P84012 Northenden Group Practice What is it like to be a patient? Meena Modi

“How To Get Your Life Back, Save More Money and Have Happier Patients Within The Next 12 Weeks”

Familiar?

Before Patient Access GPs, PMs and receptionists said… I’m embarrassed when I see rows of patients waiting We’re going to have to get another GP in at a cost of £100, We all feel totally drained & I know that patients aren’t happy either I’m annoyed by the huge number of DNAs I dread the inevitable phone blitz at 8 every morning I can’t take the aggression from frustrated patients anymore. I can’t magic up an appointment

Not To Mention The Patients… I’m frustrated that I can’t speak to my GP when I need to. I’m very tempted to change surgeries A lot of the time I don’t even need to see the GP, so why can’t I just phone, save the travel cost, hassle & my GP’s time? We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8. It’s a joke! We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8. It’s a joke! Why do I have a 3- week wait at my surgery & yet I hear of others who see their doctor the same day?

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 pressure

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

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.

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.

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

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 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

What do patients think of our service? Administrative staff views – Not happy with current appointment system – Not happy with patient queues outside in mornings – Lack of appts – Difficult for patients to get appts if they don’t call in for one – Patients not happy having to book appts a week ahead – Reception staff at brunt end of disgruntled patients – Struggle for appts thus poor feedback on NHS website – Most patients happy at Gatley

What do patients think of our service? Clinical staff views – Avoid wasting time – Patients want appts and better continuity – Current system offers appt with Dr in the morning (open surgery) – But bookable appts nearly 7 days in advance – Difficulty getting thro on phones – Difficult getting appts when at work – Often long wait on ‘extras’ list

My daily work at present Administrative staff views – Front reception ; copy / summarising notes – Scanning; insurance work Clinical staff views – Patient access too easy – Inadequate appt times – Working life in surgery has become horrendous over last 6 mths – Patient expectations and demand out of control – Increased chances of patient complaints as patients feel they can get financial compensation – Increased paperwork – never enough time to get done during the day – Afternoon clinics run late due to complex probs and elderly patients

My daily work at present Clinical staff views (cont) – Increased paperwork – never enough time to get done during the day – Afternoon clinics run late due to complex probs and elderly patients – Phone too many people back – Sometimes phones not answered / ansaphones – Too many trivial problems – Overbooked clinics with inapprop appt times – Patients struggle for appts – Poor feedback on NHS wesbite

My ideal work Administrative staff views – Being able to get job in hand done – Less chasing up / querying meds – Most admin / reception staff happy with current roles Clinical staff views – see as many patients as possible – Also safe and effective consultations – fewer FTF appts; more using technology – shorter surgeries; fewer visits; longer appt times for better consults – booked appts only – no extras or unnecessary visits – patients taking more responsibility for their health

My ideal work Clinical staff views (cont) – Have a lunch break and time to do paperwork – More telephone triage – opportunity to educate patients – Reduce home visits - mostly not necessary (93% of time) – Seamless and instant flow of information from hospital to GP via computer links – Enough time to see patients – flexible appt times – Good mix of population (young / old/ easy / complex) problems

Fear losses if changes are made? Administrative staff views – How would patients request urgent prescriptions? – Loss of jobs? – Elderly moving away unless change is for the better – Not being ale to physically book appt for patients – Job satisfaction? – Appt bookings left to the Drs Clinical staff views – Safer prescribing, less overload – Difficulty with covering triage when drs away – Lack of freedom to do other activities due to time on phones – More litigation as fewer FTF consults – More pressure on our time – new system hopefully more effective – A system that no-one understands with patients complaining – Unhappy admin staff

Why do patients call? Nearly 60% for GP.

How do patients request help? Very surprising large proportion are walk ins at 43%

When do they call? A strange double peak at 10am and 3pm – may be delayed submissions?

Do they get what they want? Appears that 93% do, but with only 124 responses, may not be all

When do they want the GP? Vast majority today, with some for a week ahead.

Consultations by day: Monday is a little higher

So far 82% of consults are face to face and only 16% by phone

Already you see 19% of consultations as “face to face not needed” – this always goes up lots.

Already you are resolving 63% of calls over the phone – though many others become visits?

Continuity seen as important in quite few consultations, only 30%. Patient requests 37%.