1. Workflow Optimisation Workflow Optimisation
hereweare.org.uk

2. Workflow Optimisation
Who we are:
Jonathan Serjeant
Lewis Smith
Workflow Optimisation

3. About Here
About Here
Here is a not-for-profit, social enterprise, membership organisation delivering NHS services. Our members are local GPs, Practice Managers, Practice Nurses and our own staff.
We believe these things to be true:
Care is something we can choose to show for ourselves for each other at any time.
Care is not exclusive to an appointment or a medical intervention.
We have a right to take control of our lives.
It takes courage to step forward and effect change. The capacity to lead is within us all.
Every interaction can be powerful if we choose to engage consciously. We know the ripples from these movements can go on to create profoundly positive change.
True care is a way of living that creates meaning between us all.
Care Unbound. To create more possibilities for care in every moment.

4. About Workflow Optimisation

5. Summary
Workflow Optimisation is a new approach to administration entering a General Practice
It saves up to 40mins per day per GP
Data quality is enhanced in the medical record
The patient journey is facilitated
Robust governance structures supported by MDOs
We have now trained in excess of 80 practices and have further training planned for more than 200 practices

6. Origins of Workflow Optimisation
Extended Integrated Primary Care (EPiC) Prime Ministers Challenge Fund April 2014
Dr Robert Varnam – Head of General Practice Development NHS England came to visit as initial data stood out
5 Workstreams
Access fund to develop further 40 practices in 3 months
Extended modes of access
Community Navigators
Community Pharmacy
Extended Hours
Redirection of Workflow
11 practices trained
1:1 training

7. Process development 1 practice – Benfield Valley Healthcare Hub
1 GP – Dr Jonathan Serjeant
1 Administrator – Jayne Williams
4 months to develop working through a variety of letters
Dr Jonathan Serjeant – 1 hour per week for governance
11 practices trained
1:1 training

8. I have never been involved in a change programme that has led to such a dramatic improvement in service so quickly. In one week the surgery was transformed
Dr Naz Khan – Chief of Clinical Leadership and Engagement Brighton and Hove CCG

9. Our Purpose
Our purpose is to help people make informed decisions about their care with their clinician.
How we achieve what matters to the person is by processing their clinical correspondence in a timely, safe and efficient manner and ensuring that their medical record is up to date when they need it. This is achieved through a comprehensive training package and supporting materials.

10. Our training journey

11. Our training journey Significant shift in how we trained people
Went from 1:1 to classroom based
Initial Challenges
Time Constraints
Clinical System and IT issues
Lack of Docman installed on our systems
Releasing the “right” staff
Developing the training model after EPiC

12. Our training journey Training sessions developed Group working
Feedback from students
“…I thoroughly enjoyed the course. It has given me the confidence to push forward the final stages of implementing workflow redirection. As a result of the course I am going to recommend the additional actions as advised. I think you have done a marvellous job in training a group of people with very different skill levels. Thank you very much...” Chapel Street Surgery
“This has proved to be more than worth the initial investment in time required to train the admin team. There has been a very noticeable reduction in the number of letters. The quality of coding of information improved in terms of both consistency and coverage - Dr Peter Devlin
“…It is a very relaxed atmosphere. It didn't matter how many questions you asked. The trainers were always happy to help. It would have been good if the venue was a little nearer! I will take back all the info to the surgery and become more efficient in coding and helping GPs to have more time to see patients. I can't think of anything I would like more help with, it will be nice to have the follow up visits, where I am sure there will be lots of questions…” Norton Brook Medical Centre

13. Our training journey Current model Learning Backlog busting
Robust practice protocol in advance of training
GP Champion identified and fully engaged – separate half day course
Administrator time agreed to implement/process workflow
Backlog busting

14. Learning Intention To understand the purpose of Workflow Optimisation.
To be able to recognise clinically relevant information contained in the clinical correspondence.
To be able to process and action a letter to completion or to forward to the correct recipient.
To begin to implement the Workflow Optimisation process in practice.

15. Learning Outcomes
To be able to process a letter to completion in a safe, efficient and timely way
To move a person through their journey in a safe, efficient and timely way
To provide an accurate and up to date record for the patient when they need it, allowing them, with their clinician, to make an informed decision as to their care

16. Clinical Governance

17. Clinical Governance How to do this safely? The structure
GP Champion
Medication Protocol
Audit and Feedback tool
Significant event collection
Medicolegal assurance .

18. GP Champion Fundamental requirement 1:1 support
Initially support, audit and feedback on weekly basis
Interval stretched over time
Collate feedback from clinicians
Helps form practice policies
Schedule requirements hours GP input over first 3/12 in this role .

19. Medication protocol Our learning shaped the protocol High risk
DMARDS
Anticoagulation
HIV Medication
Drugs prescribed outside of primary care
Enhanced patient safety when implemented
Role of pharmacist supporting? .

20. Audit and Feedback Medication Under-coding Mis-coding Over-coding
Incorrect action
RAG Status

21. Audit and Feedback
PCCPA GP
Audit Date:
Print Name:
Audit by:
Signature:
Feedback Date:
Date:
RAG Status: R = Red (Unallowable), A = Amber (Allowable), G = Green (Perfect).
Patient ID
Date of Letter
Letter Type / Speciality
Medication
Over-Coding
Under-Coding
Mis-Coding
Incorrect Action
RAG Status
Other Notes

22. MDU Underwriting

23. Benefits - At a practice level
Timely updating of medical record
Accurate and consistent information entered
Stewardship of the patient journey
DNA Check
Blood test booked there and then
Follow up appointment resolved
Etc.
Clinician time saving
Epic pilot data 40 mins per day per full time GP
Data from wave two of training 63 practices 30 mins per day per full time GP
Consistent 80% letters, read, coded, actioned and completed when fully implemented by trained practices
Assumptions underpinning time saving
Upskilling of team
Increased resilience
Ability to review back office functions and better practice sharing .

24. At a CCG level
Change management programme successfully implemented AND maintained
Data quality
Greater impact for risk stratification, risk modeling etc.
Consistent data entry across the geographical footprint
Ability to adapt Read code use to local requirements
?Read code formulary
Easier audit potential re chosen clinical areas
Local practice resilience increased
Skill to train Workflow Optimisations remains within your local team .

25. Initial Structure – Gaining Maximum Early Benefit.

26. Initial Structure – Gaining Maximum Early Benefit.

27. Initial Structure – Gaining Maximum Early Benefit.

28. Where are we now?

29. NHSE Funding

30. What you get
Signed MoU (preparation required, expectations, and benefits)
Manuals and Protocols
E-Learning tool
CPD accreditation
WebEX GP Champion support
Forum – Moodle (E-Learning and Forum functionality)
Classroom training here/there – 4 days + ½ day GP Champion training
Site visits/ WebEX offered as ongoing support
On-going online, telephone + WebEX support to trainers, to embed the learning .
“I thoroughly enjoyed the course. It has given me the confidence to push forward the final stages of implementing Workflow Redirection. As a result of the course I am going to recommend the additional actions as advised. I think you have done a marvellous job in training a group of people with very different skill levels. Thank you very much”- Chapel Street Surgery

31. Any Questions?