1. Survival – ‘managing demand’ A Stowhealth solution

2. Aim  Explain where we were  Options and decisions  Our methodology  Our conclusion

3. Where were we  Fraught  Working 0800 – 1930 and not finishing  Unhappy and unsustainable

4. Options and Decision  Do nothing - people would have walked!  Pour in more resource – not an attractive or sensible option  Try and manage demand better?......

5. Our Methodology  Look at the options  Get an external review  - choke on the next step price  Do it ourselves

6. What were we doing?  "Hybrid system": - Pre-booked routine surgeries - On The Day Team: staffed by 2 Drs/session, NP am + limited Minor Illness support  Separate LTMC clinic: LTC reviews/QOF delivery

7. External review "Patient Access" www.patient-access.org.uk Facilitated in-house survey of:  Reception: How often were you able to give people what they wanted?  Clinicians: New/follow up Acute/Acute-on-Chronic/Chronic Continuity important? Continuity achieved?

8. Duration of face to face consults around 12 minutes, and telephone stable at 4 minutes is on the fast end.

9. Continuity: judged important mostly for chronic conditions, also many acute, 42% overall, and 8% gap where not achieved.

10. Where continuity matters, and is achieved, 62% of consultations are resolved, cf only 39% where not achieved.

11. What next?  Balked at £13K + quoted for further input  Do it ourselves!  Working party - Doctor, Business Manager, Nurses, HCAs  "Suck it & see"  Regular review  Constant tweaking

12. 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%

13. Principles  Triage all Doctor appointment requests  Ask patient if there is a specific Dr that they wish to speak to - if not, allocate in turn  Use Minor Illness clinic where appropriate  Clinicians can book future appointments - beware tomorrow's demand!  Never refuse an appointment if patient wishes to be seen

14. Our system

15. Others changes  Increase in Minor Illness clinic capacity  Move more Treatment Room activity to HCAs

16. Unchanged  Bloods  LTMC  Learning disability reviews  Mental health reviews  Postnatals  Baby checks  Baby immunisations

17. Outcomes - September 2013  Average number of telephone calls/Dr/session - 17.7 (range 15.0 - 21.3)  Average number of face-to-face appointments/Dr/session - 4.4 (range 3.2 - 6.3)  Average conversion rate - 25% (range 18.2 - 36.3%)

20. Reduction in DNAs

21. Other findings  Demand is predictable (& finite!)  3/4 of daily phone demand received by 1pm  2/3 of total daily work (phone + face-to-face) dealt with by 1pm  Activity has fallen since outset, but now stable

22. Monday AM

23. Tuesday PM

24. Thursday PM

25. How does it feel? Patients and Staff  Patient survey  300 questionnaires sent  Ratio - 2 telephone only: 1 face-to-face  110 responses received  Staff survey  26 responses received

26. PATIENT - Did you find it convenient to receive a call back from the clinician during surgery hours?Yes89%No11%

27. PATIENT - Were you able to speak to/see the clinician of your choice?Yes87%No13%

28. PATIENT - Were you satisfied with the outcome of your telephone consultation?Yes88%No9% Blank3%

29. PATIENT - If required, were you given an appointment on the day that you wished to be seen?Yes87%No13%

30. PATIENT - How was your experience of our new appointment system compared to our previous system?Better50%Same31% Worse17% Blank2%

31. STAFF - How would you rate your ability to meet your patients needs? (n=26)Better73%Same23% Worse4%

32. STAFF - As a result of our new appointment system, do you feel more in control of your working day?Yes54%No19% Blank27%

33. STAFF - What is your experience of our new appointment system compared to our previous system?Better80%Same20% Worse0%

34. Pros  See the patients that need to be seen, not just those willing to wait  Better continuity  Better understanding of demand  Better able to match capacity to demand  Clinicians feel more in control of their working day  Fewer late finishes  Little needs cancelling if absence/sickness  All demand dealt with at end of day - the phones do stop ringing!

35. Cons  Hard, intense work - timely call backs important  Difficult for some people to receive call backs whilst at work  Very sensitive to "bums on seats" - can't restrict demand!  Requires stricter holiday planning  Half days  Needs telephone triage confidence  Need good LTC/QOF systems

36. The future?