ilkley moor medical practice advanced access. reasons for change 1.government targets: by 2004 all...
TRANSCRIPT
Reasons For Change
1.Government targets: By 2004 all patients should have access
to a Health Care professional within 24 hours
and a GP within 48 hours2.Waiting times:
routine Dr of choice up to 3 weeks
3.DNA’sapproximately 20 a week
4.Increased work loads 2° to 1° shiftNational Service Frameworks
Reasons For Change
5. Rapid Access Clinicthe pros and cons
6. Patient Satisfaction
7. Staff contentment
8. Doctor Stress
Advanced Access
A way to improve patient accessin General Practice based on ensuring abalance between DEMAND for servicesand the CAPACITY of the practice to deliver them.
FOUR PRINCIPLES
• UNDERSTANDING DEMAND
• SHAPING THE HANDLING OF DEMAND
• MATCHING CAPACITY TO DEMAND
• CONTINGENCY PLANS
Data collection
Offering alternatives to face to face consultation i.e. Telephone follow ups, telephone management of same day demand, email, proactive self help etc
Looking at skill mix
For predictable (holidays, meetings etc) and unpredictable (staff illness, flu epidemics etc) events
Data Collection
• The following graphs demonstrate capacity and demand for GPs over a 4 week period.
Week 1 12/08/02
0
20
40
60
80
100
120
140
160
180
Total Demand 139 84 136 86 84
Capacity 95 51 133 95 98
Mon Tues Wed Thur Fri
Data Collection
Week 2 19/08/02
0
20
40
60
80
100
120
140
160
180
Total Demand 172 104 57 101 67
Capacity 137 108 118 109 101
Mon Tues Wed Thur Fri
Data Collection
Week 3 26/08/02
0
20
40
60
80
100
120
140
160
180
Total Demand 0 140 85 91 48
Capacity 0 141 152 156 114
Mon Tues Wed Thur Fri
Data Collection
Week 4 02/09/02
0
20
40
60
80
100
120
140
160
180
Total Demand 165 111 121 90 79
Capacity 163 149 100 165 138
Mon Tues Wed Thur Fri
Data Collection
Data CollectionAverage Capacity and Demand per day for 4wks
0
20
40
60
80
100
120
140
160
180
Average Demand 159 125 100 92 70
Average Capacity 132 128 125 131 113
Mon Tues Wed Thur Fri
Data Collection
Total Capacity and Demand Per Week
0
100
200
300
400
500
600
700
800
Total Demand 529 501 364 566
Capacity 472 573 563 715
Week 1 Week 2 Week 3 Week 4
Average Capacity
Average Demand
Data Collection
Demand - Dr French
0
5
10
15
20
25
30
35
40
Total Demand 34 17 11 4 4
Capacity 34 22 0 0 7
Mon Tues Wed Thur Fri
Data Collection
Demand - Dr Rolfe
0
5
10
15
20
25
30
35
40
Total Demand 26 4 15 3 5
Capacity 36 0 35 0 4
Mon Tues Wed Thur Fri
Preparation
As long as I don’t have to work any harder
As long as this doesn'teffect my child care
I don’t like change
Happy to try, wecan always go back to theold system.
It’ll never work!
Preparation - Appointments
Previously GP’s spent 47% of their total time in surgery.Rapid Access Clinic 250 5 minute appts per week
New System
Aim at 600 10 minute appointments/week
GP’s never do more than 50% time in surgery
With all GP’s there this will drop to 35%
50% bookable same day30% bookable 1 week in advance20% bookable 3 months in advance
PreparationTotal Weekly Time in Surgery
0.00
5.00
10.00
15.00
20.00
25.00
Norm 11.67 14.33 14.33 15.67 8.83 14.33 11.33
Max 16.50 20.00 20.00 22.00 12.50 20.00 17.00
Dr French Dr Hargreaves Dr Marcoolyn Dr Poulier Dr Rolfe Dr Summers Dr Watson
Preparation - Shaping Demand Telephone Consultations
Re - directing to Practice Nurses - ContraceptionHRTHypertensionTravel Advice - Developing Protocols
Triaging Visits
Self - help information - Web Site (www.ilkleymoordoctors.co.uk)
LeafletsEtc
Preparation - Administration
Data Collection - Number of appointment Requests/DNA’s
Change in staff rota Change of rota for staffso as to best cope with busiest times
Staff Training
Initial Meeting with GP’s to talk through shaping demand.
Increased telephone lines
Trial of telephone consultations
Preparation - Administration
PublicityLeaflets and posters at reception
2 public meetings
Local press release
Preparation - The Backlog Stopped all pre bookable appointments after Christmas
Provided more appointments during 1st 10 days of January
Experience to date.Average Waiting Room Times
0
2
4
6
8
10
12
Nov-02 9.6
Jan-03 6.8
1
Experience to date.Cancelled
0
50
100
150
200
250
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
Cancelled 70 45 98 43 42 35 31 55 27 43 16 18 32 29 191
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
Average for 2002 = 43.58
Experience to date.DNA
0
20
40
60
80
100
120
140
160
180
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
DNA 101 96 104 113 114 94 141 91 157 117 105 72 36 43 22
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
Average for 2002 = 108.75
Experience to date.Total Consultations
0
500
1000
1500
2000
2500
3000
3500
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
Telephone consultations 143 187 154
10minute 1940 1488 1434 1764 1764 1365 1884 1319 1631 1682 1785 1310 2752 2438 2701
5minute 1250 1100 1150 1225 1250 1100 1275 1200 1175 1250 1150 1225
Jan-02 Feb-02 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03
Experience to date.
Spare Capacity
0
50
100
150
200
250
2002 34 21 14 23 22 12 17 11 13 21 16 7
2003 170 91 210
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Average for 2002 = 17.5
Average for 2003 to date =130
GP Comments.
I didn’t have to work any harder
BrilliantThe surgery mix is much better
Stress what’s that! I can’t believe it worked! Looks like you didn't need me
Yes94%
No3%
Didn't answer3%
Yes97%
No3%
No10%
Yes90%
No7%
Yes93%
Patient Questionnaire
Q1. Do you feel the appointment service has improved? Q2. Were you satisfied with the appointment service?
Q3. Did you see the Doctor of choice? Q4. Did you get an appointment on the same day you rang?
Yes7%
No93%
Yes57%
No43%
No3%
Yes87%
Didn't answer10%
Patient Questionnaire
Q5. Did you have to ring back for an appointment? Q6. Do you know that we provide telephone consultations?
Q7. Do you feel that the provision of telephone consultations is beneficial?
Experience to date.Surgery Attendance
0
2
4
6
8
10
12
14
16
1
GP Consultation
GP Telephone
Practice Nurse
Reception/Clerical
Self Help
Potential Problems
Popular Doctors
Continuity
Patients planning appointments around their commitments.
Elderly patients
Patients being asked to phone back
Why Bother To Change?
Doctors are spending less time in surgery freeing more time for pro active as opposed to reactive treatment.
Overall improvement in their working lives.
Staff’s working lives have been improved.
Less time spent dealing with each appointmentLess patient aggravation
All 10 minute appts - better quality service to patients.Improved continuity, Decreased waiting times.
Why Bother To Change?
2 appointments per surgery
4 per day
18 per week
810 per year
8100 per 10 years
1350 hrs less / 169 days / 34 weeks