Case study summary
Barlow Medical Centre in South Manchester has 12 whole time equivalent GPs and 3.8 whole time equivalent nurses, serving a patient population of over 14,000.
The practice’s appointments system is set up to provide both ‘on the day’ and bookable appointments. To speak to a clinician (GP or nurse), or get an ‘on the day’ appointment, telephone triage is used. A large number of calls were being requested per day which was putting pressure on clinicians’ time. To find a way to ease the pressure the practice participated in the Productive General Practice (PGP) Quick Start programme delivered by NHS England’s Sustainable Improvement team. The programme is part of the support available through the General Practice Forward View.
Use the Efficient Process module of PGP Quick Start to redesign the same day appointments system using the data already gathered by the practice that shows there are inefficiencies in this service.
A system that creates pressure
The practice has a large number of requests for calls and appointments ‘on the day’. This is partly due to an increasing demand which cannot be filled by routine bookable appointments. As a result patients were using the ‘on the day’ service telephone triage system run by clinicians.
To understand where the issues lay in the current system the practice team used the process mapping tool. Using this they mapped the current process for booking an appointment, starting from when the patient first made a call to the surgery. Several contributory factors were identified as to why so many requests for appointments were put on the list for a call back ‘on the day’.
- Signposting by the reception team was limited as the team did not have the training to do this more effectively.
- Effort was being duplicated. Many patients were receiving a call back when there was no doubt their complaint needed to be seen that day, booking them directly into an appointment would have saved valuable time.
- The practice’s pharmacy team was not being utilised for requests relating to medications.
Before commencing the programme, the team carried out an appointments audit that recorded how many hours per week clinicians spent making calls, the number of call-backs made and conversion rate to ‘on the day’ and future appointments.
Data showed that nurses were spending over 25 hours per week making approximately 100 triage call back to patients, of which 62% were subsequently converted to ‘on the day’ appointments.
Redesigning a system that leads to efficiencies
Recognising where the issues lay and the amount of time nurses were spending with the existing system, the team redesigned processes as follows.
- The nursing staff would be removed from the telephone triage system and just have appointments which could be booked into directly by the reception staff, providing they fitted a pre-arranged criteria.
- All members of the reception team would receive signposting training.
- Information of how to access appointments and brief signposting would be communicated to patients via the website, answerphone message and on-site message boards. Patients would also be encouraged to book appointments in advance via the website.
Using the Plan, Do, Study, Act cycle, which provides a structured approach to improvement, the team tested the changes. Plans are in place to review and re-audit the system after 3 and 12 months.
- The practice has released over 3 days of clinical nurse time a week (25.5 hours). This equates to 18% of clinical nurse time, an average of over 6.5 hours per week per whole time equivalent.
- Some of the time released has created approximately 63 extra 15 minute bookable nurse appointments a week. This reduces the number of call-backs per day by an average of 15.
- Patients have easier access to appointments now enabling them to get access to clinical help quicker.
Undertaking PGP Quick Start has definitely helped to identify where and what is causing the issues. The actions will help in the restructure of the appointments system leading to a better experience for patients and less pressure on clinicians.
Dr Bradshaw, Barlow Medical Centre.
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.