How new ways of working in primary care are boosting patient experiences in York
Case study summary
Dr Abbie Brooks, GP with Park View Surgery, York, part of the Priory Medical Group, explains how online patient triage and a range of consultation options are providing a better experience for patients and staff across the group.
The Priory Medical Group serves nearly 60,000 patients across nine surgery sites in the city of York and has seen increasing demand for services over several years. Patients said they were increasingly struggling to get through for ‘8am calls’ to book appointments or that they had given up calling at that time. Reception teams at each of the nine sites were also handling bookings differently, with poor differentiation between urgent and routine care.
Dr Brooks said: “We knew we had to improve our internal systems and consultation options to manage our workflow and improve overall access to appointments.
We wanted to ensure consistency, so that whether patients contacted us by phone, online or in-person, they were able to see the right person at the right time, for either urgent or routine needs”.
Recognising the impact of COVID-19
The practice was almost a year into a project looking at its access data, patient feedback and potential workflow solutions when the pandemic hit.
Based on government guidance, the work then accelerated and the practice moved to online triage, with options for consultations including face-to-face, phone and video calls as clinically appropriate. By spending time developing internal pathways, both efficiency and the flow of the clinical workload were improved.
How the new system works
The group chose the Klinik workflow system to facilitate online triage (known as PrioryCARE). It uses an online form which patients can complete at any time. Those who don’t want to or can’t complete the form can telephone the central call handling team – staffed by a team of call handlers, care navigators and care-coordinators – or pop in to see the reception team at any of the group’s surgeries. Staff at each surgery are experienced in taking the appropriate clinical information and completing the form on behalf of patients.
Clinicians log in to see their allocated requests, which are flagged as urgent or routine, depending on the information given. It errs on the side of caution when it comes to flagging urgent requests and clinicians add their knowledge to the decision-making process.
“The system allows us to identify the most appropriate clinician for each patient who contacts us,” added Dr Brooks.
“We have MSK practitioners, mental health practitioners, physician associates, pharmacists and much more. As a result of analysing the data, we have now expanded our physio team from two to three, supported by the evidence of need.”
The practice has also been able to identify that 65% of all MSK contacts are deemed urgent and 20% are requests for follow up and this has allowed them to alter the ratios/types of appointments offered in line with demand.
Dr Brooks explained that analysing data trends in this way has positively impacted how the practice plan for capacity and demand management.
She continued: “Currently, a larger cohort (than expected initially) of our routine work is following up on ongoing medical conditions. Using the online triage system, we have been able to allocate dedicated follow up slots, which has been a game changer.”
The practice can also view how long urgent waits time are before then communicating this updated information to patients.
Dr Brooks added: “A month ago our routine wait was 5 working days and we are now at 7-14 days due to clinician absences. The data has really helped us have oversight of this and explain the reasons to patients on our social media pages and website”.
Benefits for patients
Patients now only have to attend one of the group’s surgeries for a face-to-face appointment when needed. Reviews for ongoing care are provided remotely when clinically appropriate.
Appointment booking is also more flexible: staff are no longer tied to offering 10-minute slots. Dr Brooks explained: “It means clinicians can put more time aside for those who really need it, for example frail patients who may need extra checks. We can also offer more options to people who remain reluctant to attend the practice due to COVID-19 or those who find it difficult to attend, for example due to zero hours contracts or varying work patterns.
“Putting all requests through a single system has improved safety, continuity and waits for routine care. While some people can be more wary about using the website forms, we offer them support and patients can still call us as usual. We also have a direct dial for end-of-life care and people with learning disabilities.”
A staff survey showed that 92% think that the PrioryCARE system is better than the old access model. Comments included: “Appointments, follow ups, nurses appointments are all available within much better timescales. Even the waiting lists work in a much more manageable manner”; “Good team support, dynamic approach, flexibility in how much time is given to cases in more appropriate manner”.
Using what we know to move forwards
Dr Brooks added: “The data tells us how many and what type of requests we receive, and any patterns. This allows us to map demand and capacity. We are now dealing with at least a third more contacts than pre-pandemic, so we know we’re more efficient, and patient satisfaction has improved along with the staff experience.
“In September 2021 we had on average 440 requests a day for ‘GP appointments’ with around 70% designated as urgent. We offer around 300 urgent slots per day (up to around 400 on Mondays) and we complete all these contacts on the same day using our range of options.
“We will be completing a patient satisfaction survey throughout November/December 2021 to see what the data tells us about how we can make even more positive changes moving forwards”,
Visit the Priory Medical Group website for more information.