Lockfield Surgery Willenhall 9 th May 2014 Launching Patient Access Jonathan Ratcliff

Agenda Current Model Surveys from Lockfield Staff – Patient’s View – Current Workload – Ideal Work Your Performance Data A New Way Of Working Summary / Questions

Familiar?

Reception takes call GP sees patient 10-min slot GP sees patient 10-min slot Problem solved 70% “routine” 30% “urgent” “All gone, call back tomorrow” 3 week wait High DNAs Repeat booking See any GP/locum Poor continuity Repeat booking Patient pressur e

What do patients think of our service? Admin and Receptionists’ view If they want a certain Dr and have to wait for an appointment they moan an say the service is crap Some patients are very abusive and patronising and GP staff are unable to respond because there is no one to back them up Fed up with the wait for appointments, Fed up with not being able to see their preferred doctor, Fed up with wait on telephones Too many patients having to be put for triage due to lack of GP appointments. Need more commitment from the partners. Nurses’ view Majority generally satisfied. Few verbally complain unable to get appointment when want to or unable to get appointment with GP of their choice. Doctors’ view never enough appts, can't get to see the GP of choice Don’t know

My daily work at present Admin and Receptionists’ view I get very stressed when patients have been on triage and waiting over 2 hours or more for something as simple as a urine result to be looked at. Frustrated with the whole of the appointment system. Really fed up with being complained at by patients because there are no appts available. GP's screaming they are stressed but they need to be on the front line and deal with the abuse we have to tolerate. Its a very stressful job. Nurses’ view Patients attending with multiple/list of problems but not given time to cover everything. Patient expectation is to still have everything done. Doctors’ view There’s an unfair distribution of workload. Some Doctors spend time troubleshooting patient’s problems whilst others sort problems superficially with poor patient satisfaction who then return. Don’t know

My ideal work Admin and Receptionists’ view More appointments. Continuity of care. Educate our patients on our service and their expectations. Better service makes happier staff and happier patients. No complaints regarding the service or the staff. "happy staff will make happier patients", Overall a more stress free environment and happier staff that want to come to work and not feel as if they have to!!!!! Nurses’ view Interruption free with sufficient time given for the appointment. I don't like to feel rushed as I then have concerns that I may have missed something. Doctors’ view 12 face to face consultations and 12 telephone consultations per session Fair distribution of work. Ability to spend more time with patients for mutual benefit.

If changes are made, do you fear losing anything? Admin and Receptionists’ view No fears, I am up for the change if it will make things better, it cant make it worse!!!!! LESS STRESS PLEASE!!!!! I feel in the first few weeks I might struggle. If system makes things easier and stress free I am up for the change. I don't fear the loss of anything but it will be nice to want to come into work instead of dreading it, having no headaches, no verbal abuse from patients or doctors and less stress Nurses’ view No, I only hope that things can improve thus reducing stress levels, and increasing job and patient satisfaction. Doctors’ view PATIENTS MAY NOT ACCEPT CHANGES AND THEN LEAVE THE PRACTICE. Practice should change if its not effective. I fear it wont.

Why do patients call? 52% for a GP, many for nurse, admin, test results (repeat prescriptions additional to this)

Calls by day, Monday much higher – how should this affect capacity planning?

Calls by time of day – heavy weighting at 8am suggests little available later on

Outcome of requests - 22% told to call back another time, generating rework.

Vast majority of requests are for same day.

You are seeing about 45% the same day. This usually rises to over 80%

38% specified a named doctor, similar views from GP, continuity important for 41% of consults, about average.

GP consultations – highest on Tuesdays, low Weds. Need to think how to match demand – highest on Mondays.

66% of cases acute, clinically best dealt with today.

At present, just 22% of consults are by phone

But of those, 66% are resolved on the phone – good.

Your view is only 6% more consults could have been by phone – though this often changes!

Navigator shows your demand is going up week by week this year – does it feel like this?

Key points Demand heavier on Monday, but not supply. Demand rising fast – any idea why? Patients ring the day they want to be seen, but most have to wait. Demand is high at the start of the day, though it could be worse. Will spread as patients gain confidence. Continuity (choice of doctor) is agreed on by patients and GPs, though not achieved on many occasions Currently some consults by phone, and a good proportion of them are resolved, should work well but with many more calls.

A Practice In The Patient Access Community Looks, Sounds, Feels 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. Monday morning 8.30, busy day, going full tilt. All carefully worked out.

Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 20% 10% 30% 60% How Patient Access Works

Your Patient Access Launch Programme 1 Consensus 2 Preparation 3 Launch Day! 4 Adapt 5 Affirm Wk 1Wks 1-3Wk 3-4Wks 5-11Wk 12 Just 5 Simple Steps To Your Happier, Efficient, More Profitable Practice Within The Next 12 Weeks

A Typical Receptionist Day With Patient Access Reception takes call Admin question 20% solve 20% book to see nurse 20% book to see nurse Just 60% list for GP Just 60% list for GP Nurse Per Week, Patient List Of 8, % of patients call 28% on Monday 220 – mins 7 to 9 hours of calls Other days 4.5 to 6 hrs Many more calls will come in the morning, but will spread as a result of good service

GP phones patient Problem solved Come and see GP Come and see nurse 10% 30% 60% A Typical GP Day With Patient Access Per Week, Patient List of 8, % call for GP Mon - 28% of the week 130 to 180 calls on Mon calls on other days Plan for 40 each per GP per day 40 x 5 mins plus 16 x 10 mins Total consulting time 6 hrs/day Availability of nurse consultations can reduce this by ≈ 40 mins/day Mornings more phone calls, becoming more face-to-face late morning & into afternoon.

Average wait time to see a GP drops dramatically All data from Clarendon, charts by PA Navigator

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

Turns out, you can rely on the patients

The thinking goes like this… NO No targets No tick boxes No compulsion No “incentivisation” No substitute for the GP- patient relationship YES Helping patients Enhancing professional practice Evidence based Measurement for improvement Saving effort and time

Evidence from practices in the Patient Access movement 60 % of calls don’t typically need an appointment A rapid and safe system, where patients that need to be seen are always offered the same day 7% list increase with no extra GP sessions needed at Oak Tree Health Centre We’re now saving 20% of GP working hours and A&E attends are 50% below Liverpool average - Dr Chris Peterson, GP at The Elms & Liverpool CCG Urgent Care Lead The Relief of Working Efficiently

The Patient Access Launch Programme 1.Your personal training partner 2.Key actions checklist week by week 3.Datalog paperless data capture 4.Unique Navigator analysis suite 5.Private online resources portal 6.Easy to use video tutorials & FAQs 7.Patient communication materials customised for you, video & leaflet 8.Expert helpline and rapid response throughout the programme Eight ways we support you in leading change and avoiding the pitfalls

Step 1 – Consensus Explaining the process so that you’re fully informed to make the right decision Leading Change questionnaire to assess your readiness for change Working with you to identify the Change Leader within your practice. This step equips you to secure the all-important agreement of your partners

Step 2 - Preparation Your Own Training Support Partner is with you step-by-step, including: Manager planning by reviewing your rotas and current processes Advising on scheduling, process-changes & your go live date Training on the steps and actions to inform your staff and patients. Staff and patient survey Real Time Paperless Data Capture input by you interpreted by our Navigator software Whole Team Induction led by your Training Support Partner Bespoke Online Resource Portal including Video Tutorials, FAQs and Key Actions Checklist Customised Patient Communication - Video, Leaflet, Poster produced for you. Equips you to transition smoothly to your new system

Step 3 – Launch Day! The exciting, agreed day where you transition to your new system. Your Training Support Partner attends your Launch Day to: Offer support and guidance on the first day you fully implement telephone triage Monitor and advise on controlled face-to-face appointment-setting Answer staff and patient questions Feedback Wall and Patient Survey

The daily process of becoming embedding the system, building confidence and adjusting it so that it works beautifully for you. Real Time Online Data Capture continues to be input by you Navigator software continues to analyse your activity Your Training Support Partner advises you on emerging patterns so that you can adjust accordingly On-hand help continues from your Training Support Partner to answer your questions and overcome any challenges. Step 4 – Adapt

Review and refine your activity and results. Real Time Data Capture continues to be input by you to equip us to monitor your activity and advise you New Staff and Patient Survey Bespoke Before and After Report produced using Navigator software and presented by your Training Support Partner to review key learnings, maintain progress, discuss next steps Option of on-going monitoring and support with our Accelerator Programme. Step 5 – Affirm

Your step by step guide to a happier practice Start today Call | “Patient Access has given us a new lease of life” Dr. Kam Singh