“Patient First” at Ravenswood 2013

1. “Patient First”at Ravenswood 2013 We are a large, modern, urban practice with 15,500 patients 8.5 full time equivalent doctors 2 experienced nurse practitioners

2. The Need for Change • Not meeting demand • Dissatisfied patients – can’t get appointments • Harassed staff – can’t give appointments • Stressed doctors – no continuity • Inefficient system – right people not being seen at the right time by the right person

3. The Aim of Improved Access Improved patient care - • Patients seen: • when they want • by whom they want • for the time they need • the most ill people helped first • sufficient appointments for all those who want them • access GP knowledge wherever you are – home/work/away?

4. Patient First Principles • Target capacity to meet demand • Use your most experienced people first • On average, 1 in 3 telephone calls will result in a surgery appointment • The divide between urgent and routine is a source of great tension and argument – why try? • Do today’s work today – it does not go away and, in fact, often increases if not dealt with

5. Demand – a few facts • More predictable than we may think • 50% more calls on a Monday • 2/3 come in the morning and 1/3 in the afternoon – 50% by 10.30 am • Conversion rate higher in the morning than the afternoon – overall average is 1 in 3 • Sickest patients call earlier in the day • 80 % of patients given a free choice would prefer to be seen today

6. Patient First System – how it works • Patient phones the surgery and requests to speak with a doctor or nurse • Receptionist will say “yes” and ask for patient’s name, a brief reason for the call and preferred contact number • Patient will be called back or put straight through to clinician • If patient is added to the clinician’s list, they will be prioritised based on clinical need • Majority of calls for acute care and follow-up are handled this way

7. Patient Pathway Patient contacts surgery Receptionist asks for a brief description of problem and enters it onto clinician’s call back list. If identified as other query, put on appropriate clinician for routine care. Appointment not wanted Appointment needed Doctor books appointment Doctor talks to patient Patient’s issues resolved

8. The Numbers Sept 2012 Total – 5729 Face-to-Face – 3512 Telephone – 2217 DNA – 146 2013 Telephone Face-to-Face Conversion March 4898 2676 54% June 4914 2511 51% July 5288 2846 53% Doctors Daily average 34 14 41% A busy day is anything over 40 calls We rarely have days on which one doctor will take more than 50 calls

9. Negatives • Volume of work less predictable • Patients learning the system • A minority don’t like it • Some find flexibility stressful • Care with session numbers • Full screen feels busier • Busiest session 45 contacts

10. Positives • Busiest session usually 45 calls • Significantly improved access on the day and all offered a suitable appointment after discussion with the doctor • Improved continuity of care • DNAs almost non-existent • More control over structure of the day • Extreme flexibility to cover sickness or other unexpected absence • More efficient use of clinician’s time • Running to time and less congestion in the waiting room • Improved customer service in reception