N82082 St James access reportWhat is it like to be a patient?Harry Longman, Patient Accessharry.email@example.com
St James population • A high number of young adults, high deprivation • Few children, compared with national average • Usual numbers of elderly • Significant Chinese speaking group
GP consultations data capture • About 80% are face to face, some phone and a few visits
GP consultations data capture • 100% of the 19 phone consults recorded were resolved over the phone. (nurse was 1 out of 4, small sample)
Face to face seen as appropriate 90% of time • Only about 10% as “could have been phone”
85% of demand is acute, and 82% new/f-up • High acute demand reflects young population • Most are about 50-60%
GPs value continuity highly, 75% of consults • This particular week, continuity very good • Sometimes a problem during holidays
Patients too, with 68% requesting a named GP • Small practices are often good for relationship continuity • Allowing patients a choice is good for efficiency too
Reception data capture • Very high proportion is admin/repeat Rx. Usually most is for GP • Possibly some of the “demand” is really admin work?
When and how do patients call? • Busy times at 8 but also later in the day. • Asked to call back more often in the afternoon
When and how do patients call? • Phone is largest, online also very popular, but complicated to manage • 26% are walk-ins. Surprisingly high – difficult to get through on phone?
Requesting a clinician, 30% asked to call again • This is a high rate of rework, reflecting real pressure
When do patients want the doctor? • Vast majority of requests are for same or next day • How does this match up with availability?
Tough on reception desk • Patients saying, why don’t you answer the phone? • Patients complaining they were told to ring back, now they have and there’s still nothing • Language problems, many Chinese speakers but limited capacity • Elderly walking in as it’s hard to get through on the phone. • Patients want to see a regular doctor, not locum • Overall, the picture is looking a bit like this…
Rework The traditional model “All gone. Call back tomorrow” 3 week wait, high DNAs, repeat booking Reception takes call GP sees patient 10 min slot 70% “routine” Problem solved Patient pressure 30% “urgent” See any GP/locum Poor continuity, repeat booking
Conclusions • A traditional mainly face to face appointment system • Some use is made of telephone consulting, and it works in that even a small sample has 100% resolved • Webex being tried – interesting, how will it work? • It is a concern to see so many patients asked to call back • Many patients do book online. Do they have priority, or do they also struggle? • Further evidence and case studies of our work on access and continuity, based on a GP innovation, is at www.patient-access.org.uk • To make a difference, need to think about the system as a whole. It could all feel so different.
System outline – practices adapt to their situation Come and see me Admin question 30% 20% Reception takes call GP phones patient 60% 60% Problem solved 10% 20% Come and see the nurse PA Navigator measures the flows, which vary by GP & practice.