GP Provider Support Unit, Birmingham and Solihull

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Right Access First Time

Right Access First Time

Right Access First Time is a peer-led improvement programme in Birmingham and Solihull general practice. 

The aim is to help practices implement practical changes to improve access and manage workload.

The programme is based on principles established in April 2023 by all of the PCN CDs and managers in BSol:

  • access is at the heart of good care for patients and a better working life for GPs and practices
  • improving access will take action across the whole system – the ICB is stepping up work to increase capacity and reduce inappropriate demand on general practice … and there are some actions which only practices themselves can take
  • we want to make changes that connect patients with the right person at the right time in the right place for the right care – and do it first time, without patients being ‘bounced’ between members of the practice team or having to call back repeatedly
  • we will bring together different streams of funding for improving access, to make a coherent programme of clinically led improvement at practice level
  • we ask the new Provider Support Unit to take a joined-up approach to supporting practical changes that will help patients and practices 

The RAFT programme has been established to support locality collaboratives of practices as they plan and implement change. It is particularly focused on a menu of ‘Access Actions‘. These are practical changes proposed by BSol primary care leaders themselves:

  1. Website signposting.  Ensure the practice website has simple information about the best ways to access care, along with functions supporting self-directed care and online services.
  2. Electronic repeat dispensing. Maximise the use of Electronic Repeat Dispensing (eRD) to reduce the need for patients to contact the practice for their regular medication.
  3. Increase use of online services. Work with patients and practice systems to increase the use and benefit of online services for patients.
  4. Optimise telephony. Make the most of cloud-based telephony systems to reduce waiting times and inform improvement of the appointment system.
  5. Get info first time (GIFT). Obtain enough information when the patient contacts the practice to know how best to serve them.
  6. Enhance signposting. Signpost patients to the most appropriate person or service with the minimum of ‘bouncing’ between staff in the practice.
  7. Directory of Services. Develop a directory of local services for patients and care navigators to refer to when seeking the most appropriate service.
  8. Design for continuity. Use every opportunity in the patient journey to promote continuity of care for those who need it most.
  9. Flexible appointment book. Design the appointment system so that staff are able to select the right slot for the patient.
  10. Online records access. Support more patients to access their full medical record, to reduce their dependence on contacting the practice.
  11. Productive follow-up. Plan follow-up processes so they make the most appropriate use of clinical time.
  12. Joined-up care (integration). Make special provision for smoother collaboration in the care of patients accessing several different teams.

Read more about the Access Actions and the way locality collaboratives help practices make sustainable improvements faster. 

Being part of the RAFT programme will help practices to make practical improvements benefiting patients and the practice. 

For patients, there will be less stress and frustration in accessing care and they will more often be connected directly with the right person first time. 

For practices, it will be easier to manage the daily workload, there will be fewer frustations created by patients ‘bouncing’ between people in the team and quick things will be done quickly more of the time.

The Access Actions also help practices to meet their contractual obligations for improving access. Participating in a locality collaborative will help practices with:

  • GMS. Ending the ‘8am rush‘ caused by not being able to address patients’ needs on the day they contact the practice.
  • QOF. Managing capacity and demand more systematically and smoothly, reducing inappropriate appointments and improving staff wellbeing as part of shared PCN work.
  • BSol’s ESO. Additional funding from the ICB towards the costs of participating in improvement work.
  • IIF. 30% of the fund which rewards improvement in patient experience of contact, ease of access and demand management, and the accuracy of the appointment book.
  • TCTS. Transition cover and transformation support, funding backfill for the work of planning and implementing so-called ‘modern general practice’: better digital telephony, simpler online requests, and faster navigation, assessment and response

 

Read more about the funding and support available for practices

Access is a system issue

Improving access in primary care requires action throughout the NHS in BSol. RAFT has therefore been confirmed by the ICB as a system-wide programme, as well as its main transformation focus for general practice. The RAFT programme team are helping to connect and bolster workstreams in other parts of the system, and ensure primary care is kept informed about them.

Some of the changes proposed to improve access are areas where the ICB is already taking action but where primary care believes more can be done. Some of them are things only practices themselves can address, through streamlining ways of working.

 

There are three aspects to delivering Right Access First Time for patients:

 
Reducing demand and increasing capacity are chiefly the responsibility of the system and other providers, while releasing time is about practices implementing changes to work smarter, freeing up clinical time and improving patient pathways. 
 
The RAFT programme is providing a wide range of practical support for practices to plan and implement changes that improve access and manage workload. Some are being run across the whole of BSol (eg care navigation training, a new directory of services) but the majority of the practical work is happening at locality level, through improvement collaboratives. This ensures the priorities for action continue to be led by practices themselves, and that practice leaders received high quality support for work of turning good ideas into sustainable improvements.