1. Haxby Prospective Review Of Patient ACcess, Time Management and Workload to ImproVe Efficiency (PROACTIVE) Project Dr Mike Holmes Partner, Haxby Group RCGP Clinical Lead, Supporting Federations Programme

2. Haxby Group
Large Practice , 50,000 patients
2 Cities, 10 sites

3. Challenges Workload Workforce Patient Demographics Shifting Care
GP/Consultant
GP training
Practice Nurse
Patient Demographics
Shifting Care
A ‘new deal’ – 7/7 working?
Finance

4. So what do we do?
Data helps to know where you are, and where you have come from
‘Resilience thinking’ – deal with the challenges of complexity
Accept we will meet challenge – (don’t be negative, embrace it)
Do not erect strong defences – do not do what you’ve always done
Efficiency is important but the key is adaptability
Tighten the cycle of change – OODA, PDSA etc etc
Observe – Data, Orientate – put in context, Decision – collaborative thinking, Act – mandated, acceptable, resilient change
To be adaptable we must support rapid logical change – don’t be afraid – but if its not working then review – go round the loop again…..
No funding, Released Clinical Leadership – self funding?

5. PROACTIVE Aims Patient Care Sustainability Collaboration
Improving Access, Improving pathways, engage with communities, increase satisfaction
Sustainability
Workload (change is difficult when at capacity)
Financial – ensure stability – protect viability
Recruit – Attractive, Developing Diversity promotes adaptability
Develop – upskill, collaborative teams within the team, training and education
Collaboration
Internally and with other social worlds (external)
Develop leadership at all levels – OD, Systems, Complexity, Social Worlds
Phase 1 – Understanding where we are, understand the environment (Observe & Orientate)
Phase 2 – Agree changes and direction (Decision)
Phase 3 – Implement (Act)
Phase 4 – Evaluate and review (Observe)

6. Data Correspondence Blood tests Reception workload Appointment Data
Workforce distribution
Measure of Acute/Booked/Telephone
Use of Wider Clinical Team

7. Admin Tasks - Letters

8. Admin Tasks - Bloods

9. Telephone Calls to Reception

10. Letter Filing Protocol
BIT to File
GP to File
All clinic letters with no action
All letters for adults arranging appts of informing of DNA
ED/OOH attendance with no action
All letters with prescribing action to pharmacists
All letters with GP action request
Letters re palliative patients
Letters re unplanned admission
All letters re patient death
All letters where BIT are unsure

11. Correspondence – initial data
6 weeks data
GPs Filing 31%
BIT Filing 65%
Pharmacist 4%
Easier for BIT
No additional staff required

12. Making Time…. 2250 letters per week – 30 seconds per letter 69% - 1552
776 minutes = c13 hours GP time per week
2500 bloods per month – 625 per week
30 seconds per test on average
20% filed by HCA – 1 hour per week
60% - 3 hours per week
Current GP saving 14 hours per week

13. What Next? Develop diverse clinical team
Upskill – all healthcare professionals
Involve patients
Protect, Support and Mentor new GPs
Promote the on-line space
Use technology
Collaborate
Questions