Matching supply & demand and setting practice standards

David Carson

Reviewing Urgent Care in General Practice

Primary Care Foundation

Matching Supply & Demand

Phone Book Ahead Same Day Options

Primary Care Foundation

Phone

Will patients get through?

Using data to benchmark existing service

Primary Care Foundation

What works

Measure your demand Dedicate enough staff Have enough lines

Primary Care Foundation

What seems to be less effective

Multitasking Not enough lines example Managing demand by restricting access

Primary Care Foundation

Question

What should practices do next? Are you able to get the data and analyse it? Can PCTs support? Should PCTs support?

Primary Care Foundation

Book Ahead

What did we say

About 2/3 total capacity book ahead No set time but between 8 and 12 weeks seems reasonable Relieves pressure on same day system
Reduce morning peak Spreads demand

Primary Care Foundation

What are the implications

More DNA? Patients will not use it Does the practice have enough overall capacity What is the nurses role?

Primary Care Foundation

Same Day

What did we say

1/3 total capacity same day Bias towards earlier in the day Not only an appointment
Phone Appointment Walk in Other

Primary Care Foundation

Questions

Will more capacity create more demand? Making it too easy stimulates demand? How do we work out what we need?

How much is created by doctors and nurses?

Primary Care Foundation

Setting Standards

What did we say

Local standards Clinically safe Appropriate for condition Excessive waits should be avoided Consistency within and across practices

Primary Care Foundation

Questions

Standards for reception staff

Phone Identification of urgent cases Training

Practice standards
Response time Phone Clinical input time (Home visits) Waiting time (1/2 Hour for walk ins) What about locally agreed standards in PBC group?

Primary Care Foundation

Discussion

Action Points for Practices 1 & 2

Recommendation 1 - Access Ensure patients with urgent conditions will receive timely care however they access the service. Many practices aim to achieve this but a small number have tried to channel patients so rigidly into one process that barriers are created increasing the risk that urgent needs may be missed. Recommendation 2 Matching capacity to demand Ensure processes minimise avoidable peaks in demand. Practices should assess the pattern of phone demand and make sure that sufficient staff and lines are available so that patients do not find it difficult to contact the practice.

Primary Care Foundation

Action Points for Practices 3 & 4

Recommendation 3 Reviewing capacity Make sufficient appointments available to meet demand from patients. Practices should review the number of appointments available each week (across all skill groups and including telephone consultations) to ensure that they meet the needs of their patient population. Capacity should be sufficient to meet the predictable demand without resorting to unplanned extra appointments. Recommendation 4 Capacity for same-day and advance appointments The balance of book ahead to same-day appointments (including other options such as telephone consultation or other responses) should be matched to the pattern of demand. We found two-thirds advance to one-third same-day appointments appears to be the right mix for the normal demand facing many practices as this reflects the character of General Practice workload in studies and surveys.
Primary Care Foundation

Action Points for Practices 5 & 6

Recommendation 5 - Responding to urgent cases Review how the practice would identify and respond to a range of urgent cases. Look both at symptoms that might indicate urgency and consider particular groups of patients that may need to be handled differently. Recommendation 6 - Training Review receptionist training to ensure these front-line teams understand and use the right process to identify and handle urgent calls. Where required, practices should run refresher sessions involving both clinical and non-clinical staff.

Primary Care Foundation

Action Points for Practices 7 & 8

Recommendation 7 Deadline for assessment Define your own practice standard for the length of time from the patient first ringing to assessment by a clinician (telephone or face-toface). Practices should monitor performance against their standard and review this measure. Recommendation 8 Deadline for intervention Define your own practice standard for the length of time until appropriate clinical intervention or hand-off takes place where a clinician has assessed the case as urgent. Practices should monitor performance against their standard and review this measure.

Primary Care Foundation

Action Points for Practices 9 & 10

Recommendation 9 Quality Carry out regular audits of the process for urgent care to review the quality and consistency of telephone response, consultations and decision-making. Consider making use of approaches such as those of the Royal College of GPs practice accreditation scheme. Recommendation 10 Home visits Any patient or carer requesting an urgent home visit should be offered a rapid assessment by a clinician. Normally this will be by phone but in some cases the clinician, knowing the patients condition may choose to plan an early visit.

Primary Care Foundation

For more information

Visit our website: www.primarycarefoundation.co.uk Or contact us: David Carson 07703 025775 david.carson@primarycarefoundation.co.uk Henry Clay 07775 696360 henry.clay@primarycarefoundation.co.uk Rick Stern 07709 746771 rick.stern@primarycarefoundation.co.uk
Primary Care Foundation