1. Ilkley Moor Medical Practice
Advanced Access

2. 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

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

4. 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.

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

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

7. Data Collection

8. Data Collection

9. Data Collection

10. Data Collection

11. Data Collection

12. Data Collection

13. Data Collection

14. Data Collection

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

16. 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

17. Preparation

18. 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

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

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

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

22. Experience to date.

23. Experience to date.

24. Experience to date.

25. Experience to date.

26. Experience to date.

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

28. 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?

29. 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?

30. Experience to date.

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

32. Why Bother To Change?
All 10 minute appts - better quality service to patients.
Improved continuity,
Decreased waiting times.
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

33. 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