1. Howard House Surgery What is it like to be a patient? Thoreya Swage thoreya.swage@patient-access.org.uk thoreya.swage@patient-access.org.uk

2. What are demands on reception? GP requests, also many admin tasks.

3. Requests for GP by day: Monday much higher

4. What time? Big spike at 8am, but a flow throughout

5. About 30% don’t get what they wanted, 14% given a telephone call instead, 11% asked to phone again, generating rework

6. Vast majority want the doctor today.

7. Surprisingly high 35% of requests for GP are walk ins. Is it difficult to get through on the phone?

8. Does continuity matter? For patients, 41%, GPs very similar 42%, nice agreement!

9. What do patients think of our service? Administrative staff views – Lack of available appointments. Can’t get through on the telephone – good friendly approachable surgery – Good staff generally offering a good service but its really difficult to get an appointment particularly if you want to see a particular GP for continuity. – Don't have much contact with patients but when have had seem happy with service just some niggles about appointments Clinical staff views – getting difficult to make appointments – Frustrating they cannot book ahead. Have to wait ages to see me for routine diabetic appointments. – patients do not like to wait for telephone call backs on the day may have problems taking phone call at work or trouble arranging child care if appointment on the day with no set time

10. Telephone consultations well established, almost half of consults for GPs. Visits quite high at 7.4%

11. Outcomes from telephone consults: 70% resolved, very typical rate, and most brought in to see same GP.

12. Acuity: surprising high level of exacerbations. GPs describe 37% of consults as urgent, also high.

13. GPs still say some 7% of consults, face to face not needed

14. Change in May as GP telephone triage introduced

15. Response times: patients are waiting often over an hour, many 6 hours.

16. Time has come down, now 80 mins median. But bringing below 30 minutes makes a huge difference.

17. Real problem here: wait for a GP telephone call is more than a day, and for a face to face it’s 10 days.

18. Made up of 30% same day consults, but many booked ahead for days or weeks.

19. Proportion of same day consults has fallen since change. New system will give patients choice, expect over 80%

20. Consultation duration: face to face has steadily risen. We have not seen this before – it must be hard work.

21. Continuity: better than many at 75%, but variable. We help to improve this and have seen over 85%.

22. My daily work at present Administrative staff views – Busy! A challenge as patients hate telephone triage.. a joy when they like it! 99% of our patients are great & I hope I present a helpful first point of contact for them. – Does not involve making appointments but I understand the frustration of patients when they are not able to get appointments and the challenges for the Reception staff. – Challenging in terms of quantity with an unacceptably high cost of failure e.g. increasing level of complaints and DNAs. Clinical staff views – hard. 8-8pm on call days. paperwork building up unacceptably. risking complaints. Overall pts not suffering but Drs putting in longer hours. – feeling under pressure everyday with confines of appointment times and patients expectations when they attend – Frustrating not being able to juggle appointment times throughout the day

23. My ideal work Administrative staff views – Being able to work together as a practice team with good communication – Would like to ensure patients get the appointments they need.... which will reduce complaints. – I'd like to be able to offer a same day appt for patients as that seems to be mostly what is required. – To be adding value with zero cost of failure and having happy staff and patients. Clinical staff views – until recently used to go home at 7pm if on call with most sorted. leave by 6pm otherwise. to leave work at a reasonable time. – would like regular team meetings for staff open frank discussions and time to reflect on current practice / improvements for team building – For patients to be able to see the doctor of their choice at a convenient time. To stop the phoning at 8 am in order to get an on the day appointment

24. Summary With an elderly population, the overall contact rate should be manageable at 5.9%, though many calls are clinically urgent. The practice changed last year to providing many more telephone consults Telephone consultations are managed well with 70% resolved, but other routes mean that the face to face volume has fallen little. With face to face durations climbing too, the overall workload has increased. Response times to phone calls are quite slow, and pre-booking means average waits are very high. This is the likely reason for spiky demand at 8am, driven by anxiety on when the call back will come and appointment be made. A whole system approach, concentrating on rapid response and continuity, will transform the practice.

25. 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%

26. “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

27. 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)

28. 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