Ilkley Moor Medical Practice Advanced Access

Reasons For Change 1.Government targets: By 2004 all patients should have access to a Health Care professional within 24 hours and a GP within 48 hours 2.Waiting times: routine Dr of choice up to 3 weeks 3.DNA’s approximately 20 a week 4.Increased work loads 2° to 1° shift National Service Frameworks

Reasons For Change 5. Rapid Access Clinic the pros and cons 6. Patient Satisfaction 7. Staff contentment 8. Doctor Stress

Advanced Access A way to improve patient access in General Practice based on ensuring a balance between DEMAND for services and the CAPACITY of the practice to deliver them.

FOUR PRINCIPLES UNDERSTANDING DEMAND SHAPING THE HANDLING OF DEMAND MATCHING CAPACITY TO DEMAND CONTINGENCY PLANS Data collection Offering alternatives to face to face consultation i.e. Telephone follow ups, telephone management of same day demand, , proactive self help etc Looking at skill mix For predictable (holidays, meetings etc) and unpredictable (staff illness, flu epidemics etc) events

Data Collection The following graphs demonstrate capacity and demand for GPs over a 4 week period.

Data Collection

Preparation As long as I don’t have to work any harder As long as this doesn't effect my child care I don’t like change Happy to try, we can always go back to the old system. It’ll never work!

Preparation - Appointments Previously GP’s spent 47% of their total time in surgery. Rapid Access Clinic minute appts per week New System Aim at minute appointments/week GP’s never do more than 50% time in surgery With all GP’s there this will drop to 35% 50% bookable same day 30% bookable 1 week in advance 20% bookable 3 months in advance

Preparation

Preparation - Shaping Demand Telephone Consultations Re - directing to Practice Nurses - Contraception HRT Hypertension Travel Advice - Developing Protocols Triaging Visits Self - help information - Web Site ( Leaflets Etc

Preparation - Administration Data Collection - Number of appointment Requests/DNA’s Change in staff rotaChange of rota for staff so as to best cope with busiest times Staff Training Initial Meeting with GP’s to talk through shaping demand. Increased telephone lines Trial of telephone consultations

Preparation - Administration Publicity Leaflets and posters at reception 2 public meetings Local press release

Preparation - The Backlog Stopped all pre bookable appointments after Christmas Provided more appointments during 1st 10 days of January

Experience to date.

GP Comments. I didn’t have to work any harder BrilliantThe surgery mix is much better Stress what’s that!I can’t believe it worked! Looks like you didn't need me

Patient Questionnaire Q1. Do you feel the appointment service has improved?Q2. Were you satisfied with the appointment service? Q3. Did you see the Doctor of choice?Q4. Did you get an appointment on the same day you rang?

Patient Questionnaire Q5. Did you have to ring back for an appointment?Q6. Do you know that we provide telephone consultations? Q7. Do you feel that the provision of telephone consultations is beneficial?

Experience to date.

Potential Problems Popular Doctors Continuity Patients planning appointments around their commitments. Elderly patients Patients being asked to phone back

Why Bother To Change? Doctors are spending less time in surgery freeing more time for pro active as opposed to reactive treatment. Overall improvement in their working lives. Staff’s working lives have been improved. Less time spent dealing with each appointment Less patient aggravation All 10 minute appts - better quality service to patients. Improved continuity, Decreased waiting times.

Why Bother To Change? 2 appointments per surgery 4 per day 18 per week 810 per year 8100 per 10 years 1350 hrs less / 169 days / 34 weeks