1. Threeways Surgery What is it like to be a patient? Thoreya Swage, Patient Access thoreya.swage@patient-access.org.uk thoreya.swage@patient-access.org.uk

2. Outside a traditional surgery People waiting on the phone, the same, unseen

3. The traditional model Reception takes call GP sees patient 10 min slot GP sees patient 10 min slot Problem solved 70% “routine” 30% “urgent” 60% “All gone. Call back tomorrow” 3 week wait, high DNAs, repeat booking See any GP/locum Poor continuity, repeat booking Patient pressure

4. 80% of consults are face to face, but quite a few by phone

5. Of those, 56% resolved over the phone

6. Though when asked if consultation was appropriate, only 10% said it could have been by phone.

7. Hourly demand, slopes downward, good service implied here

8. GPs see continuity as important in 38% of consultations.

9. 57% of patients ask for a named doctor. Significantly more than GPs. Something that needs to be addressed, and can be.

10. Vast majority of requests are for same day

11. But still 10% of requests told to call back another time - rework

12. 30% of requests from walk ins suggest that patients find it difficult to get through on the phone.

13. Patients’ views of our service ‘Difficulty in getting appointments/lack of appointments’ ‘Patients like the continuity of seeing the same doctor but we have to have locums in and they are not always happy to see them as an alternative’ ‘many new patients have left their old surgeries to join Threeways because they have heard such good things about it’ ‘Most people seem happy about the quality of the consultation but are always fed up with me running late’ ‘Excellent. Only frustration can be getting through at 8-9am on the phone and 2-3pm i.e. peak call times

14. My daily work at present ‘ on commencement of shift there are rarely enough appointments available’ ‘Gaining more patients and no more appointments’ ‘would prefer to have any visits assigned as soon as they come in to aid time management/planning’ ‘very stressful and the feeling is that all members of staff are being stretched to the limit’ ‘lack of appointments with particular GPs’ ‘very long hours, most days 12-13 hours

15. My ideal work ‘more flexibility in working hours and more late appointments for people who work’ ‘having enough appointments’ ‘a surgery where all streams of work are seen and dealt with by the appropriate staff member. Time in the day to check results and paperwork and may be even have a cup of tea and see other staff members’ ‘To be able to give patients appointments at the times they would like and to generally have more appointments’ ‘seeing only those patients who really need to see a doctor’

16. A practice in the Patient Access community looks a little different Monday morning 8.30, Busy day, going full tilt. All carefully worked out. Dr Chris Barlow of Quorn, one of the earliest pioneers in 2000

17. The traditional view of general practice, every problem requires 10 minutes face to face with the GP One tiny problem Perfect service

18. We help all our patients, all day, every day The Patient Access method makes this a daily reality. A new principle is at work

19. Simple, but the whole system changes PA Navigator measures the flows, which vary by GP & practice. Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 10% 20% 10% 30% 60% 70%

20. Magic 1: Over half need only the call Call fulfils demandSee doctor See nurse Two practices, 8,000 patients, 9 months to May 2011

21. Magic 2: The call takes about 3 minutes Four practices, 17,000 patients, 9 months to May 2011 Traditionally, all patients take ten minutes. Why?

22. “How are we going to help all our patients, all day, every day?” You answer, over five stages of the programme. Consensus Preparation Staff survey Patient survey Data capture Training System setup Whole team New deal for patients Feedback wall Test & learn Build confidence Launch day Routine Review Evidence: New measures New staff survey New patient survey Your decision Yes. Pledge to each other and to patients

23. What happens next? All to agree to a change Change leader Decide on a launch date Do not book any appointments from launch date onwards Workforce planning (GPs and reception staff)

24. What happens next? Inform the patients – e.g. flyer, PPG, website, media, answerphone message etc Train staff – Procedure for reception staff to follow Support provided by Patient Access training partner – before, at launch and afterwards

25. Which is the best pancake? Cold and soggy Hot, fresh and crispy