“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

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

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?

The Aim of Improved Access

Improved patient care -

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

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

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

Patient contacts surgery

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.

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.

Doctor books appointment

Doctor books appointment

Doctor talks to patient

Doctor talks to patient

Appointment needed

Appointment not wanted Patient’s

issues resolved

Patient’s issues

resolved

Patient Pathway

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%

DoctorsDaily 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

The Numbers

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

Negatives

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