Gallions Reach Health Centre What is it like to be a patient? Thoreya Swage

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

The traditional model Reception takes call GP sees patient 10 min slot GP sees patient 10 min slot Problem solved 70% “routine” 30% “urgent” 60% “All gone. Call back tomorrow” 3 week wait, high DNAs, repeat booking See any GP/locum Poor continuity, repeat booking Patient pressure

Face-to-face consultations vs telephone consultations

Appointment bookings by time of day

No of days wait to see a GP

Some appointments are up to two weeks ahead (or more)

About 28% are telephone consultations

75% of telephone consultations resolved there and then

Appropriateness of consultations – about 15% face-to-face not needed

Length of time for tel vs face-to-face consultations

GP continuity

What do patients think of our service? Administrative staff views – not enough appointments, difficult to get through on the phone and difficult to get appointments with specific doctors – lack of appointments, unable to get through on phones – Patients get frustrated when they are unable to get an appointment for 2 weeks – Often patients have to wait for a long time for a call to be answered in order to make an appointment, – They have to wait too long for an appointment Clinical staff views – Difficult to make appointment or get through to reception. – Receptionists obstructive (though clearly just trying to cope with demand) – No continuity with the same doctor, difficult to get appointment on the day or when they want to be seen. – not seeing the doctor they wanted to. – difficult to get nurse appointment

My daily work at present Administrative staff views – it is very busy working on the reception and can be difficult not being able to offer patients what they are asking for – stresses are caused by arguments with patients because of lack of appointments – unable to offer appointments and dealing with upset patients due to frustration. Clinical staff views – DNAs, inappropriate use of appointments – Having to follow up other Doctor's patients where I am not happy to issue sick notes etc or have to catch up on long history in short period. – can be very difficult, often older patients need more than 10 mins appointments. Also some patients don’t turn up often and clump problems together hence you over run, become stressed, more likely to miss things. – People who book on the day appointments and don't turn up for them

My ideal work Administrative staff views – in an ideal world it would be good if every patient could be offered what they ask for – I would like to offer patients appointments rather than having daily arguments about lack of them. – I would like to help patients in every way, elderly patients come in for prescriptions I would like to do it there and then not ask them to come back the next day. Clinical staff views – More appropriate use of appointments. More control over my work load and continuity with patients. – for patient to get more flexibility when booking their appointments. – Ideally i would like greater continuity with the patients – I want to manage my workload, I want to be able to know what is going to be discussed in the appointment before the consultation

A practice in the Patient Access community looks a little different Monday morning 8.30, Busy day, going full tilt. All carefully worked out. Dr Chris Barlow of Quorn, one of the earliest pioneers in 2000

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

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

Simple, but the whole system changes 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%

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

What happens next? All to agree to a change Change leader Decide on a launch date Do not book any appointments from launch date onwards Workforce planning (GPs and reception staff)

What happens next? Inform the patients – e.g. flyer, PPG, website, media, answerphone message etc Train staff – Procedure for reception staff to follow Support provided by Patient Access training partner – before, at launch and afterwards

Which is the best pancake? Cold and soggy Hot, fresh and crispy