Case study summary
North Brink Practice in Cambridgeshire has five GPs all of who are whole time equivalents, serving a patient population of over 19,000. When a three day backlog of tasks had built up in its Patient Services Team it was having an impact on GP and staff time, as well as morale. To find a solution to reducing the backlog 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 Processes module to reduce the volume, and improve the turnaround time, of tasks going through SystmOne.
Understanding how a three day backlog of admin tasks occurred
A working group was formed of representatives across the practice including Patient Services Team Members, the patient services manager and practice manager. They began the work by brainstorming what they thought the root causes were of the three day backlog of admin tasks, specifically Patient Contact tasks going through the Patient Services Team via SystmOne.
The top three tasks taking up most of GP and staff time were prioritised; contacting patients, urgent prescriptions and hospital admin. The group created process maps to identify what the areas for improvement were, with a view to developing an improved future state. All staff in the practice were encouraged to contribute their ideas and thoughts and have a voice in where they felt the problems lay.
- The volume of daily admin tasks was large, on average 120 tasks were going through the system per day.
- A number of tasks were being returned to GPs because information was missing e.g. a task to check if a patient had been seen by a hospital did not always include the name of the hospital to contact.
- Turnaround times for completing tasks was made longer with the use of acronyms that caused confusion e.g. HR could mean Human Resources or heart rate. Delays also occurred when staff were unsure of where to send tasks and forwarded them to a centralised group for redirecting.
- Multiple handoffs were occurring in the urgent prescription process where the requests were going through a number of different people before even being issued. This was wasting up to three hours of admin staff time per week.
- There was huge duplication through multiple tasks for patients and waste in the patient contact process, because the team were calling patients up to three times to clarify queries or book in for appointments, in some cases patient contact details were out of date. This wasted up to two hours a day of the Practice Services Team’s time.
Tackling the issues
A better understanding of what the issues were led the team to redesign the priority processes so they resulted in less queries and handovers, saved time and were easier to follow. This required the practice team to commit to making a number of changes.
- GPs will provide more detail and clearer information on tasks. Acronyms would no longer be used unless common.
- Staff will be educated on where tasks should be directed to avoid sending them to the centralised team for redirection. This will be done through training sessions and discussions with different teams.
- Unless a patient is vulnerable the Patient Services Team would no longer chase hospitals on their behalf. Patients will be advised to contact the hospital themselves and be informed of expected waiting times for a response.
- Patient services will only attempt to call a patient once regarding queries, if this fails they will send out a letter requesting the information. Clinicians will work with the team to draw up the standard letters that should be used. Urgent queries would be left open; however a quicker process would also be implemented.
- A protocol will be set up to review patient contact details, if these are not reviewed in the last month a pop-up reminder will appear on screens when the patient next contacts the practice, so their latest contact details can be captured.
The working group put in place an action plan to roll out the new processes. Progress and feedback from staff would be discussed at monthly group meetings.
- The three day backlog has now cleared with tasks completed on the day unless action requires more time.
- Improvements in the way staff contact patients regarding queries, hospitals and looking at the process of repeat prescriptions and urgent prescriptions, have released approximately 70 hours a week*.
- There has been a 65% reduction in tasks with an average of 200 per day in Patient Contact now down to 70. As a result morale has improved for GPs and staff, who now feel less pressure and able to deal with tasks quicker.
- One hour a day of an experienced member of admin staff has been released per week as they no longer need to spend as long to check, redirect and manage outstanding tasks.
- Patients are receiving a better experience of care with a quicker and more efficient service.
* Time based on approximately 70 hours per week collectively released for 1.9 whole time equivalent members of the Patient Services Team.
- Get enough staff and the right staff to the sessions to make it beneficial, including staff who could have a positive impact and champion the work.
- Be open minded, do not find fault and someone to blame for the problems – look at it as bettering the way you work.
The programme has opened the door for continued dialogue for continuous improvement within the practice, we now have regular meetings with GPs to discuss ongoing improvement. We can’t see any reason why you wouldn’t want to do Productive General Practice Quick Start.
Jen Boughen, Dispensary and Pharmacy Business Manager, North Brink Practice.
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.