Case study summary
The Leith Hill Practice in Surrey is made up of 4 whole time equivalent GPs serving a patient population of 8,000. Working over 2 sites the practice’s dispensary and reception/admin teams were overloaded with a high demand for dispensing medication, and participated in the Productive General Practice Quick Start programme to look at ways it could reduce this workload. The programme is delivered by NHS England and NHS Improvement and part of the Time for Care support available through the General Practice Forward View.
Develop new, and update existing Standard Operating Procedures (SOPs) and protocols, to create a more efficient dispensary process that will release staff time.
Tasks that are missed
Being a dispensing practice that offers to supply medication directly to patients living more than a mile from a chemist, creates a large workload for the dispensary and admin/reception teams. Concerned that at times tasks were missed due to the high volume of work, both teams listed all the tasks involved and identified those essential steps that were frequently not completed.
- 35% of dispensary tasks were missed e.g. jobs relating to controlled drugs
- 39% of admin/reception jobs were missed e.g. booking appointments for patients that need a medication review.
Working together as a team they discussed the reasons why this was happening.
- Some of the SOPs were not easy to follow. For experienced team members who knew their way around the system SOPs were less of an issue but for new or inexperienced team members, certain steps were missing or the wording was difficult to understand, therefore they were unable to progress any further.
- There were some gaps in staff skills. Despite believing that training had been undertaken a skills matrix completed by all staff identified areas where team members were lacking in training. This in turn led to a high level of interruptions on other staff members (where skill levels were low so too was confidence, making staff less willing to do a task without first checking with a more experienced colleague).
- The heavy workload meant the team were in reactive mode and unable to plan their approach.
Understanding the issues gave the team focus on what changes needed to be made.
Quick changes leading to significant impact
The skills matrix highlighted a need to develop new, and update existing SOPs and protocols for the matching of medicines owed. The teams felt they could make quick changes to this process that would require little effort, but lead to significant impact in improving the patient journey.
The dispensary team mapped out the current process and asked admin/reception to objectively query every step to identify waste and value/non-value adding work. Both teams agreed 5 of the 11 steps in the process were unnecessary and should be eliminated e.g. the process of “scanning the drugs barcode” onto the system upon delivery was being repeated when the team was scanning drugs for a patient order making the drugs complete a circle twice. This was eliminated and the team agreed to add the barcodes at the same time as scanning medication for a patient. Only one further corrective process step was required if things went wrong, which is to add a date to each ordered item with a deadline of 5 days. The whole dispensary team was involved in the decision, training and review of the SOP.
A new process was designed and tested, alongside which a number of other changes were made.
- There is a basket for “controlled drugs” to ensure they are dealt with immediately.
- Where there are multiple items on a prescription script but not all available for dispensing, the prescription is made up as far as it can be and marked with “owing” status. It is then set aside for completion once the out of stock items become available.
- To ensure that items owing are re-ordered in a timely manner, “temporarily out of stock” items are now re-ordered daily and levels regularly monitored.
- There is a box for “temporarily out of stock” (TOS) owings in which items are date stamped (to track traceability and audit), ensuring that the patient is called if the item(s) are still out of stock after 5 days. After this time the patient has several options. They can either continue waiting for dispensary to get the medicine, ask the GP to offer an alternative or get the prescription signed so they can take it to another pharmacy.
Following testing the teams reported back positively on the new process and changes made. As a result existing SOPs and protocols were rewritten to reflect the changes and a new SOP written for matching owings. This was shared and training took place with all team members and agreed as the new way of working.
- Approximately 11 hours per day of the dispensary and admin/reception teams’ time across both sites has been released, equating to 55 hours per week.
- The time released is being used to improve the overall service provided at the dispensary. This includes more time for face-to-face contact with patients, medicines reviews, staff training, supervision and ensuring SOPs are up to date and relevant. For the admin/reception team they are now more able to work on patient and practice operational improvements including staff training, patient education and signposting.
- Patients feel reassured, supported and better informed. They benefit from an improved system that reduces their need to go to the practice and receive their medication quicker.
- Collaboration between dispensary and admin/reception has been hugely successful. It has demonstrated that teams from different areas of the practice can work together to successfully deliver improvements that impact patients, staff and the practice as a whole.
- Group based learning sessions offered the practice an opportunity to network with other colleagues within their Primary Care Network. These relationships are being nurtured and developed as close working within the network grows.
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.
“We all knew we had to change but just didn’t know where to start. PGP Quick Start helped us put in place the appropriate tools we needed to evaluate how we work and what we need to do. I now have very enthusiastic staff who are keen to take responsibility to improve how we can work better and more efficiently.” Jackie Crichton, Practice Manager, The Leith Hill Practice
“There are so many improvements we can make within dispensary by simply going through the process map again.” Teresa Trower, Dispensary Manager, The Leith Hill Practice
“Staff morale has improved and I can see and feel the enthusiasm.” Dr Bower, GP , The Leith Hill Practice