Prospect Road Surgery Advanced Access

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Prospect Road SurgeryAdvanced Access

• HOW YOU COULD GET HERE !!
• Chris Nicholls
• chris.nicholls_at_wakeha.nhs.uk
• 01924 274 123

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Prospect Road Surgery

• Practice Population 7,288
• 3.5 WTE GPs
• 1.75 WTE Nurses
• 5 Receptionists all part time
• GMS Practice
• Large population increase over the last two years
  

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Why Advanced Access?

• GP 3rd Available Appointment 14 days!
• Nurse 3rd Available Appointment 16 days!
• Stress, Stress, Stress
• Unhappy Patients Unhappy Staff
• Senior Partner Retiring (October 2002)
• How would we cope with no extra capacity?
• Advanced Access????

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What Happened Next?

• Presentation by Access Facilitator
• Committed to working with the Collaborative
• Capacity Demand Measuring (two weeks August 2002)

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August 2002

• Total GP Demand 540 appointments per week
  (Follow Ups 15)
• Total Nurse Demand 165 appointments per week
  (Follow Ups 32)
• GP Backlog 1512 Appointments
• Nurse Backlog 462 Appointments
• GP DNAs 64 per month
• Nurse DNAs 55 per month
• Shortfall in GP appointments only 3 per week
• Shortfall was going to jump to 100 per week in
  October

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Practice Wide Data
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Where did we start?

• Plan to clear the backlog when Senior Partner
  replaced
• Changed Monday Working
• Mondays booked on the day only (except 1st hour)
• No follow up appointments on a Monday
• After two weeks extended to Fridays
• GP 3rd available appointment dropped from 14 days
  to 3.9 days
• Nurse 3rd available appointment dropped from 16
  days to 1.2 days

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Gloomy October

• Dr. Brad Retired
• Mid - week wait went back up to 14 days
• Practice became disillusioned
• Had anything changed?
• Ray of Light.
• Dr. Gs Telephone Consultations
• Potential to save 10 appointments per week per GP
  

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Telephone Consultations

• 14, 5 minute appointments per week
• (7 on Mondays, 7 on Fridays)
• Mainly for discussion of labs/ X-ray results/
  hospital letters
• Very clear guidelines for reception about who is
  suitable
• Telephone consultations taking 5 minutes as
  opposed to 10
• Only 1 in 20 is resulting in a face to face
  consultation as well
• The patients like them!

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Clearing the Backlog

• No replacement for retired partner to be found
• Locums difficult to find
• Appointments booked on the day only over
  Christmas
• Started the New Year with a clean slate

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New Year New Start

• Mondays booked on the day only (except 1st 1/2
  hour)
• Follow up appointments kept to the middle of the
  week
• Patients educated to ring the day they want to be
  seen
• Patients educated to ring after 10.30am for
  anything other than an appointment
• Roughly 40 appointments can be pre - booked
• Introduced GP led Clinics
• Extending telephone consultations to other GPs
• New appointment slips
• Contingency Planning

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Problems

• Selling it to the rest of the Practice
• Gaining the patients trust in the new system
• Clarifying the system to Reception
• Getting Reception to use it!
• Change is scary - what if it doesnt work!

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Success

• GP 3rd available appointment 0.42 days (from 14)
• Nurse 3rd available appointment 3.13 days (from
  16)
• Happy Patients
• Happy Staff
• Happier GPs - well you cant please everyone!
• FREE APPOINTMENTS!

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Where Now

• Practice nurse starting minor illness training
  April 03
• Receptionist training to be Health Care Assistant
  April 03
• Out of Hours usage reduced
• DNAs reduced
• Practice moved to all 10 minute appointments
• Staff and patient questionnaire to assess impact
  of work April 03
• Identified need to increase the amount of
  pre-booking

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