Wallington Medical Centre What is it like to be a patient? Thoreya Swage

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

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

Face-to face vs telephone consultations

Already 24% of consultations are by phone

Sample is small at 17, but of these 88% were resolved on the phone.

Requests for appointments are reasonably well spread

Confirmed by datalog collection - a good sign

But outcome of requests – 17% told to call back – generating more work

You are seeing about 100/wk and 40 phone/wk, total of about 6% of your list, well within expectations.

Average no of days wait to see a GP is 3.5 days

Some appointments are up to 2 weeks ahead

Vast majority of requests are for same day.

Continuity is about 75%

32% specified a named doctor, interestingly more often important to GPs at 43%, about average.

What do patients think of our service? Administrative staff views – Some complain about lack of appointments but the majority seem ok. – They want more appointments with Dr. – generally patient's are happy. Minority of rude, demanding patients complaining they are unable to make an appointment to see the GP. Clinical staff views – Overall good but can be long wait for routine appointment which can lead to higher DNA rate. Sometimes inconsistent some patients are offered telephone appointments if they can't get a routine appointment but some are not. – Patients complain that it is difficult to get an appointment with a doctor However having seen a clinician they are usually positive about their experience.

My daily work at present Administrative staff views – Spend most of my time on reception whilst juggling paperwork between callers. Difficult to finish anything. – Mainly administration work; Audits, QOF, etc. Can become stressful when interrupted with patient queries/ reaching QOF targets. Clinical staff views – Generally manageable as we operate 15min appointments and patients are usually seen on time. – I feel my surgeries are not too stressful, they can be if there are many extras or I will get stressed if the surgery is over-running. Patients do complain about access and it can be stressful to explain to them that we are trying our best.

My ideal work Administrative staff views – I would prefer to be on reception all the time and the patients then get to know you and its easier to explain a difficult situation to them. – Ideal day! Having more time - not feeling rushed to get work done. Clinical staff views – More structure to the course of my day with greater flexibility. Would like to do more proactive management of LTC patients – Patients arriving on time, surgery running on time, no extras, no interruptions, patients with single problems in each consultation!

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.

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

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

If telephone lines open 9am, so do Dr callbacks All patients are called back – no Doctors appointments made by receptionists Call back within the hour All Drs on telephone call backs (exception Duty Dr or locum/trainee) Call patients in for face to face from mid morning (and mid/late afternoon)

Consensus Preparation Detailed planning Staff survey Patient comms Whole team meeting New deal for patients Predicting demand & matching capacity. Patient & staff feedback Launch day Routine Review New measures help tuning. Build confidence Affirmation Yes. Pledge to each other and to patients Launch programme - just 12 weeks to a happier, less stressful practice

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