GP Provider Support Unit, Birmingham and Solihull

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Meeting 2, 24 January 2024, 12:30-16:30. The Saffron Centre

This is the second meeting of our improvement collaborative, sharing ideas and plans for improving access and managing workload.

Agenda

12:30Arrival & Refreshments
13:00Welcome & IntroductionsDr Sunando Ghosh /
Dr Naresh Chauhan
13:05RAFT Programme & Update on PSUAnna Hammond
13:15Release Time

Websites & Digital
PSU Digital Team
13:40Increase Capacity

Avoidable Appointments Audit Update
Dr Aftab Arif &
Jacqui Morgan
14:10Break (10 minutes)
14:20Release Time

Helping General Practice with End of Life Care for RAFT
Dr Nadia Khan

(Palliative Care Consultant, John Taylor Hospice)
14:35Reduce Demand

Greenridge – Total Triage Feedback
Dr Nadia Wahid
14:50How we Work as a Locality

Central Locality Update:
Update and discussion about Central Locality MOU
Sophia-Bi Raja
15:00System and Partnerships Working

Community Care Collaborative:
Locality and Neighbourhood Working
Chris Holt /
Paul Sherriff /
Dr Sunando Ghosh
16:00Close

1. DESIGN the patient pathway

How will you connect patients with the right person at the right time in the right way first time?

Click the steps in the pathway below for prompts to guide your planning (you can then also edit this pathway to customise it for your practice)

…or click here to open a PDF of the pathway and prompts

2. PLAN how to implement the changes

Increasing patient usage and optimising practice pathways for online contacts, to improve access and manage workload

Before jumping in with our changes, planning is an essential process that helps set us up for success. This is often where we can learn most from other practices – about the choices we have to make, what works and what to be careful about. Good planning engages the whole team, especially once our main aims and choices have been established. 

Choose a planning template

It’s not a plan until it’s written down, they say 😁

We have prepared three templates to help you record practical plans quickly…

Outline plan

A simple and quick start
Quickly note your goals and key actions

Open the template here

Project plan

More detailed plan
Include details of who needs to do what and when

Open the template here

PDSA plan

Practical implementation of changes
A simple guide to using Plan-Do-Study-Act cycles to test and refine specific changes

Open the template here

Areas to consider planning for: Set a date, Update guides, Create message templates, Adapt appointment book

It is worth setting a date for launching your new system well in advance. This helps focus everyone’s minds and ensures you have enough preparation time.

Where staff will be required to work in new ways, you will want to update guides and protocols to support them to implement them safely and effectively. 

It is worth asking other practices about the guides and protocols they have found effective.

Where you will be making more use of online contact routes, it is helpful to prepare templates of common messages to be sent to practices. This saves time and ensures patients are dealt with in a consistent way. 

Many changes to the access system create a need or opportunity to adapt the appointment book. Changes to the structure of appointment templates and the routines for updating and releasing slots will help to ensure that staff are able to direct patients to the most appropriate person.

Some of the changes required in the appointment book can be planned precisely in advance, but some will requrie an element of informed guesswork. It is therefore essential to monitor the performance of the new system closely in the first few hours, days and weeks. 

3. PREPARE to implement changes

Preparing the team and patients so the new system has every chance of success

Most significant changes to the practice’s access system need a period of preparation before launch. Good preparation often involves the whole team and helps increase the success of the changes, reduce the number of problems and makes it an easier experience for patients and the team. 

The key aspects of preparation may vary depending on the specific changes you have planned, but the four tasks below are usually important when making significant changes to the access system. They are often projects to run in parallel, rather than being ‘steps’ in sequence. 

Steps to consider: Clear backlogs, Test with staff, Prepare patients, Update website

Many improved access systems make it much easier for patients to be connected first time with the most appropriate person in the practice team. This can be hampered if there are currently large numbers of patients waiting for prebooked appointments. 

It is often helpful to clear the ‘waiting list’ by temporarily increasing clinical capacity. The TCTS fund announced in the GP contract is available to support the costs of this additional capacity. Read more here

Testing out each of the changes you plan before going fully live with them is a good way to iron out issues and increase staff confidence. 

Sometimes you can test individual aspects of the changes you’ve planned, and sometimes you’ll want to test the whole process. This can be harder to do before launch, so it’s often necessary to run some ‘virtual walkthroughs’ of the process rather than doing it for real.

