The idea

Redesign the repeat prescription and medication review processes to help release unnecessary GP and reception time, and provide a better service for patients.

Over 50 hours a week being utilised

The practice formed a focus group made up of a GP Partner, the practice’s clinical pharmacist and office manager, to drive forward the project.  The group began by gathering feedback from the GPs and reception about where they felt time was being wasted in the current processes.  From here they process mapped the different steps it took for the practice to deal with medication requests and reviews, involving the whole practice team for their input.  The visual presentation of the process map helped the team identify where the problem areas lay.

• The practice received from 200 to 300 repeat prescription requests per day which came in through multiple channels including email, online, hard copy and in person. This was time consuming for reception to monitor.
• Duplicate requests were being made where both the community pharmacist and the patient would make a request for medication.
• A culture had developed where same day requests were accepted and turned around within 24 hours. Most were not urgent but due to the patient not having submitted the request in good time.
• Some medication reviews conducted by phone should have been face to face, in order to conduct investigations, discuss bloods and what tests the patient may need.
• Medication reviews were managed reactively and booked when a patient had run out of their allocated repeat prescriptions, but before the relevant checks had been undertaken. This led to important data such as recent blood pressures being unavailable at the review.  A new appointment would have to be scheduled for when the data was available.

Over one week an audit was carried out to measure how much of the team’s time was being taken up.

• GPs were collectively spending 6 hours per week on calls for medication reviews. An analysis of a sample of 78 calls found that 58 would have been more appropriate as a face to face appointment as they required further investigation.
• GPs were spending 5 hours per week on medication review queries received from the hospital.
• The practice’s nurses were spending 20 hours per week on long term conditions reviews where they were unable to issue the relevant prescription because it had to go to either a GP or prescriber.
• Reception staff were spending 10.5 hours per week calling patients about medication queries, plus a further 9 hours chasing up additional checks.

The current processes were utilising a staggering 50 hours per week of the practice team’s time.

Making processes work better for staff and patients

Understanding the time wasted and issues with the current processes helped get all staff on board to support the changes the group put forward to make the way the practice worked better.  All the staff engaged in understanding the problems with the current processes and proposing solutions. This created buy-in to a range of improvements.

• Turnaround for a prescription is now 48 hours if the patient comes into the practice to collect it, and 4 days if it goes through the Electronic Prescription Service Tracker. Same day requests are only accepted if the practice itself has made an error or it is clinically urgent.
• Patients are encouraged to submit their requests online and email requests are no longer accepted.
• There is now a two-month window for medication reviews which are now scheduled close to the patient’s birthday, and channelled through the clinical pharmacist for management. The time allows for reminders to be sent to the patient and all checks undertaken ahead of the review.
• A new one-stop shop for long term condition appointments has been introduced where patients also see the clinical pharmacist during the same visit to the practice. This avoids the need for an additional appointment.
• After receiving training, admin staff now go through all letters and discharge summaries from the hospital, so GPs no longer need to. Any medication related queries are forwarded to the clinical pharmacist.

Patients were kept informed of the changes through information in the patient newsletter, practice TV screen, website, patient survey and social media. Staff also shared the changes verbally when there was an opportunity to speak to patients.

The changes were reviewed with the rest of the team at partnership meetings and wider team meeting with adjustments made where required.

Impact

• Over 28 hours per month of GP time have been released, equating to 168 GP appointments a month. This has allowed GPs to do more 15 minute appointments focussing on patients with complex needs, long term conditions and mental health issues.
• 72 long term condition appointments have been released a month equating to 12 hours per month due to the one-stop shop appointment where patients also see the clinical pharmacist during the same visit.
• 42 hours a month of the reception team’s time has been released. This is due to the increased efficiency of processes and the proportion of online appointments increasing from 15% to 30%.  The time released has improved patient access and allowed time for back office administrations to be completed far more efficiently and safely.
• Patients have benefitted hugely from the changes. They appreciate seeing the clinical pharmacist to discuss their medications and review what they no longer need.  Better availability of appointments has also reduced frustrations and made the patient experience better.
• By attending group based learning sessions with other practices in their Primary Care Network, the practice has already started to build relationships with their network colleagues that will continue to develop as their network grows.

“We have had the opportunity to look at our processes and identify areas which could be made more efficient. The PGP Quick Start programme has given us a opportunity to create that headspace to look critically at the way we do things in the practice“.”Dennis Chan, GP, Trent Meadows Medical Practice

“A 360 review allowed us to be fresh and creative in developing the new system. Since implementation, the feedback from the patients has been fantastic.“.”Asir Ayaz, Clinical Pharmacist, Trent Meadows Medical Practice

“As a practice we feel more in control, things feel much better and our processes are working better for our staff and patients. PGP Quick start was very beneficial as it allowed us time to focus on the mapping and planning of processes to achieve these efficiencies“.”Angela Drozd, Office Manager, Trent Meadows Medical Practice

If you would like to find out more about how you can access the Productive General Practice Quick Start programme, visit our ‘Releasing time for care’ web page.