SunnyBank Medical Centre

1. SunnyBank Medical Centre Moving Towards Advanced Access Dr Graham Hillary & Susan Dawrant

2. Organisation at April 2000 6 Doctors 4 Full Time 2 Part Time Locum Cover 4 Practice Nurses (2.3wte) Recruiting: Treatment Room Nurse HCA Phlebotomist List Size 9400 + increasing Clinical Appointments 10minutes Full Time GP 21.75 hours surgery per week 24.25 hours surgery per week at holiday time Fully Computerised Paperless Dr Graham Hillary & Susan Dawrant

3. Demands on Time 8 Weeks Holiday 2 weeks Study leave No Bank holiday work Closed Wednesday Lunchtime In-house Diabetic Clinic Outreach Diabetic Session ENT Outreach Minor Surgery Sessions Undergraduate Teaching Training Acupuncture PCT Meetings Collaborative Core Training Session Management Meeting Dr Graham Hillary & Susan Dawrant

4. April 2000 • Appointments booked up to 8weeks ahead • Held appointments (Routine/Reserved/Urgent) • Long queue for routine appointments • 3rd Available appointment - Average 9days • Up to 160 - 200 DNA’s per month • Low staff morale - constant pressure for limited availability • Patient satisfaction poor • Duty Doctor always very pressured Dr Graham Hillary & Susan Dawrant

5. Matching Capacity to Demand • Understand Daily Demand • Measure requests for Appointments over a one week period. • Tally Sheet. • Analyse results • Average of 20% - 30% shortfall Dr Graham Hillary & Susan Dawrant

6. Review Workload/SystemsPDSA Cycles • Maximise manpower on days of high demand. • Monitor follow-up • Delegate to the most appropriately trained clinical member of the team. • Length of appointments/type of consultation • Reduce DNA rate Dr Graham Hillary & Susan Dawrant

7. Working Smarter not Harder • Match the Team to the work • Expand the role of the Nursing Team • Nurse led Specialist Clinics • Treatment Room Nurse • HCA’s • Phlebotomist • Salaried GP • Locum Cover Dr Graham Hillary & Susan Dawrant

8. Increasing alternative forms of Access • Telephone Consultation • Trialing the System (PDSA Cycles) • Evaluation & Review • Implement & Trial New System • Re-Evaluate • Monitor Dr Graham Hillary & Susan Dawrant

9. Increasing alternative forms of Access • Telephone Consultation. • Routing patient to other healthcare professional where appropriate • Group Consultation (Smoking Cessation Clinics). • Outside Agencies Clinics - Benefit Advice/Cancer Support Team • NHS Direct • Self-help - other agencies • Video/Leaflets/Booklets for patient use. Dr Graham Hillary & Susan Dawrant

10. Appointment System for GP Bookings • Highest Demand/Maximum Capacity • Monday - No pre-bookable appointments. • Tuesday - Friday • 50% of appointments are bookable up to 3 working days in advance. • A GP can override the booking policy • Telephone Consultations • Duty GP would triage request for appointment once availability exceeded. Dr Graham Hillary & Susan Dawrant

11. Advertising the Changes • Communication Across the Team • Reception Team inform patient when taking appointments. • Practice Leaflet • Handouts available in reception • Flyer included in routine correspondence • Call Display Dr Graham Hillary & Susan Dawrant

12. Unblock Future Capacity • Commenced New Appointment Booking System from Jan2001. • Diary Planned and New Appointment System implemented. • Existing Diary not extended beyond Christmas. • Over Christmas & New Year no prebookable appointments for any GP. Dr Graham Hillary & Susan Dawrant

13. Evaluation - PDSA Cycle • Initially no appointments may be booked more than 3 days in advance. • Concerned about creating an artificial backlog. • Evaluate after a 6 month period • Increase the booking time to 7 days in advance. • Unequal spread of demand across clinicians Dr Graham Hillary & Susan Dawrant

14. Appointment Availability 2001 • March-Spare Capacity in the System 92% of the time. • September-Spare Capacity in the System 97.5% of the time • Spare availability not always utilised • patients’ preferred time option • choice of clinician • timeframe available to book appointments Dr Graham Hillary & Susan Dawrant

15. Organisation at October 2001 6 Doctors 4 Full Time 2 Part Time 1 Salaried GP 8 Sessions per week Long-Term Locum 4 Sessions per week 6 Practice Nurses (3wte) 3 G Grade 2 F Grade 1 D Grade 2 HCA (1.5wte) Phlebotomist (Extended Role of Receptionists) Training Reception Members to undertake HCA Role List Size 9600 + increasing Clinical Appointments 10minutes Full Time GP 18 hours surgery per week 21 hours surgery per week at holiday time Fully Computerised Paperless Dr Graham Hillary & Susan Dawrant

16. March 38 29% GP Booked Reviews 26% booked on same day 5% booked 1 day in advance 24% booked 2 days in advance 16% booked 3 days in advance September 40 8% GP Booked Reviews 53% booked on same day 13% booked 1 day in advance 6% booked 2 days in advance 3% booked 3 days in advance 6% booked 6 days in advance 20% booked 7 days in advance DNA’sPreviously 160 - 200 per month Dr Graham Hillary & Susan Dawrant

17. Conclusion • It Works • Match manpower to demand (holiday/sickness) • Routing the patient to the most appropriate member of the team. • Increased accessibility • Reduced DNA’s • Less harassed staff • Patients have stopped playing the system • Positive feedback from patients/staff/clinical team • Empty slots Dr Graham Hillary & Susan Dawrant

18. Sunnybank Medical Centre 01274 424111 • E-mail sdawrant@bradford-ha.nhs.uk • National Primary Care Development Team • E-mail npcdt@manchester.nwest.nhs.uk Dr Graham Hillary & Susan Dawrant