Patients themselves will be crucial to the success of your changes. There are a number of ways you can engage with them during planning and preparation.

  1. Involve patients as partners in the planning and preparation. People such as PPG members can be invaluable sources of insight into the patient experience. 
  2. Review comments, audits and complaints relating to access, to understand where some of the most impactful improvements can be made. 
  3. Involve volunteer patients in testing out new aspects of the access system, to gain their feedback. This often provides essential insights into how information is understood by people outside the practice team.
  4. Gather feedback from patients as the new system launches, to identify areas it could be improved. 
 
It is worth providing information to all patients in a variety of ways ahead of launching any significant change to the access system. This can be done through:
  • text message
  • email
  • the practice newsletter
  • updates on social media
  • information in the waiting room
  • information on the phone system
  • information on the website

 

Simple changes to the practice website can help ensure the preferred options are the most visible for patients. 

It is important to give your website hosting company enough notice of the changes you want, so they are ready for your launch date. 

4. GO live with the changes

Launching the new system and rapidly making any required adjustments

After planning and preparation, it’s time to implement your changes. Here are some prompts to help the new system work as safely and smoothly as possible.

Steps to consider: Launch, Measure, Adjust & improve

Go live with the new system

For the first few days of a new access pathway, it’s helpful to ensure you have enough senior people around to provide additional support or to address issues promptly. Most significant changes don’t work entirely as expected, so smoothing out problems quickly helps both patients and staff. 

Encourage everyone in the team to watch out for and report any issues or improvement opportunities they spot, and make it easy for people to report them. Several heads are better than one partly because they bring more eyes to spot how things are working. 

How are we doing?

GPAD data is not perfect, but is slowly improving. NHS England have recently published new ‘consolidated’ guidance about how to ensure your GPAD data is as accurate and useful as possible. Click here to read it.

Tips shared in the meeting for improving our data quality:

  • ensure all appointments on the clinical system are mapped to the 8 national categories (see ACC-08 in the NHSE guidance)
  • if your practice uses AccuRx, ensure clinicians complete the new pop-up box at the end of a consultation, which asks what type of appointment this was
  • ensure PCN-related activity is being coded properly, to ensure you are paid correctly

How will you know your change is an improvement?

Measuring is essential to knowing how your new system is working. Practices will usually want to measure several different aspects of the new pathway, initially very closely and then less intensively as things settle in. 

In addition to the (rather limited) data provided automatically by NHSE, consider what else you would want to measure. For example:

  • Process measures. Things which measure the volume of activity, ideally at each stage of the patient pathway. These help you know if the new system is being used in the ways you had expected. Examples could include:
    • number of phone calls
    • answering times for phone calls
    • number of online contacts
    • times of day for contacts
    • types of request being received (eg admin / clinical)
    • total patient contacts, eg:
      • phone
      • online
      • reception desk
      • third party
    • total clinical consultations, eg:
      • General consultation acute
      • General consultation routine
      • Unplanned clinical activity
      • Clinical triage
      • Walk-in
      • Home visit
      • Care home visit
      • Care related encounter but does not fit into any other category.

  • Outcome measures. Things which assess how well you are achieving your aims in making these changes. These measure improvements such as:
    • DNA rate
    • avoidable consultations rate
    • ease of booking patients into the most appropriate slot (eg ‘third next available appointment’, staffing rating 1-5)
    • patient experience
    • staff stress levels


  • Balancing measures. Things which detect potential adverse consequences of the change. Examples might include:
    • problems noticed by staff
    • problems reported by patients
    • inappropriate signposting

Don’t “set and forget” it – aim for continuous improvement

Implementing change can be exhausting, and one reason is that we often approach things as very big changes. Using the principles of improvement science, we can implement many changes in a more stepwise fashion. This makes it easier to spot and address issues before they impact too many people, and it reduces the burden on the team. 

In the first few hours and days of a new access system, practices will usually need to monitor access very closely, and have senior staff available to take action as required. 

One of the opportunities practices sometimes overlook once they’ve launched a new system is to look deliberately at ways to further increase use of the new pathway by patients and to make it easier for staff to do the ‘right thing’ first time. These opportunities will sometimes reveal themselves through your data, and often through comments of staff and patients – so it’s important to continue being proactive in gathering those insights, including through regular team meetings where comments and ideas are invited.