ARGYLL AND BUTE Practice Administrative Staff Collaborative 4 GP - PowerPoint PPT Presentation

ARGYLL AND BUTE Practice Administrative Staff Collaborative 4 GP Cluster Teams/Cluster Quality Leads Helensburgh Oban and Mid Argyll Cowal and Lomond surrounding areas Dr Rebecca Dr Alida Dr Ewan Glen Dr Nick Dunn Helliwell MacGregor 7 GP Practices 5 GP Practices 7 GP Practices 7 GP Practices

A&B is a “geographically challenging area” • 4 localities • 6 Cluster Groups • 9 Locality Planning Groups • 33 GP Practices • 96 GPs • 4 GP run Community Hospitals, including A&E • VOL GP support for OOH • Islands (25 inhabited) • 89,000 Population

NP Patient & other undifferentiated stakeholder illness communication NP Visits VC facilities in NP all GP practices Anticipatory Areas for Care Collaboration/ Quality Improvement improvement Physio role tools Acute Pharmacy role Phone Meds rec management Document What else Management

Core areas v Opportunities • Core 1. Reducing Docman by > 50% 2. Nurse Practitioner a. Increased House visits b. Increased role in Undifferentiated Illness c. Improved Anticipatory Care Planning • Opportunities 1. Extended NP Role 2. Physiotherapy role in Acute presentation 3. Pharmacology role in IDLs etc 4. Increased use of targeted Phone Consultations

Risks • Not focussing on Core areas and being distracted by mission creep • GPs / Practices being overwhelmed by service provision • Inability to recruit GPs – Increasing Practice Stress • Inability to recruit adequate calibre of NP /AHPs • Lack of funding for support staff • Resistance to change from AHPs • Inadequate measurement of change

Core 1:Reducing Volume of Docman • Month 1 : Communicate aim / Identify “Champions” • Month 2: Listen to stakeholders / Assess Baseline workload / Learn from other areas/ • Month 3: Formulate Plan / Implement early wins • Month 4: Training manual • Month 5-6: Training • Month 7: Implementation • Month 9: Assessment

Core 2: Nurse Practitioner Role • House visits: Target 50% Reduction • Undifferentiated illness: 1. Who to see – Infections/ Dermatology/Depression • Anticipatory Care Planning: 1. Improve quality and targeting 2. Clearer training and protocols 3. Improve measurement of where we are 4. Role of DNs/ NH Staff

Development of Acute Physio Role • Liaise with existing physio service in Rothesay • Identify unmet need by consultation analysis • Negotiate with Physio for Acute Physio time • Look to implement and assess in practices • Formulate recommendations for development of service across locality

Pharmacology Role • IDLs: Target - All complex IDLs requiring change are completed by pharmacist • WHERE NEXT • Special Requests: Target overall reduction in volume of special requests and increase number done by pharmacist? • Improving medication review strategies and recording of reasons for prescriptions / review arrangements?

Phone Consultations • We have a Practice which uses these extensively • Which patients offer the greatest opportunity for this and how can these by identified by reception staff • Can this be rolled out across other practices within the cluster

Pilot Mail workflow project 200 Letters and Results Pilot breakdown of volume of mail per area 5% 6% 20% 6% 7% 4% 56% Results * Clinic * IDL * FDL AE OOH Other

Pilot Mail workflow project All incoming mail (100%) Results (20%) Letters (80%) Pilot Results * Clinic * IDL * FDL AE OOH Other Total Estimate 20% 56% 4% 6% 5% 6% 5% 100% 1st 1st 1st 1st 1st 1st 1st 1st Completed Completed Completed Completed Completed Completed Completed Completed Admin 0 0 Docman Lead 11 36 2 4.5 3.5 3 2.5 62.5 0 Pharmacy 0 0 Clinician 8.5 20 2 1 1 2.5 2.5 37.5 0 100 0 % by Docman Lead 56% #DIV/0! 64% #DIV/0! 50% #DIV/0! 82% #DIV/0! 78% #DIV/0! 55% #DIV/0! 50% #DIV/0! 63% #DIV/0! Pilot - Estimate % Mail that could be completed by Docman Lead 90% 80% Average 63% 70% 60% 50% 40% Target 50% 30% 20% 10% 0% Results * Clinic * IDL * FDL AE OOH Other Total

Pilot Mail workflow project 200 Letters and Results Estimated Mail Volume & Hours Per Patient Per 9,300 pt Practice Per 84,301 Cluster Mail per week 0.2 1,920 17,400 Mail per year 11 100,000 906,400 Hours per year (10 minutes) 1666 Hours 15,100 Hours Hours per week 32 Hours 290 Hours

Pilot Mail workflow project WORKFLOW ALGORITHM All Mail scanned by ADMIN or arrives electronically and -> Patient notes LOMOND and ARGYLL See Appendix for Descriptors (1-9) Letters Results Very Simple Normal Abnormal Detailed letters(1) letters(2) Results(3) Results(4) COMPLETED by ADMIN DOCMAN LEAD Simple Coding required(6) Simple Meds Complex Meds Code if Important (No meds change) .+/- letter(5) Change(7) Change(8) req Letter(9) Actioned by DOCMAN LEAD PHARMACIST Simple letter(5) Important Letter(9) COMPLETED by DOCMAN LEAD Named CLINICIAN COMPLETED Admin for Action or feedback to Docman Lead or Pharmacist. by CLINICIAN Either Complete or return to named clinician.

Pilot Mail workflow project 1 week of “Normal Results” being filed directly Results after implementation of Normal results filed by admin (9,300 patient practice) 387 Results per week GP Practice Nurse Pharmacist Total Annual Requested by 253 88 46 387 20,124 Filed directly by admin 92 (36%) 47 (53%) 25 (54%) 164 (42%) 8,528 Seen by Clinician 161 (64%) 41 (47%) 21 (46%) 223 (58%) 11,596