit .

Where are we now?

NHSE Funding

What you get Signed MoU (preparation required, expectations, and benefits) Manuals and Protocols E-Learning tool CPD accreditation WebEX GP Champion support Forum – Moodle (E-Learning and Forum functionality) Classroom training here/there – 4 days + ½ day GP Champion training Site visits/ WebEX offered as ongoing support On-going online, telephone + WebEX support to trainers, to embed the learning . “I thoroughly enjoyed the course. It has given me the confidence to push forward the final stages of implementing Workflow Redirection. As a result of the course I am going to recommend the additional actions as advised. I think you have done a marvellous job in training a group of people with very different skill levels. Thank you very much”- Chapel Street Surgery

Any Questions?