© Productive Primary Care Ltd Access System Review - Solutions St Martin’s Practice - Leeds...

© Productive Primary Care Ltd

Access System Review - Solutions

St Martin’s Practice - Leeds

Michelle Webster (Associate)Productive Primary Care Ltd

Thursday 6 March 2014

Agenda

Refresher of principles of access improvement

Discussion on what your data reveals and

identification of any problem areas for your

practice, split between

Next steps, etc


Refresher of principles around access improvement


The ABCD ofThe ABCD ofAccess ImprovementAccess Improvement

• AActivity How many appointments did you deliver?

• BBacklog How many appointments are already booked?

• CCapacity How many appointments could you deliver?

• DDemand How many consultations (of any type) are wanted by your patient population?


Appointment

Requests (Demand)

Imagine patient demand as a bathtub!

Backlog

Appointment Supply

(Activity)

Appointment

Requests (Demand)

The Solution:

Today’s WorkBacklo

gAppointme

nt Supply(Activit

y)(Capacity

)

A&E WIC OOH

Increase Capacity

(Short term)

Remove the backlog, match capacity to demand

Match Capacity to Demand; and Activity to Capacity© Productive Primary Care Ltd

+ Unmet Need!

Discussion on what your data reveals and identifying any

problem areas for your practice


ActivityDay

Routine slots + extras seen

Phone Consults

DNAsPatients Actually

Seen

Routine slots + extras seen

Phone Consults

DNAsPatients Actually

Seen

Week 1

Monday 77 84 4 74

Tuesday 56 55 6 49

Wednesday 48 50 1 44

Thursday 70 49 4 61

Friday 66 60 3 65

Week 2

Monday 54 66 1 53

Tuesday 58 73 3 52

Wednesday 58 70 5 51 16 6 1 15

Thursday 55 54 4 47 10 1 10

Friday 44 48 3 44 10 3 10

Week 3

Monday 53 83 2 52 8 5 13

Tuesday 56 66 4 54

Wednesday 53 62 3 45 17 6 17

Thursday 57 59 7 55 10 10

Friday 57 54 7 55 10 3 10

Week 4

Monday 75 99 5 71 13 6 13

Tuesday 45 75 4 41

Wednesday 30 50 3 29 12 6 1 12

Thursday 22 33 1 21

Friday 63 81 6 62 15 5 2 15

Total 1097 1271 76 1025 121 40 5 125

GP Nurse Practitioner

Current Consultationsper month

c 55 % Dr consultations by phoneRelevance to Dr First :

VERY SIGNIFICANT current practice for DOCTORS VERY SIGNIFICANT current practice for PATIENTS

GP Routine slots +

extras seen Phone Consults DNAs Patients Actually Seen

Total 1097 1271 76 1025

DNA’s

DNA Cost76 x £11 / 4 x 52 = c £ 11,000 per annum

GP Routine slots +

extras seen Phone Consults DNAs Patients Actually Seen

Total 1097 1271 76 1025

BacklogFrom:

Day GP Nurse

Practitioner Total

Average number of patients seen

per session14 10

Week 1 220

Monday 27 11 38

Tuesday 48 48

Wednesday 31 16 47

Thursday 24 15 39

Friday 30 18 48Week 2 208

Monday 25 25

Tuesday 33 33

Wednesday 48 14 62

Thursday 33 8 41

Friday 47 47Week 3 81

Monday 5 6 11

Tuesday 6 6

Wednesday 26 7 33

Thursday 9 4 13

Friday 13 5 18Week 4 24

Monday

Tuesday 4 4

Wednesday 6 3 9

Thursday 3 1 4

Friday 6 1 7

Total 424 109 533Additional Sessions

Needed per 31 11

Backlog Sessions

Needed per Week inc Demand

8 3

Demand

Look forward at how many patients are booked in each week from now and enter them into the table below

DemandEstimated v Practice Collected

Weekly Total

am pm am pm am pm am pm am pm

Measured Demand (from demand sheet)Estimated Demand Calculated 610 109 55 71 47 61 41 60 40 77 50

Estimated Demand Highested of estimated and collected Exc unmet needDoctor First 0 610 109 55 71 47 61 41 60 40 77 50

Hybrid Doctor First 0 610 109 55 71 47 61 41 60 40 77 50Telephone Consulting- T2 129 480 88 44 58 39 50 34 44 29 57 37Telephone Consulting- T1 129 480 88 44 58 39 50 34 44 29 57 37

Nurse Triage 131 479 88 44 58 39 50 34 43 29 57 37Standard 133 476 88 44 58 39 50 34 41 28 57 37

