About this event • Key findings from the Healthwatch Southwark report – Appointment systems at GP practices – are they working? • What the NHS Southwark CCG is doing to support general practice services and how they are going to use the HWS report • Reflections from the ‘expert’ panel • Q&A discussion • Final reflections and next steps
Appointment systems at Southwark GP practices – are they working? Aarti (Healthwatch Manager)
Why did we look into this? • Top issue identified when we asked Southwark residents what should be our priority areas in 2017/18. – Frustrations with appointment systems. – Every practice has a different system. – Time to wait for an appointment. • GP Patient Survey shows Southwark performs lower than the national average when it comes to the experience of making or ability to get an appointment.
What we did • Enter and View visits to every Southwark GP practice. What is Enter and View? • We spoke to 550 patients registered with Southwark GP When trained authorised practices. representatives visit publicly funded health and social • We spoke to 50 receptionists (at care services to talk to service users, their relatives least one from each practice) and carers, as well as staff. • 39 Practice Managers completed an online survey.
Information we gathered • • Contacting the GP practice The role of receptionists – • Understanding of appointment redirecting patients • systems Support and training for • Booking appointments in receptionists • advance Walk-in systems • • Booking same-day Alternatives to face-to-face appointments appointments • • Clinical triage Use of Advanced Nurse • Extended Primary Care Service Practitioners (ANPs) • • Receptionists asking about a Pressures and challenges patient’s condition
Today’s focus… • • Contacting the practice The role of receptionists – • Understanding of appointment redirecting patients • systems Support and training for • Booking appointments in receptionists • advance Walk-in systems • • Booking same-day Alternatives to face-to-face appointments appointments • • Clinical triage Use of Advanced Nurse • Extended Primary Care Service Practitioners (ANPs) • • Receptionists asking about a Pressures and challenges patient’s condition
Our findings • Information is purely based on what we heard from Practice Managers, receptionists, and patients. • Not our intention to recommend the ‘ideal’ appointment system , or to rank practices. • Not reflective of all the views and experiences of all Southwark’s GP registered population and practice staff. • However, we did speak to a large sample of people , and had conversations with them.
Booking appointments in advance (‘rou ti ne’)
Time patients wait for advanced appointment “...the waiting time was about 5 weeks to see my Doctor and about 4 weeks to • see ANY Doctor. By that time, any 28% of people said they waited ailment will probably have cleared up less that 1 week for their last or killed me!” (Patient) GP appointment. • 71% waited less than 2 weeks and 5% waiting longer than 4 “...Their booking system is the biggest weeks . problem, e.g. if you call on a Monday, they’ll only offer you an appointment • Some people spoke to us about for the next Monday – or they say not being able to book there’s no appointment and tell you to call back the next day at 8am, maybe appointments far enough ahead, then there’ll be one for the Tuesday a for convenience . week later.” (Patient)
When practices ‘release’ their advance appointments • Significant variation in how far ahead practices release their appointments. • 13 practices told us that they stagger the release of their appointments e.g. every few days of every few weeks. “…the practice release “When I was told that there was a appointments at least 3 times a minimum 4 week wait, I was told to week which they call embargo ring at 8am and then somehow there appointments but are for when might be appointments available? I'm patients want to book an really not sure how that can be the appointment sooner than 4 case...” (Patient) weeks” (Receptionist)
Recommendations • Practices should consider: – If they are operating ideal ratio of same-day vs. booked-ahead appointment system. – If their system for booked-ahead appointments is fit-for- purpose and that there is a rationale for the system.
Booking same-day appointments (‘urgent’)
Ease of getting a same-day appointment • 42% of patients said they could ‘always’ or usually’ get a same-day appointment • Those who can get a same-day appointment mentioned need to call at certain times and difficulty getting through on the phone. “You have to call immediately after 8am and redial repeatedly – but all the slots tend to go within 20 minutes or so, before the surgery opens for face-to- face bookings.” (Patient) “There will not be any appointments in the day if they miss the morning call “You have to programme yourself to get up in times.” (Receptionist) and get an appointment.” (Patient)
Recommendations • Practices should consider when same-day appointments should be made available e.g. if two release times (morning and afternoon) might work for patients.
Clinical triage
When do practices use triage? • One practice triages all patients requesting any type of appointments. • Most often used when patients want a same-day appointment. • There are two main ways triage can be used: – In 16 practices, all patients requesting a same-day appointment are triaged. – In 27 practices, receptionists book in patients requesting a same-day appointment up to a certain point, and then triage is used once all/certain number of appointments have run out.
Advantages “The duty doctor calls • GP decides in what order to talk to urgent cases first and leaves each patient based on description sick notes and blood results to the end of the day.” provided to reception. (Receptionist) • It can save GP time , as some patients can be dealt with quickly over the phone as it may not require them to come in to “They get an advisor to call be seen. you back to decide if you need to be seen that day.” • In-surgery slots are available for those (Patient) that need them .
Disadvantages • Patients have to ‘wait about’ for the GP to call them. “They usually do call back. It’s ok – what I want gets • Some practices specify a call time dealt with. [But] if it’s a and others don’t (e.g. if they call in real emergency I don’t want to have to have to wait for order of priority). the GP to call me back to find out I’ll get an • If triage requires a referral to the appointment – I’ll just go to Extended Primary Care Service, this A&E.” (Patient) could involve another phone call. “It just creates more work for everyone. Often I have to call the patient back a few times to get through and book them in [at EPCS], or the patient keeps calling back. One of the GPs just booked them in himself which is much easier, its just time- wasting otherwise” (Receptionist)
Recommendations • Practices should ensure they are carefully reviewing their triage system on an ongoing basis, from both a staff and patient perspective. • NHS Southwark CCG and GP federations should explore the different triage systems in operation to determine: – How practices can share learning about their triage systems. – What systems work well and why. – Whether practices should adopt any good practice identified. • Practices and GP federations should consider how triage call-back systems could be improved from both a staff and patient perspective.
Extended Primary Care Service (EPCS)
Practice feedback - referring patients to EPCS • Extent of use of EPCS varied significantly. What is the Extended Primary • Care Service (EPCS)? For some practices, it is the only option for same-day appointments, for others it We have an EPCS in the north is a final option (when their own slots and south of the borough – at have run out). Bermondsey Spa and at Lister • Primary Care Centre. During our visits we notices that practice staff refer to the EPCS in quite different Patients who can’t get an ways. appointment at their own “A central hub “QHS” practice can be offered an location in North “The hub” appointment the EPCS. Southwark” “IHL” It is open 7 days a week, 8am – “The “EPCS 8pm. Lister” hub” “Peckham overflow”
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