Hazeldene Medical Centre in Wembley, London, has four sites and 6.5 whole time equivalent GPs serving a patient population of approximately 14k. The practice participated in the Productive General Practice (PGP) Quick Start programme, to bring all its sites together and work more collaboratively to improve availability of appointments for patients. PGP Quick Start is delivered by NHS England and NHS Improvement and part of the support available through Time for Care.
Understanding patient needs
Patient demand for a face to face appointment with a GP was high across all four sites. GPs were already stretched and unable to take on any more workload. The practice wanted to find ways to improve patient access and design a consistent approach across all sites that would provide a better service for patients.
Over a one-week period the practice collected data to get a better understanding of how effectively appointments were being used. It found the following.
- 6% of GP appointments were judged to have been potentially avoidable.
- Patients were unaware of what services non-GP clinicians could provide e.g. health checks with nurses.
- Reception staff often felt pressured to book a GP appointment if this was what the patient wanted.
- Due to lack of knowledge, some staff did not feel confident directing patients to other more appropriate services.
- Face to face appointments were not always necessary.
- Some staff groups were not being fully utilised e.g. practice pharmacists and Advanced Nurse Practitioners.
The sites worked collaboratively to tackle the issues and develop a common approach for using available appointments.
Managing patient demand differently
The sites looked at a range of different types of patient demand that came into the practice and opportunities to manage them differently. Patients were categorised into whether the appointment was appropriate, and if not, how could the patient be better supported e.g. by another service or through self-care. Teams from the different sites shared with each other and learned about the different services patients could access when a GP appointment was not necessary.
A significant outcome was that staff felt most patients could have been seen via an online consultation. Whilst the practice already had online consultations in place it was not being promoted heavily as most staff lacked knowledge of the online system, eConsult, and the benefits of using it.
One GP, Dr Jahan Mahmoodi, who was using the system extensively, shared his knowledge and experience to help boost staff confidence. Using real-life examples, they worked with staff on the following.
- Guided staff through how to use the system, from when a patient submission is received, to how it is directed to the most appropriate healthcare profession or service.
- Demonstrated the value it delivered for staff and patients e.g. quicker access to appropriate care and scheduling appointments around patient availability.
Taking forward this learning, staff role-played a new approach to booking appointments. This helped build their confidence and knowledge for when they took the new approach into practice and used it for real.
- When patients request a GP appointment, reception staff ascertain whether a GP appointment is necessary or whether another healthcare professional or service is more appropriate.
- If a GP appointment is required, an online consultation is offered first, unless a face to face is necessary.
A new standard approach was agreed and tested before it was fully implemented across all sites.
Being prepared for COVID-19
The work the practice did put it in good stead for when COVID-19 hit. With face to face appointments significantly reduced and social distancing in place, it tweaked its approach further to make online consultations a key feature of its remote offering. This made it easier for staff to adjust to the changes the pandemic created whilst continuing to meet patient needs.
- Over 16 weeks online consultations increased by 100%.
- Inappropriate face to face appointments have reduced by 95%, reducing waste and allowing GPs more time with patients who need their care.
- The practice has one standard approach that efficiently books appointments across sites, ensuring patients are offered the most suitable service.
- Reception and admin staff feel less pressure to schedule a GP appointment if it is not necessary, they now have the knowledge and confidence to direct patients more appropriately.
- COVID-19 requires most patients to seek advice from home; the practice has a system in place to efficiently do this.
- Online appointments provide patients with a quicker service that can be scheduled to fit around them e.g. after work.
“eConsult has enabled us to precisely match all forms of capacity to demand. For example, 40% of eConsults are skin related, so we have now employed daily dermatology specialist capacity.”
Jahan Mahmoodi, GP Principal, Hazeldene Medical Centre
“Our online consultations have increased by 100%. If we had not done the work we did through Time for Care we wouldn’t have been able to adapt as quickly in meeting patient needs when COVID-19 hit.”
Paviniya Vemaleswaran, Administrator, Hazeldene Medical Centre