Skewen Medical Centre What is it like to be a patient? Jo Newton, Harry Longman

What do patients think of our service? Receptionists’ view – Workload can be frustrating and stressful – especially first 45mins – Many patients getting used to phone triage, but frustrated if can’t see Dr they want to see, or if delay in call back Doctors’ view – ‘Patients generally happy with service & easy access to GPs’ – ‘Mixed – some like triage, others can’t get through, lines engaged, appointment times when on school run / commute to work’ Nurses – Patients happy with service except when.. – Can’t get through on phone, no appointments for 2 days, can’t see Dr of choice Admin – Patients complain about engaged phone / no appointments / no choice

My daily work at present Receptionists’ view – ‘busy stressful putting up with complaints’ – Phone constantly ringing disrupts ability to do other work – ‘Drs don’t always follow system & block lines to phone for coffee’ Doctors’ view – ‘not too bad on non on call days – on call is busy & stressful’ – ‘I am miserable & get frustrated because I see flaws in the system but can’t correct them’ Nurses – ‘some patients book with us thinking we can make appt with GP’ Admin – When answering phones some patients get frustrated

My ideal work Receptionists’ view – ‘no pre-bookable appts just open access all day every day with all Drs’ – Less stress: patients to take complaints eg timekeeping to Dr not us Doctors’ view – ‘I want the happy team we had back (we lost it in 2012)’ – ‘it is important to have a patient centred service but not at detriment of doctor’s working day’ – Retired. Nurses /Admin – ‘to be able to assist everyone and find an appt asap without any problems’ – ‘have enough available appts without feeling agitated or stressed’

Demand is fairly steady at about 550 phone and 250 f2f consults per week, total new contacts estimated around 600 or 7.5% of list pw, medium. Prescriptions recorded as GP consults shown separately at 200 pw.

A problem is revealed looking at the time of booking. Almost all f2f is booked in a mad rush at 8am – though phone consults are booked all through the day. Prescriptions mainly afternoon.

Response times to telephone calls: median 62 minutes. This could easily be halved, improving satisfaction and flow.

The average wait to see a GP appears to be one day and rising, but more like two days to speak to a GP. Scripts are all same day.

In truth almost all appear to be booked on the same day, though a number of phone consults are booked a week or two in advance, which skews the mean.

It appears that 82% of GP f2f appts are booked on the day, but we don’t know how many requests are rework from previous days.

Duration of appointments, mean f2f 8 mins and phone below 4 mins, on the low end. Prescription requests shown as short consults.

Average response time is consistently around 100 minutes. Tracking this week by week will be important feedback.

Continuity within the month is stable around 80%. This is the chance that a patient will see the same doctor on each visit – it can move higher.

Your consultation data over two weeks, by mode of consultation

Consultation mode is 62% face to face, 37% phone and a few visits If all demand is triaged, this is 60% bring in rate – higher than expected 40%?

About 55% of consultations are new vs 45% follow up

57% of consultations are acute conditions, a further 8% exacerbations.

Phone consultations: 50% of acutes resolved by phone, rising to 80% of chronic routine calls

Your view, was the consultation appropriate? Almost all yes, with about 5% could have been phone, almost none “self care”

Continuity: considered important in 58% of consults, achieved 90% of the time, and unimportant in 42% of cases

Reception: 60% of requests are for a GP appt or phone call.

Requests are about 50% higher on Mondays than other days. Many requests for appts are “downgraded” to phonecall, some offered later date.

Looked at by hour of the day, requests for GP come in one manic rush at 8am

Almost all requests for a GP are for the same day.

Almost all are reported as “first time” calls, although comments made… eg, “chasing a call made earlier for a phone call” “will call another day for a specific doctor”

Summary – something not working? In many ways the service looks good – Almost all same day service – Total demands about expected level of 7.5% pw – Mostly phone initially, plenty of f2f – Continuity looks OK Data reveals problems – 8am rush is very pronounced and hard work – Response time is high because of the rush People feel under pressure – Doctors not happy with situation – Receptions feel stress from patients – It’s difficult to see the doctor you want to Looks like a hybrid system, and fixable

How? A new system. Simple, but different PA Navigator measures the flows, which vary by GP & practice. Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 10% 20% 10% 30% 60% 70%