The idea

Reduce workload pressures on GPs and staff by redesigning current systems to make them more efficient and effective.

A shared purpose

To engage and get the support of staff, the GP brought the whole practice team together to discuss a shared purpose for the project.  Staff contributed their views and suggestions as to what this should be and collectively agreed on the following shared purpose:

Review our current systems to ensure that we safely meet demand for care, whilst ensuring care is effectively delivered by a strong and resilient workforce.

To achieve the shared purpose the team developed an aim statement to work towards which was to, Reduce routine GP appointment waiting times by 30% over 18 months.

Understanding what the problem areas are

Whist the team had views on where they felt the problems lay there was no strong evidence to support a single solution.  The GP, therefore, conducted a series of surveys with the team that provided a number of key findings.

• The average waiting time for a routine GP appointment was 19 days, creating greater demand for urgent appointments (as patients’ conditions worsened during the time they had to wait for their routine appointment to come round). Reception also received high levels of patient complaints due to the long waiting time.  As a result the average stress levels for reception and the duty team were 3.5/5 (5 being the top score).
• Only 3% of all appointments were by telephone however, feedback from the whole team suggested this could be higher as some appointments they were dealing with did not require face to face. As telephone appointments are shorter than face to face they would, therefore, be more efficient.
• GPs were collectively spending up to eight hours per week on medication tasks, most of these could have been dealt with by a clinical pharmacist.
• 30% of GP interruptions were inappropriate or could have waited, a further 40% of interruptions could have been dealt with by a more junior member of the clinical team.

Having a clearer understanding of what the problems were and their impact, helped the practice prioritise which areas they needed to focus on.

Working as a team to make changes

Different members of the practice team took the lead in making changes to their areas of work.  The lead GP supported and worked alongside them throughout the project, helping them to drive forward actions and test the changes which led to the following.

• A new nurse practitioner was recruited, increasing the size of the duty team and the number of nurse appointments available.
• Patients are now offered a telephone appointment first rather than face to face. For every one face to face appointment a GP can deal with two patient calls, freeing up capacity to deal with more patients.
• A clinical pharmacist has been appointed to deal with all medication tasks, which has helped free up some of the GPs’ time.
• An interruption protocol has been created setting out when it is necessary or not to interrupt a GP. Interruptions that can wait are dealt with in a new duty team huddle at 11:30am daily.
• The reception team received training on signposting with in-house workshops and external trainers, and are actively directing patients to other clinicians or services when a GP appointment is not necessary.

Impact

• The average waiting time for a routine GP appointment has reduced from 19 days to 10 days, an improvement of 47% which has surpassed the team’s aim set at the start of the project. The practice is continuing to make improvements so hoping this waiting time will reduce further.  For patients this means quicker access to a routine appointment.
• As patients are able to see or speak to a GP sooner the demand for urgent care appointments has reduced, meaning the urgent appointments have fallen from 48% of the total, to 37%.
• There has been a 12% increase in telephone appointments which has reduced the number of patients seeing a GP face to face by 8%.
• The new clinical pharmacist has helped release six hours of GP time per week across the practice. This represents a 90% drop in medication tasks that were previously sent to GPs and are now dealt with by the pharmacist.
• Interruptions to GPs have reduced by 30%, helping GPs finish duty earlier and safer. This is due to GPs feeling less stressed as they are able to focus on their work without constant interruption.
• Better signposting and patient awareness has led to a 20% increase for nurse appointments, which are picked up by the increased capacity made available through the new nurse practitioner recruited.
• A self assessment of nurses, nurse practitioners and GPs on duty; before and after the changes (which covered a number of different factors including how well supported they felt and how safe they felt clinically), showed there has been a 15% improvement in stress levels across on-call staff.
• Unnecessary interruptions to GPs and general staff have fell by 60%.

The programme has had a great impact on me, the practice, my role in the CCG and federation.  It’s energised my enthusiasm in a time of great pressure and given me something to enjoy.  There’s been lots of benefits for my practice and patients, and I am really proud of the changes we’ve made.

Helena Ebbs, GP, Pickering Medical Practice

If you would like to find out more about participating in the General Practice Improvement Leaders programme, along with details on how to apply, visit our web page.