Prospect Road SurgeryProspect Road SurgeryAdvanced AccessAdvanced Access

HOW YOU COULD GET HERE HOW YOU COULD GET HERE !!!!

Chris NichollsChris Nichollschris.nicholls@wakeha.nhs.ukchris.nicholls@wakeha.nhs.uk

01924 274 12301924 274 123

Prospect Road SurgeryProspect Road Surgery

• Practice Population = 7,288 Practice Population = 7,288

• 3.5 WTE GPs3.5 WTE GPs

• 1.75 WTE Nurses1.75 WTE Nurses

• 5 Receptionists – all part time5 Receptionists – all part time

• GMS Practice GMS Practice

• Large population increase over the last two yearsLarge population increase over the last two years

Why Advanced Access?Why Advanced Access?

• GP 3GP 3rdrd Available Appointment 14 days! Available Appointment 14 days!

• Nurse 3Nurse 3rdrd Available Appointment 16 days! Available Appointment 16 days!

• Stress, Stress, Stress Stress, Stress, Stress

• Unhappy Patients = Unhappy StaffUnhappy Patients = Unhappy Staff

• Senior Partner Retiring (October 2002)Senior Partner Retiring (October 2002)

• How would we cope with no extra capacity?How would we cope with no extra capacity?

• Advanced Access????Advanced Access????

What Happened Next?What Happened Next?

• Presentation by Access Facilitator Presentation by Access Facilitator

• Committed to working with the CollaborativeCommitted to working with the Collaborative

• Capacity Demand Measuring (two weeks August 2002)Capacity Demand Measuring (two weeks August 2002)

AugustAugust 20022002

• Total GP Demand 540 appointments per week Total GP Demand 540 appointments per week (Follow Ups 15%) (Follow Ups 15%)

• Total Nurse Demand 165 appointments per week (Total Nurse Demand 165 appointments per week (Follow Ups Follow Ups 32%)32%)

• GP Backlog 1512 AppointmentsGP Backlog 1512 Appointments

• Nurse Backlog 462 Appointments Nurse Backlog 462 Appointments

• GP DNAs – 64 per month GP DNAs – 64 per month

• Nurse DNAs – 55 per month Nurse DNAs – 55 per month

• Shortfall in GP appointments only 3 per weekShortfall in GP appointments only 3 per week

• Shortfall was going to jump to 100 per week in OctoberShortfall was going to jump to 100 per week in October

Practice Wide DataPractice Wide DataGP Capacity & Demand

0

20

40

60

80

100

120

140

160

180

Mon Tue Wed Thu Fri

Fus1stsCapacity

Where did we start?Where did we start?• Plan to clear the backlog when Senior Partner replacedPlan to clear the backlog when Senior Partner replaced

• Changed Monday WorkingChanged Monday Working

• Mondays booked on the day only (except 1st hour)Mondays booked on the day only (except 1st hour)

• No follow up appointments on a MondayNo follow up appointments on a Monday

• After two weeks extended to FridaysAfter two weeks extended to Fridays

• GP 3rd available appointment dropped from 14 days to GP 3rd available appointment dropped from 14 days to 3.9 days3.9 days

• Nurse 3rd available appointment dropped from 16 days Nurse 3rd available appointment dropped from 16 days to to 1.2 days1.2 days

Gloomy OctoberGloomy October• Dr. Brad RetiredDr. Brad Retired

• Mid - week wait went back up to 14 daysMid - week wait went back up to 14 days

• Practice became disillusionedPractice became disillusioned

• Had anything changed?Had anything changed?

• Ray of Light…………….Ray of Light…………….

– Dr. G’s Telephone ConsultationsDr. G’s Telephone Consultations

– Potential to save 10 appointments per week per GPPotential to save 10 appointments per week per GP

Telephone ConsultationsTelephone Consultations

• 14, 5 minute appointments per week 14, 5 minute appointments per week

(7 on Mondays, 7 on Fridays)(7 on Mondays, 7 on Fridays)

• Mainly for discussion of labs/ X-ray results/ hospital lettersMainly for discussion of labs/ X-ray results/ hospital letters

• Very clear guidelines for reception about who is suitableVery clear guidelines for reception about who is suitable

• Telephone consultations taking 5 minutes as opposed to 10Telephone consultations taking 5 minutes as opposed to 10

• Only 1 in 20 is resulting in a face to face consultation as wellOnly 1 in 20 is resulting in a face to face consultation as well

• The patients like them!The patients like them!

Clearing the BacklogClearing the Backlog

• No replacement for retired partner to be foundNo replacement for retired partner to be found

• Locums difficult to findLocums difficult to find

• Appointments booked on the day only over ChristmasAppointments booked on the day only over Christmas

• Started the New Year with a clean slateStarted the New Year with a clean slate

New Year New StartNew Year New Start

• Mondays booked on the day only (except 1st 1/2 hour)Mondays booked on the day only (except 1st 1/2 hour)

• Follow up appointments kept to the middle of the weekFollow up appointments kept to the middle of the week

• Patients educated to ring the day they want to be seenPatients educated to ring the day they want to be seen

• Patients educated to ring after 10.30am for anything other than an Patients educated to ring after 10.30am for anything other than an appointment appointment

• Roughly 40% appointments can be pre - bookedRoughly 40% appointments can be pre - booked

• Introduced GP led ClinicsIntroduced GP led Clinics

• Extending telephone consultations to other GPsExtending telephone consultations to other GPs

• New appointment slips New appointment slips

• Contingency PlanningContingency Planning

ProblemsProblems

• Selling it to the rest of the PracticeSelling it to the rest of the Practice

• Gaining the patients trust in the new systemGaining the patients trust in the new system

• Clarifying the system to ReceptionClarifying the system to Reception

• Getting Reception to use it!Getting Reception to use it!

• Change is scary - what if it doesn’t work!Change is scary - what if it doesn’t work!

SuccessSuccess

• GP 3rd available GP 3rd available appointment appointment 0.42 days 0.42 days (from (from 14)14)

• Nurse 3rd available Nurse 3rd available appointment appointment 3.13 days 3.13 days (from (from 16)16)

• Happy PatientsHappy Patients

• Happy StaffHappy Staff

• Happier GPs - well you Happier GPs - well you can’t please everyone!can’t please everyone!

• FREE APPOINTMENTS!FREE APPOINTMENTS!

3rd Available Appointment

14

1.273.29

2.070.36 0.42

14

3.9 4.12.24

0.26

3.13

02468

10121416

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GP 3rdAvailableNurse 3rdAvailable

Where NowWhere Now

• Practice nurse starting minor illness training April 03Practice nurse starting minor illness training April 03

• Receptionist training to be Health Care Assistant April 03Receptionist training to be Health Care Assistant April 03

• Out of Hours usage reduced Out of Hours usage reduced

• DNA’s reducedDNA’s reduced

• Practice moved to all 10 minute appointments Practice moved to all 10 minute appointments

• Staff and patient questionnaire to assess impact of work Staff and patient questionnaire to assess impact of work April 03April 03

• Identified need to increase the amount of pre-booking Identified need to increase the amount of pre-booking