“Patient First”
at Ravenswood 2013
We are a large, modern, urban practice with
15,500 patients
8.5 full time equivalent doctors
2 experienced nurse practitioners
The Need for Change

Not meeting demand

Dissatisfied patients – can’t get appointments

Harassed staff – can’t give appointments

Stressed doctors – no continuity

Inefficient system – right people not being seen at the
right time by the right person
The Aim of Improved Access
Improved patient care - Patients seen:
when they want
by whom they want
for the time they need
the most ill people helped
first
• sufficient appointments for all
those who want them
• access GP knowledge
wherever you are –
home/work/away?
•
•
•
•
Patient First Principles

Target capacity to meet demand

Use your most experienced people first



On average, 1 in 3 telephone calls will result in a surgery
appointment
The divide between urgent and routine is a source of
great tension and argument – why try?
Do today’s work today – it does not go away and, in fact,
often increases if not dealt with
Demand – a few facts

More predictable than we may think

50% more calls on a Monday




2/3 come in the morning and 1/3 in the afternoon – 50%
by 10.30 am
Conversion rate higher in the morning than the afternoon
– overall average is 1 in 3
Sickest patients call earlier in the day
80 % of patients given a free choice would prefer to be
seen today
Patient First System – how it works





Patient phones the surgery and requests to speak with a
doctor or nurse
Receptionist will say “yes” and ask for patient’s name, a
brief reason for the call and preferred contact number
Patient will be called back or put straight through to
clinician
If patient is added to the clinician’s list, they will be
prioritised based on clinical need
Majority of calls for acute care and follow-up are handled
this way
Patient Pathway
Patient contacts
surgery
Receptionist asks for a brief
description of problem and enters
it onto clinician’s call back list. If
identified as other query, put on
appropriate clinician for routine
care.
Doctor books
appointment
Appointment
needed
Doctor talks to
patient
Appointment
not wanted
Patient’s issues
resolved
The Numbers
Sept 2012 Total – 5729
2013
March
June
July
Doctors
Daily average
Telephone
4898
4914
5288
34
Face-to-Face – 3512
Telephone – 2217
DNA – 146
Face-to-Face Conversion
2676
54%
2511
51%
2846
53%
14
41%
A busy day is anything over 40 calls
We rarely have days on which one doctor will take more than 50 calls
Negatives

Volume of work less predictable

Patients learning the system

A minority don’t like it

Some find flexibility stressful

Care with session numbers

Full screen feels busier

Busiest session 45 contacts
Positives


Busiest session usually 45 calls
Significantly improved access on the day and all offered a
suitable appointment after discussion with the doctor

Improved continuity of care

DNAs almost non-existent

More control over structure of the day

Extreme flexibility to cover sickness or other unexpected
absence

More efficient use of clinician’s time

Running to time and less congestion in the waiting room

Improved customer service in reception