1. Tudor House & Rectory Road Medical Practice Pathfinder Harry Longman Harry.Longman@patient-access.org.uk 0150981629307939148618 Nicci Iacovou Nicci.Iacovou@patient-access.org.uk 07970848573

2. What is it like to be a patient? Patient wants the doctor – When do I have to call? – Will I be seen? – Will they see me when I want to come? – Who will I see?

3. On average, I will wait 4-5 days, getting longer over last six months

4. Though in truth this is a blend of 40% chance to be seen on the day (lower than most), or several days wait

5. Spread of appts booked ahead is quite large

6. DNA’s running at 40-50 in a full week – related to days waiting to see GP

7. To get in on the day I will have to phone at 8am on the dot and hang on, hoping something left.

8. Understanding demand volumes by week will be crucial. Currently looks like 1200/week.

9. By day and hour, matching supply to demand will fine tune the system. This is hard - but will change.

10. Continuity: chance of seeing my own doctor is 74%, high for the practice size and a good base. Example: a patient making 5 appts seeing the same doctor 3 times has continuity of 60% All patients, all doctors, all consultations are included Highest measured is 80% (Stour, 10,000 list) Hard in large practices Will see before & after Have assumed data OK

11. Your data capture: what most patients want is to see the GP, but 25% for NP, nurse

12. Requests for GP much higher on Monday. Proportion “not agreed” constant around 20%

13. Volume of appts also flexes by day, but need relatively more on Monday

14. Most patients ring the surgery first thing, so appts are soon gone – matches EMIS Web data, plus “no”

15. Most patients want the GP today

16. 15% of patients dealt with by phone consultation

17. Of the phone consultations, 85% don’t have to come in

18. Contrast: when asked, is this consultation appropriate? GPs say 85% are, only 5% f2f not needed

19. Continuity is important in 40% of consults

20. Of that 40%, continuity is achieved 94% of the time.

21. Patients’ views of our service Fed up with having to phone again and again…can never get through at 8am…appts gone by 8.10 a.m. Frustration with not being able to get a routine appointment as soon as they would like. Not enough access to their own GP. Patients who work have difficulty turning around to come back for an appt we could have given the day they phoned.

23. My daily work here Stress…phone is constantly ringing. Frustrating to tell patients we don’t have any appts Patients booked in at inappropriate times. Fear a mistake may be made because we are so busy. Frustrations with patient demand and political decisions beyond our control. 14-hour days…often can be as late as 23.00!!! yet not enough time in the working day for admin tasks. Frustrating when patients booked in…could have easily have been dealt with over the phone.

24. My ideal work More appointments available on the day. No phones on front desk so can deal with patients in person…designated phone areas and admin areas. To give a friendly efficient service to patients. Time in day to read letters, look at path results, plan. A cheerful, enjoyable place to work, where people work together as a team…where all staff appreciated. Some way of advising patients re self care v when they actually need to be seen. I would like a lunch hour (or half hour).

25. How will the new system change things? Reception takes call GP phones patient Problem solved Come and see me Admin question Come and see the nurse 10% 20% 10% 30% 60% PA Navigator measures the flows, which vary by GP & practice. 70%

29. Comments from Victoria Med Centre, recently launched their Patient Access system I actually had time to have a laugh with a patient. I wasn’t praying for lunch time to come today. I don’t feel as drained as I normally do at the end of a morning. We’re actually smiling! Patients are more respectful. It was a piece of cake – more efficient. I was finished by 12, normally I am still going at 12.45pm. The patients were pleased.

30. What predicts the outcome? Success Leadership and teamwork Purpose, being open to patients Knowing how you are doing Learning and adapting from evidence and from peers Perseverance to make it your own Failure No change to slot thinking Patients sink it with complaints GPs don’t want to change Staff undermine the change with each other and patients Lack of understanding demand, overwork