conway pms what is it like to be a patient? thoreya swage [email protected]...
TRANSCRIPT
Outside a traditional surgery
People waiting on the phone, the same, unseen
The traditional model
Reception takes
call
GP sees patient
10 min slot
Problem solved
70% “routine”
30% “urgent”
60%
“All gone.Call backtomorrow”
3 week wait,high DNAs,repeat booking
See any GP/locumPoor continuity,repeat booking
Patientpressure
Rework
What do patients think of our service?(small sample – 5)
• Administrative staff views– NOT VERY HAPPY AT THE MOMENT RE APPOINTMENTS– patients seem to be happy with telephone triage but feel
they have to wait a while to prebook an appointment– I only really get to speak to patients about access when
they are not happy. There has been a reduction in complaints about access since we started a form of tel triage in the practice.
– SOME GOOD SOME BAD
• Clinical staff views– None recorded
Already, many patients ask for a GP phone call
Monday has much higher demand
Very heavy demand 8-9am. Little left later on.
Most phone, but 17% walk-ins suggest it can be hard to get through, or they think this will beat the
queue
A large number of requests are turned down. 17% “call again”, a lot of rework
Just over half request a named doctor
The vast majority who call want the doctor today.
Just 18 GP consults recorded – but mixture of phone, f2f
Telephone outcomes – views of GPs from daily work? (sample is only 5 calls so analysis only illustrative)
Small sample but this is typical, continuity important in around half of consults in GP view.
My ideal work
• Administrative staff views– happy working environment is essential which we are
lucky to have and helping patients and making them feel comfortable is our top priority
– More time for clinicians to see patients. Less frantic approach to healthcare leading to a safer service.
• Clinical staff views– None recorded
A Typical Receptionist Day With Patient Access
Reception takes call
Admin question
20% solve
20% bookto see nurse
Just 60% list
for GP
Nurse
Per Week, Patient List Of
8,000
10-12% of patients call
28% on Monday
220 – 270 calls @ 2
mins
7 to 9 hours of calls
Other days 4.5 to 6 hrs
Many more calls will come
in the morning, but will
spread as a result of good
service
GP phones patient
Problem solved
Come and see GP
Come and see nurse
10%
30%
60%
A Typical GP Day With Patient Access
Per Week,
Patient List of 8,000
6-8% call for GP
Mon - 28% of the week
130 to 180 calls on Mon
80-120 calls on other days
Plan for 40 each per GP per
day
40 x 5 mins plus 16 x 10 mins
Total consulting time 6
hrs/day
Availability of nurse
consultations can reduce this
by ≈ 40 mins/day
Mornings more phone calls,
becoming more face-to-face
late morning & into afternoon.
A Practice In The Patient Access Community Looks, Sounds, Feels Different
Dr Chris Barlow
of Quorn, one of
the earliest
pioneers in 2000
Monday morning
8.30, busy day, going
full tilt.
All carefully worked
out.
Evidence from practices in the Patient Access movement
60% of calls don’t typically need an appointment
A rapid and safe system, where patients that need
to be seen are
7% list increase with no extra GP sessions needed at
Oak Tree Health Centre
We’re now saving
20% of GP working hours and A&E attends are
50% below Liverpool average - Dr Chris
Peterson,
GP at The Elms & Liverpool CCG
Urgent Care Lead
The Relief of Working Efficiently
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%
40%
50%
70%
Consensus
Preparation
Detailed planningStaff surveyPatient commsWhole team meeting
New deal for patientsPredicting demand & matching capacity.Patient & staff feedback
Launch day
Routine
Review
New measures help tuning.Build confidenceAffirmation
Yes.Pledge toeach otherand to patients
Launch programme - just 12 weeksto a happier, less stressful practice
Golden Rules
• If telephone lines open 9am, so do Dr callbacks• All patients are called back – no Doctors appointments
made by receptionists• Call back within the hour• All Drs on telephone call backs (exception Duty Dr or
locum/trainee)• Call patients in for face to face from mid morning (and
mid/late afternoon)
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)
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
“Patient Access has given us a new lease of life” Dr. Kam Singh
• Work on the whole practice system with the whole team.
• Change is hard. We make the process easy and fast.• 5 stages over 8-12 weeks, knowing how you are doing• Every practice differs. You make the decisions.
You lead. We guide you through the change.
Which is the best pancake?
Cold and soggy
Hot, fresh and crispy