Monday Tuesday Wednesday Thursday Friday

ESTIMATED DEMAND

am pm am pm am pm am pm am pm Total

88 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 37 451

88 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 3788 44 58 39 50 34 26 18 57 37

FridayMonday Wednesday ThursdayTuesday

PRACTICE COLLECTED DEMAND

WEEK 1 Chart - Demand/Capacity/Backlog

Summary Chart - Demand/Capacity/Backlog

Sessions

Estimated

Practice Collected

Current am pm am pm am pm am pm am pm am pm am pm

Enter "X" if Surgery Closed x x x x

Weekly Sessions 4.3 3.6 3.0 3.3 3.3 2.3 3.3 3.3 3.3 3.6 0.0 0.0 0.0 0.0

% efficiency compared to GPGPs (Partners) sessions 29 29 3 3 3 3 3 2 3 3 3 3 100%

GP (Salaried) sessions 0 0 100%

GP (Trainee) sessions 0 0 50%

GP (Other) sessions (e.g.locum) 1 1 1 100%

Nurse Practitioner sessions 3 11 1 2 1 1 1 1 1 1 2 30%

33

FridayMonday Tuesday Saturday SundayWednesday ThursdayTotal Sessions

Systems Available Sessions available Sessions Needed am pm am pm am pm am pm am pmDoctor First 33 32 6 3 4 2 3 2 3 2 4 3

Hybrid Doctor First 33 32 6 3 4 2 3 2 3 2 4 3Telephone Consulting- T2 33 28 5 3 3 2 3 2 3 2 3 2Telephone Consulting- T1 33 37 7 3 4 3 4 3 3 2 4 3Nurse Triage (Nurse Time) 3 16 3 1 2 1 2 1 1 1 2 1

Nurse Triage (Dr Time) 30 12 2 1 1 1 1 1 1 1 1 1Standard 33 36 7 3 4 3 4 3 3 2 4 3

Number of sessions needed to fully deal with patientsTuesday Wednesday Thursday FridayMonday

Systems Available Sessions availableDoctor First 33

Hybrid Doctor First 33Telephone Consulting- T2 33Telephone Consulting- T1 33Nurse Triage (Nurse Time) 3

Nurse Triage (Dr Time) 30Standard 33

Sessions Needed29293136101137

am pm am pm am pm am pm am pm6 3 4 2 3 2 2 1 4 26 3 4 2 3 2 2 1 4 26 3 4 3 3 2 2 1 4 37 4 5 3 4 3 2 1 5 32 1 1 1 1 1 1 0 1 12 1 1 1 1 1 1 0 1 17 4 5 3 4 3 2 1 5 3

FridayMonday Tuesday Thursday

Number of sessions needed to deal with PRACTICE COLLECTED DEMAND

Wednesday

Discussion ItemsIncluding :

Similarities between Estimated & Practice Collected!When looking at different systems always consider relative ‘Unmet Need’ HOTSPOTS : MONDAY a.m. TUESDAY a.m. FRIDAY a.m.How does it feel in reality ? Chaotic? Pressured?

Discussion Items – Which system?

Including :

Overall Standard system requires more sessions than any other – and with most Unmet Need

Doctor First requires fewer sessions – whilst minimising Unmet Need

If Backlog worked down and Doctor First adopted, then spare capacity can be used for other clinical/non- clinical work and to ease the pressure at annual leave time

What influences the choice to introduce Doctor First?

Understanding of the options available Practice makeup Team members attitude to change (particularly doctors) Result of ABCD assessment

ActivityBacklogCapacityDemand

Patients

Doctor First Patient pathwayPatient contacts

surgery phone/walk-in/on line

Receptionist asks for patient name, DOB, a brief description of problem and enters it onto clinicians call back list. If identified as

other query, put on appropriate clinician for routine care.

Dr books appt Dr talks to patientAppt needed

Appt not wanted Patient’s issues

resolved

Increasing Appointment CapacityStandard system • 18 patients x 10 min = 3 hours

Doctor First system• 3 people can be consulted by phone in 10 min• 18/3 x 10 min = 1 hour• 1/3 will want to see Dr = 6• 6 patients x 10 min = 1 hour

Outcome• What took 3 hours now takes 2, or;• In 3 hours 27 people can be helped rather than 18 (a 50%

increase in productivity)

The time saving bit…

The increased efficiency bit…

Contact Details

[email protected]: 0800 6990184 (Office)Mobile: 0779 524 8771

Twitter: @ProdPrimCareWebsite: www.productiveprimarycare.co.uk Longfields Court, G07Middlewoods WayWharncliffe Business Park,Carlton,BarnsleyS71 3GN

http://www.productiveprimarycare.co.uk/

© Productive Primary Care Ltd Access System Review - Solutions St Martin’s Practice - Leeds...

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