Berkley practice what is it like to be a patient
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Berkley Practice What is it like to be a patient?. “How To Get Your Life Back, Save More Money and Have Happier Patients Within The Next 12 Weeks”. Familiar?. Familiar?. Before Patient Access GPs, PMs and receptionists said…. I’m embarrassed when I see rows of patients waiting.

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Berkley Practice What is it like to be a patient?

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Berkley practice what is it like to be a patient

Berkley PracticeWhat is it like to be a patient?


Berkley practice what is it like to be a patient

“How To Get Your Life Back, Save More Money

and Have Happier Patients

Within The Next 12 Weeks”


Berkley practice what is it like to be a patient

Familiar?

Familiar?


Berkley practice what is it like to be a patient

Before Patient Access GPs, PMs and receptionists said…

I’m embarrassed when I see rows of patients waiting

We’re going to have to get another GP in at a cost of £100,000.00

I’m annoyed by the huge number of DNAs

I dread the inevitable phone blitz at 8 every morning

I can’t take the aggression from frustrated patients anymore. I can’t magic up an appointment

We all feel totally drained & I know that patients aren’t happy either


Berkley practice what is it like to be a patient

Not To Mention The Patients…

Why do I have a 3-week wait at my surgery & yet I hear of others who see their doctor the same day?

I’m frustrated that I can’t speak to my GP when I need to. I’m very tempted to change surgeries

A lot of the time I don’t even need to see the GP, so why can’t I just phone, save the travel cost, hassle & my GP’s time?

We’re told to ring at 8 but can never get through because they’ve told everyone to call at 8.

It’s a joke!


Berkley practice what is it like to be a patient

“All gone,

call back

tomorrow”

3 week wait

High DNAs

Repeat booking

Reception takes call

GP sees

patient

10-min slot

70% “routine”

Problem solved

Patient

pressure

30% “urgent”

See any GP/locum

Poor continuity

Repeat booking


How patient access works

How Patient Access Works

Come and see GP

Admin question

30%

20%

Reception takes call

GP phones patient

60%

60%

Problem solved

10%

20%

Come andsee nurse


A typical receptionist d ay with patient access

A Typical Receptionist Day With Patient Access

Admin question

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

20% solve

Reception takes call

Just 60%

list

for GP

20% book

to see nurse

Nurse


A typical gp day with patient access

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 minsplus 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.

Come and see GP

30%

GP phones patient

60%

Problem solved

10%

Come and see nurse


A practice i n t he patient access community looks sounds feels d ifferent

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.


Berkley practice what is it like to be a patient

The Relief of Working Efficiently

  • 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 saving20% of GP working hoursand A&E attends are 50% below Liverpool average- DrChris Peterson, GP at The Elms & Liverpool CCG Urgent Care Lead


What do patients think of our service

What do patients think of our service?

  • Administrative staff views

    • Not very happy – wait to see GP & opening hours

    • ‘Patients satisfied with system – can get to see GP at their demand whatever day or time’

  • Clinical staff views

    • Wait too long but then receive a good service

    • Can’t get through, access, inconvenient times, can’t book ahead

    • Can’t see doctor so offered nurse triage which helps


My daily work at present

My daily work at present

  • Administrative staff views

    • Work very stressful

    • Can’t get work done, feel dissatisfied

  • Clinical staff views

    • Face to face triage

    • Busy busybusy


My ideal work

My ideal work

  • Administrative staff views

    • Want to help patients

    • Happy in current role

    • Would like to meet patients demands

  • Clinical staff views

    • ‘Would like less stress and improved access’

    • ‘Would like to start at 9am, be in control and finish on time’

    • ‘Would like to continue to do telephone triage’


Fear losses if changes are made

Fear losses if changes are made?

  • Administrative staff views

    • What will the effects be long term?

    • Will we lose control of GP appointments?

    • ‘Staff sanity and loss of control of appointments’

  • Clinical staff views

    • How will my role be effected? (nurse)

    • None


Consultations all face to face 6 5 of list per week avg

Consultations all face to face, 6.5% of list per week, avg


Average wait to see a gp is 7 days imagine just 1

Average wait to see a GP is 7 days. Imagine just 1.


Wide variety of demands on reception nb many in other are gp or nurse requests

Wide variety of demands on reception (NB many in “other” are GP or nurse requests)


Monday is much busier than other days

Monday is MUCH busier than other days


High demand at 8 9am but reasonable spread through the day 97 of requests agreed high

High demand at 8-9am, but reasonable spread through the day. 97% of requests agreed – high!


One third of patients are walk ins this is high again suggests it s hard to get through

One third of patients are walk-ins. This is high, again suggests it’s hard to get through.


