2. Prospect Road Surgery Advanced Access HOW YOU COULD GET HERE !! Chris Nicholls Chris Nichollschris.nicholls@wakeha.nhs.uk 01924 274 123

3. Prospect Road Surgery Practice Population = 7,288 Practice Population = 7,288 3.5 WTE GPs 3.5 WTE GPs 1.75 WTE Nurses 1.75 WTE Nurses 5 Receptionists – all part time 5 Receptionists – all part time GMS Practice GMS Practice Large population increase over the last two years Large population increase over the last two years

4. Why Advanced Access? GP 3 rd Available Appointment 14 days! GP 3 rd Available Appointment 14 days! Nurse 3 rd Available Appointment 16 days! Nurse 3 rd Available Appointment 16 days! Stress, Stress, Stress Stress, Stress, Stress Unhappy Patients = Unhappy Staff Unhappy Patients = Unhappy Staff Senior Partner Retiring (October 2002) Senior Partner Retiring (October 2002) How would we cope with no extra capacity? How would we cope with no extra capacity? Advanced Access???? Advanced Access????

5. What Happened Next? Presentation by Access Facilitator Presentation by Access Facilitator Committed to working with the Collaborative Committed to working with the Collaborative Capacity Demand Measuring (two weeks August 2002) Capacity Demand Measuring (two weeks August 2002)

6. August 2002 Total GP Demand 540 appointments per week (Follow Ups 15%) Total GP Demand 540 appointments per week (Follow Ups 15%) Total Nurse Demand 165 appointments per week ( Follow Ups 32%) Total Nurse Demand 165 appointments per week ( Follow Ups 32%) GP Backlog 1512 Appointments GP Backlog 1512 Appointments Nurse Backlog 462 Appointments Nurse Backlog 462 Appointments GP DNAs – 64 per month GP DNAs – 64 per month Nurse DNAs – 55 per month Nurse DNAs – 55 per month Shortfall in GP appointments only 3 per week Shortfall in GP appointments only 3 per week Shortfall was going to jump to 100 per week in October Shortfall was going to jump to 100 per week in October

7. Practice Wide Data

8. Where did we start? Plan to clear the backlog when Senior Partner replaced Plan to clear the backlog when Senior Partner replaced Changed Monday Working Changed Monday Working Mondays booked on the day only (except 1st hour) Mondays booked on the day only (except 1st hour) No follow up appointments on a Monday No follow up appointments on a Monday After two weeks extended to Fridays After two weeks extended to Fridays GP 3rd available appointment dropped from 14 days to 3.9 days GP 3rd available appointment dropped from 14 days to 3.9 days Nurse 3rd available appointment dropped from 16 days to 1.2 days Nurse 3rd available appointment dropped from 16 days to 1.2 days

9. Gloomy October Dr. Brad Retired Dr. Brad Retired Mid - week wait went back up to 14 days Mid - week wait went back up to 14 days Practice became disillusioned Practice became disillusioned Had anything changed? Had anything changed? Ray of Light……………. Ray of Light……………. –Dr. Gs Telephone Consultations –Potential to save 10 appointments per week per GP

10. Telephone Consultations 14, 5 minute appointments per week 14, 5 minute appointments per week (7 on Mondays, 7 on Fridays) (7 on Mondays, 7 on Fridays) Mainly for discussion of labs/ X-ray results/ hospital letters Mainly for discussion of labs/ X-ray results/ hospital letters Very clear guidelines for reception about who is suitable Very clear guidelines for reception about who is suitable Telephone consultations taking 5 minutes as opposed to 10 Telephone consultations taking 5 minutes as opposed to 10 Only 1 in 20 is resulting in a face to face consultation as well Only 1 in 20 is resulting in a face to face consultation as well The patients like them! The patients like them!

11. Clearing the Backlog Clearing the Backlog No replacement for retired partner to be found No replacement for retired partner to be found Locums difficult to find Locums difficult to find Appointments booked on the day only over Christmas Appointments booked on the day only over Christmas Started the New Year with a clean slate Started the New Year with a clean slate

12. New Year New Start New Year New Start Mondays booked on the day only (except 1st 1/2 hour) Mondays booked on the day only (except 1st 1/2 hour) Follow up appointments kept to the middle of the week Follow up appointments kept to the middle of the week Patients educated to ring the day they want to be seen Patients educated to ring the day they want to be seen Patients educated to ring after 10.30am for anything other than an appointment Patients educated to ring after 10.30am for anything other than an appointment Roughly 40% appointments can be pre - booked Roughly 40% appointments can be pre - booked Introduced GP led Clinics Introduced GP led Clinics Extending telephone consultations to other GPs Extending telephone consultations to other GPs New appointment slips New appointment slips Contingency Planning Contingency Planning

13. Problems Selling it to the rest of the Practice Selling it to the rest of the Practice Gaining the patients trust in the new system Gaining the patients trust in the new system Clarifying the system to Reception Clarifying the system to Reception Getting Reception to use it! Getting Reception to use it! Change is scary - what if it doesnt work! Change is scary - what if it doesnt work!

14. Success GP 3rd available appointment 0.42 days (from 14) GP 3rd available appointment 0.42 days (from 14) Nurse 3rd available appointment 3.13 days (from 16) Nurse 3rd available appointment 3.13 days (from 16) Happy Patients Happy Patients Happy Staff Happy Staff Happier GPs - well you cant please everyone! Happier GPs - well you cant please everyone! FREE APPOINTMENTS! FREE APPOINTMENTS!

15. Where Now Practice nurse starting minor illness training April 03 Practice nurse starting minor illness training April 03 Receptionist training to be Health Care Assistant April 03 Receptionist training to be Health Care Assistant April 03 Out of Hours usage reduced Out of Hours usage reduced DNAs reduced DNAs reduced Practice moved to all 10 minute appointments Practice moved to all 10 minute appointments Staff and patient questionnaire to assess impact of work April 03 Staff and patient questionnaire to assess impact of work April 03 Identified need to increase the amount of pre-booking Identified need to increase the amount of pre-booking