Some of the changes required to deliver right access first time can only be made at practice level. They involve working smarter, changing systems and processes to to improve appropriateness and efficiency of work.
The Access Actions for practices
The Access Actions is a framework for improving access for patients and managing workload for practices. It is being used as a menu of changes to implement as part of the RAFT programme. The Actions were developed by PCN clinical directors and managers across Birmingham and Solihull in April 2023, with the aim of making it easier for practices to connect patients with the right person, at the right time, in the right place for the right care.
The Provider Support Unit will be producing case studies, guides and other resources to support practices in assessing their situation, planning changes and measuring improvement. These will be provided as part of locality improvement collaboratives, launching in September 2023.
Actions which reduce the pressure on practices, particularly the demand for GP appointments. These complement the larger programme of work across the ICS to reduce demand on general practice.
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.
With the expansion in services and skills accessible via general practice it is more important than ever to ensure patients can find the right information easily online. National resources provide detailed guidance about designing and updating highly usable general practice websites.
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.
Electronic Repeat Dispensing (eRD) was first introduced in 2009, and incorporated into the GP Contract in 2019. It means that patients who regularly get the same medicine do not need to visit their GP every time they need a repeat prescription. Instead, the prescription can be sent straight to their pharmacist for dispensing. Using eRD, GPs can issue up to 12 months’ worth of regular prescriptions, which can be stored securely on the NHS database, so they are ready at the pharmacy each time a patient needs them.
eRD offers benefits for patients and practices:
- two-thirds of prescriptions issued in primary care are repeat prescriptions. These repeat prescriptions account for nearly 80% of NHS medicine costs for primary care
- 410 million repeat prescriptions are generated every year – equivalent to an average of more than 375 per GP per week
- it’s estimated that up to 330 million, or 80%, of all repeat prescriptions could eventually be replaced with eRD
- this could save 2.7 million hours of GP and practice time
Changes to the way patients contact the practice. These provide a more modern service, reduce the need for patients to come into the practice and help connect patients with the right person or service first time.
3 Increase use of online services
Work with patients and practice systems to increase the use and benefit of online services for patients.
Apps and web access enable patients to engage with the practice efficiently and confidentially. Patient ordering of prescriptions and checking their record enables them to continue their care without having to contact the practice. Contacts initiated online are easier for care navigators to signpost effectively. They can also improve patient safety by allowing red flags to be acted on more promptly, and support more efficient clinical triage.
4 Optimise telephony
Make the most of cloud-based telephony systems to reduce waiting times and inform improvement of the appointment system.
All BSol practices now use modern cloud-based telephony. This offers benefits for patients and practices, as long as the full functionality of call-back queues is used and practices are comfortable interpreting the activity data provided by the system.
Enhancements to the way patients’ needs are assessed so they can be directed to the right person or service, at the right time and in the right way. These actions help ‘care navigators’ (receptionists) do their job more effectively.
5 Get info first time (GIFT)
Obtain enough information when the patient contacts the practice to know how best to serve them.
Modern general practice offers a wide range of care, with many different staff roles, services and appointment types. To connect patients with the right person, at the right time in the right way requires information about their reason for contacting the practice. Care navigators need more information than has historically been obtained from patients (in the days when the main options were “I need information” or “I need an appointment”).
6 Enhance signposting
Signpost patients to the most appropriate person or service with the minimum of ‘bouncing’ between staff in the practice.
Once the right information has been obtained about the patient’s need, care navigators need to be able to use protocols which safely and appropriately identify the best person or service for them. They also need high level communication skills and the confidence to signpost patients with compassion and clarity.
7 Directory of Services
Develop a directory of local services for patients and care navigators to refer to when seeking the most appropriate service.
There is a large number of services which patients can be signposted to. It is important to have comprehensive and up-to-date information about these, in a format that is easily accessible and searchable.
8 Design for continuity
Use every opportunity in the patient journey to promote continuity of care for those who need it most.
Continuity of care is highly valued by patients and clinicians. It has been shown to reduce workload, improve clinical outcomes and increase satisfaction for patients and clinicians. However, general practices have not often designed continuity into their ways of working, sometimes prioritising speed of access at the cost of appropriateness.
Redesigning the patient journey provides an opportunity to include specific measures that increase continuity of care for patients who most need it. As part of the RAFT programme the Provider Support Unit is able to support these changes.
Innovations in how clinical care is scheduled and delivered. These changes make it easier for patients to speak to the right person at the right time, and improve the ability of staff to select the most appropriate ‘slot’ for the patient’s need. They also smooth the process of care for people engaged with multiple services, such as in an integrated neighbourhood team.
9 Flexible appointment book
Design the appointment system so that staff are able to select the right slot for the patient.
Once it has been confirmed that a patient needs to speak with a particular person at a particular time in a particular way, care navigators and clinicians need to have confidence that they will be able to book this or give the patient a direct booking web link. In many cases, however, the design of the appointment book makes this difficult. Many practices can benefit from having a wider range of appointment types (online, phone, face-to-face, group) and lengths available, as well as a more flexible approach to the ‘rolling release’ of future slots.
It is often necessary to clear the backlog of appointments before launching a new system. Funding is available for practices to support this process, including the use of additional locum sessions for example. Details will be sent to practices about the ways to apply for this funding.
10 Online records access
Support more patients to access their full medical record, to reduce their dependence on contacting the practice.
The NHS has enabled access for patients and authorised carers to their full medical record online. There are benefits for patients, carers and staff. Experience has shown that this reduces the need for patients to contact the practice with queries about their care. Especially for people with complex needs, having full onlne access increases adherence to management plans, reduces the consultation rate and helps patients prepare better for longterm conditions reviews.
11 Productive follow-up
Plan follow-up processes so they make the most appropriate use of clinical time.
The majority of work in general practice is is part of an ongoing process. Ideally the way patients contact the practice will be different for follow-up care. Intentional design of the access system can help to reduce wasted time for patients and clinicians, and increase continuity of care.
Greater use of online consultations, scheduled text messaging, direct booking links and automation in follow-up processes can have significant benefits for patients and the practice. Some of these can be implemented very quickly by clinicians, while others require a larger project involving other members of the team and, in some cases, digital tools which are newer to some practices.
12 Joined-up care (integration)
Make special provision for smoother collaboration in the care of patients accessing several different teams.
Many of a practice’s patients with the greatest needs are under the care of other teams as well. Communication and handovers in these cases are a common source of risk, wasted time and frustration – for patients and carers as well as staff. The NHS is seeking to establish ‘integrated neighbourhood teams’ – a collaborative approach which wraps community teams around the patient and their primary care team. As part of this, it will be important for practices to work with community teams and other providers to ensure that patient pathways do not create unecessary barriers or delays to collaborative working.
The Provider Support Unit is working closely with BCHC to shape the emerging plans for integrated neighbourhood teams. More information will be posted here as the programme develops, and RAFT collaboratives will be able to undertake practical work as part improving integrated care.