LEADING GENERAL PRACTICE TOWARDS OUR 2020 VISION:MEETING THE CHALLENGE OF INCREASING DEMANDChair – Sir Lewis Ritchie, University of Aberdeen

Learning outcomes for this session

• Discuss with general practitioners the application of lean tools and techniques, aspects of leadership and team working and practical benefits

• Identify innovative ways to work locally in practices as part of the whole system to improve access for patients, prescribing, consultations, safety, and the working lives of staff

• Hear about the concept of using design principles to redesign a practice to meet demographic, professional and business challenges

Leading General Practice towards our 2020 Vision

• Use of lean is one way to release time for Delivering Quality in Primary Care

• The focus is on improving quality, reducing variation and waste at the same time

• Productive General Practice partnership with RCGP, QIHub, Health Boards

• Innovate to enable Our 2020 Vision

Lean principles and practise

• Whole team• Leadership• Culture change• Day to day measurement

What’s it got to do with Delivering Quality in Primary Care?

Effectiveness• Removes wasteful steps

in prescriptions process• Brings consistency in

prescribing decisions• Helps you work with

pharmacy and care home colleagues

Safety• Being used by practices

undertaking Patient Safety in Primary Care

• Incorporates the SafeQuest safety culture assessment tool

Person centredness•Uses the voice of the patient to decide what adds value

•Involves patients in improvement work•Links to the RCGP patient involvement project

•Supports practices to implement the Patient’s Rights Bill

Demands on general practice are rising

• Increasing consultation rates• Ageing population• Complexity of care• Shifting Balance of Care• Patient expectations

• Reducing demand on A and E and OOH• Demand will continue rising

Doing nothing is not an option

GP and Practice Nurse Consultations in Scotland

• 2003/4 21.4 million• 2010/11 23.1 million

Go to your GP

By reviewing current nursing templates and appointments a team

• created an additional 10 nurse practitioner and 14 practice nurse appointments a week while still maintaining an efficient nursing service

• decided that it was not necessary to appoint another nurse to the recent vacancy the team had which had a cost avoidance of £15,000

Offers benefits: additional appointments

Offers benefits: blood testing staff costs reduced

£3.50 per

episode

£1.50 per

episode

100%

of

bloo

d te

sts

Nurse

Phlebotomist

£1.50 per

episode

The benefits it offers…Stanley Medical Group, County Durham

• Reviewed their recall system for patients needing routine drug monitoring

• Applied lean principles to understand the current process and design an improved process

• Existing system lead to inconsistencies, waste and patient safety risk

• Results:– Patient Safety (faster lead time and higher degree of

accuracy)

– Time (35 hours/month to 0.53 hours/week)– Patient experience (increased HCA patient facing

time)– Money (£4150/year)

“Streamlining this process has saved us time but the real benefit has been that we have improved patient safety and the patient experience, as we are now able to offer more appropriate appointments”

Sue Elsbury, Practice Manager

Offers benefits: reduced turnaround times for reports

This front of house team reduced the number of inappropriate enquiries, redirecting them to the right team in their practice

Offers benefits: more efficient use of consulting rooms through using 5S tool

Before

Offers benefits: more efficient use of consulting rooms through using 5S tool

After

This team reduced the average time for staff to find prescriptions from 118 to 21 seconds, by mapping their routes with spaghetti diagrams and using the 5S improvement tool in reception

Offers benefits: reduced costs through improving consumables re-ordering process

"PGP is a very productive system to assess our working life and to improve it with support. It enables us to review processes and develop consistency."

Crescent Medical Practice

“The experience with Productive General Practice has been a good one. It has been good to

establish where we were in the first place and where we want to go and the change has been

fully supported. It has helped to build a picture of where we want to

be in five years time. We want to make it the ‘super surgery’ that it could be through continuing

to strive for better patient feedback, and maintaining the drive that we’ve established so far,

because we have achieved some really brilliant work.

We’re looking forward to the further change that’s about to come.”

Go explore …2 out of 4 work stations

Shaping OurFuture

Practice

SafeQuest Elmbank Practice

Crescent Practice