45 of patients request a named doctor

45% of patients request a named doctor


Vast majority of patients want to see the doctor today that s why they called today

Vast majority of patients want to see the doctor today- that’s why they called today.


Consultations more on mondays good

Consultations – more on Mondays, good


55 of consults are acute or exacerbations ie best dealt with today

55% of consults are acute or exacerbations, iebest dealt with today.


Very few phone consults at present 97 f2f but of the 4 phone consults all resolved

Very few phone consults at present, 97% f2f, but of the 4 phone consults, all resolved.


In your view 38 did not need a face to face even more will be evident

In your view, 38% did not need a face to face. Even more will be evident.


Continuity despite patient views yours is that it matters only 27 of consultations

Continuity: despite patient views, yours is that it matters only 27% of consultations


Launch programme just 12 weeks to a happier less stressful practice

Launch programme - just 12 weeksto a happier, less stressful practice

Detailed planning

Staff survey

Patient comms

Whole team meeting

New deal for patients

Predicting demand & matching capacity.

Patient & staff feedback

Review

Launch day

Preparation

Routine

New measures help tuning.

Build confidence

Affirmation

Consensus

Yes.

Pledge to

each other

and to patients


Simple but the whole system changes

Simple, but the whole system changes

Come and see GP

Admin question

40%

10%

Reception takes call

GP phones patient

70%

50%

Problem solved

10%

20%

Come and see nurse

PA Navigator measures the flows, which vary by GP & practice.


Phone consults take about 3 minutes

Phone consults take about 3 minutes

Traditionally, all patients take ten minutes. Why?

Four practices, 17,000 patients, 9 months to May 2011


Berkley practice what is it like to be a patient

Clarendon, a training and teaching practice in Salford.Previously drowning in demand, now feelingon top of workload

Before

After

Reduced stress!

Abuse of reception staff gone

All patients who need it are seen

Saving one clinical session

  • Frustrated, stressed doctors

  • Miserable reception staff

  • Unhappy patients

  • Reputational issues

  • List size effect


Within 12 weeks response time median 30 minutes now 19min

Within 12 weeks, response time median 30 minutes(now 19min)


Golden rules

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)


You lead we guide you through the change

You lead. We guide you through the change.

  • 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.

“Patient Access has given us a new lease of life” Dr. Kam Singh


Launch programme just 12 weeks to a happier less stressful practice1

Launch programme - just 12 weeksto a happier, less stressful practice

Detailed planning

Staff survey

Patient comms

Whole team meeting

New deal for patients

Predicting demand & matching capacity.

Patient & staff feedback

Review

Launch day

Preparation

Routine

New measures help tuning.

Build confidence

Affirmation

Consensus

Yes.

Pledge to

each other

and to patients


Evidence now links method with outcomes

Evidence now links method with outcomes

Lower costs within practice

GP control of work load, staff job satisfaction

“We’re saving

GP sessions”

“Stress has melted

away”

“I can see my own GP”

Access & Continuity

Transformed, measured, understood.

GP service innovation

- new thinking

Patient safety & satisfaction

20% reduction from

faster response

20% reduction through improved continuity

& management

Lower A&E attendance

Lower OP referrals and emergency admissions


Berkley practice what is it like to be a patient

Matching supply with demand coming in hour by hour enables outstanding patient service and the sense of flow.

Loadmaster chart shows variation by day and hour.


Berkley practice what is it like to be a patient

Changing to demand led planning: the volume ranges of patient requests ranges from 5.5 to 10% of list per week.

Note: 1. Practices have effectively unlimited access

2. Coding and data quality issues may affect comparisons


Berkley practice what is it like to be a patient

Safety: either doctor or patient can call for a face to face. Conversion rate falls through the day,and varies by GP.

1 in 3 called in at 8am, falling to 1 in 5 before 11

Calls after 1700 result in only 7% conversion to ftf

Data from Thurmaston HC, 25/7/11 – 3/2/12. n = 10,367 calls

Bubble chart: area of circle in proportion to number of GP calls made by hour

Assumptions: all GP appts booked following GP phone call, at time of call


Over time your patients are 20 less likely to attend a e

Over time, your patients are 20% less likely to attend A&E

At mean deprivation, line shows 21% saving

Best fit line for 8,000 practices

Best fit line for 31 Patient Access practices

Design H Longman, A&E data calc EMQO from HESOnline FY0910, deprivation from SPH


Crucial to match demand capacity

Crucial to match demand & capacity

We know that clinically urgent demand

is about 23% of consultations (blue)

Offering an urgent only service

means a daily work profile with only

around ¼ demand at weekends

Hence lower requirement for sessions

OOH one GP for approx 8,000 patients


When service is all day by 1800 it drops off

When service is all day, by 1800 it drops off


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