Alton St PathfinderWhat is it like to be a patient?

Jo Newton, Patient Accessjo.newton@patient-access.org.uk

My daily work at present - positives

• Receptionists’ view– ‘work with a fantastic team’ (100%)– ‘love the variety of my job’ (100%) – Some patients great

• Doctors’ view– ‘great colleagues’– ‘great staff – we work as a team’

• Nurses– Enjoy the variety– Developing nursing skills

My daily work at present - challenges

• Receptionists’ view– ‘busy stressful with some patients waiting a long time to see Dr’– ‘feels a rushed job…probably has reduced standards of care’– ‘struggling to manage between patients and doctors’– ‘morale dipped over last year’ (2 comments)

• Doctors’ view– ‘ever increasing workload causing stress’– ‘patients increasingly demanding’– ‘patients still come in(with letters) even though we’ve seen them recently’

• Nurses– ‘everyone is working to their limits’– Stress maybe effecting some working relationships

My ideal work• Receptionists’ view

– Better balance of workload to reduce stress– See the right patients and reduce waiting times for patients

• Doctors’ view– ‘increase time available for admin, partner mtgs and training’– Only see patients face to face who need it whilst retaining quality– Less stress

• Nurses– ‘to be able to assist everyone and find an appt asap without any

problems’– ‘have enough available appts without feeling agitated or stressed’

Some potential concerns…

• Will we miss serious illnesses if we don’t see the patient? (GP / receptionist)

• ‘I can’t afford this to take more time’ (GP)• How do we manage our vulnerable patients?

(nurse)• I will the interaction with patients

(receptionists)

GP consultations from data capture. Busy Sunday!

Currently, 91% of consults are f2f, only 8% phone and 1% visit

Acuity: 45% acute, 10% exacerbations and 45% chronic.Usually we find a higher proportion of acute.

Sample size is small at 47, but majority of phone consults are resolved over the phone, up to 80% for chronic conditions.

New/follow up ratio 53-47. Not far from normal, on low side.

Continuity, GPs consider it matters in about half of consults, achieved in 84% of these. Will aim to maximise this number.

Already, GPs consider that many consults could be by phone, especially for chronic routine. We always find this goes up after change!

Reception data capture: Monday high, but also Friday, a surprise?

GP demand pattern through the day: very busy 8-9am, tapering down.But good service throughout.

What do patients want? 30% for GP is no surprise, but very high demand for repeat prescriptions & other admin is unusual. May need to look at this too.

Patients request a named doctor 57% of the time. This is normal and to be encouraged where appropriate. Continuity good for patients and GPs.

How far ahead are patients choosing to book? A wide range, many up to a week in advance. Because they can? After launch, we find 80% plus choose same day. Good, because it avoids need for “just in case” & f2f follow ups.

Outcome of requests for GP: 93% agreed, 4% call back.This is better than most and a good place to start.

Navigator: GP consultations are almost all face to face, and steady at around 650 per week with about 90 by telephone. Total is about 7.1% of list pw.

Wait to see the GP is about 3.5 days average and has risen this year. Wait for a telephone consult 1-2 days.

This is made up of about 30% booked on the day, most of the rest over the next 7 days and a few 2 or 3 weeks ahead.

Bookings are high in the mornings, which is normal, but the steady flow through the day suggests access is not too bad at present.

Continuity, important to both patient and doctor, is stable at about 70% (measured within month) but could be much higher.

A good place to start• Overall access does not appear to be badly choked at present, though

waiting times have edged upwards this year.• At 7.1% for all consults, demand is moderate and the pattern through the

day suggests that patients feel they can book ahead at any time.• This pattern of demand lends itself to rapid response by GPs, which will be

measured from launch onwards.• By telephoning all patients first, significant time can be saved as well as

always offering same day service.• Continuity can be raised by good design and understanding through GPs and

reception. This could make a measurable difference soon. 70% is normal before launch, but could easily be 80-90%

• Larger than expected proportion of consults are chronic-routine. From a phone call, these are least likely to be brought in, especially if continuity is right. Opportunity for large time saving.