>>Dr Farzana Hussain: So this month has been really busy with a whole host of meetings.
I’ve had appraiser’s, support group meetings and CCG meetings and also federation meetings.
It’s also school holidays with the kids and trying to juggle that and the day job
of being a GP has been a challenge but we got there.
So I’m a board director at our local GP federation and yesterday there was a workshop
on the accountable care system. This is a very new way of working which really puts
the patient at the centre of all the care and breaks down the barriers between general
practice, community trusts, acute trusts, and there’s sort of a theory that there’s
one pot of money and there’s one patient and we all work together to improve the health
of the patient.
At yesterday’s workshop a colleague mentioned that they were concerned about protecting
general practice’s autonomy and funding in the accountable care system where we will
be working with different partners. I remembered working on the Change Model and the element
called shared purpose, and it occurred to me that if all the organisations such as the
hospitals and the community trusts all worked together with the shared purpose of improving
the patient’s journey, and making that happy in the most cost efficient fashion, then there
really would be no barriers. So I mentioned it at the meeting and we all felt that was
a real move forward, and the next step for us is going to be having conversations with
our partners and seeing how we can actually vocalise our shared purpose to improve the
health of our patients.
I use the Change Model practically everybody in my work and I really wanted to share it
with my team. So I brought it along to a whole practice team meeting and I actually asked
the question who do you think leads the practice cause I found the leadership by all element
really helpful in my work. And at the beginning a couple of people said that they thought
it was me as the lead GP and then as we got thinking some people thought it was the nurse
for the nursing areas, and it was by the next two minutes we realised that actually everybody
was a leader in their area. And it was lovely to hear even the new receptionist say that.
So once we had seen that actually this practice had leadership by all it was much easier I
felt for everyone to voice what they thought were the strengths and weaknesses in the practice.
It was really nice for me to see the amount of agreement and that everybody in the practice
felt our telephone consultations were working really well and were a strength, and they
felt communication in the practice was really good. But one of the areas of improvement
that was highlighted by everyone was things like the equipment not working when its required
by a doctor or nurse. So the spiral meter doesn’t have batteries in it or the doppler’s
not working, and of course the staff member who used to look at that for me is on maternity
leave and I realised I hadn’t trained the new member of staff to do that. This got me
thinking about the measurement aspect of the Change Model and when I had been on my GP
Improvement Leaders programme I found the measurement particularly challenging and now
I can see how important it is. So now my next step will really be to use some measurement
and particularly with the equipment and improve things for us to make it quicker and easier
on a daily basis.
I learnt about process mapping on the GP Improvement Leaders programme and I was particularly concerned
about the nursing time that was being wasted with our travel vaccine service. We were losing
two hours of our 20 hours of nursing on a weekly basis because families of four or five
would book travel vaccine appointments and then not turn up. And I wanted to do something
about that and I wanted to use the process mapping because travel vaccines are mainly
nurse led and I really wanted the involvement of all of the team to see what they felt about
how we could make any improvement.
So Shuzna you were talking about reception and their input into the booking process.
>>Fateha Begum: It really helped us after the process mapping because after we started
to book telephone appointments first and then Shabnam spoke to them on the phone, and it
was decided what injections they needed, Shabnam did the prescription. It was really helpful
for us because we can look at the consultation and see what’s happening and then she would
book the patient in to see them. So when the patient calls us we can look at their records
and see what’s done next, so even if they forget their appointment we’d be like the
prescription has been done for you just need to come and collect it and there’s an appointment
booked for you by the nurse which Shabnam would book it on the first call.
>>Dr Farzana Hussain: So you didn’t think there was any confusion.
>>Fateha Begum: The patients were really happy whereas before we were getting aggression
at reception. After this it was so much better.
>>Shabnam Khushi: There was more structure and everyone understood the protocol so it
made more sense.
>>Dr Farzana Hussain: On average how many complaints were we verbally getting a week?
>>Fateha Begum: About two a week before and now there’s none.
>>Fateha Begum: When I used to obviously used to see the patients on a weekly basis there
used to be on average 12 DNAs. So 12 slots were unattended and patients had less value
for appointments at that point.
>>Dr Farzana Hussain: Gosh so two hours were wasted.
>>Shabnam Khushi: Two clinical hours were wasted, there you go. During that time I mean
I could have seen patients with wound care or anything which obviously which is much
more priority than travel. So that time was gone to waste so that was quite a shame. But
now at the moment the way everything’s gone into place and the way its followed on protocol
we get one DNA per week.
>>Dr Farzana Hussain: Only ten minutes lost.
>>Shabnam Khushi: Verses the 12 DNAs and some of the weeks its 100 per cent compliant, saves
money saves time, gives more priority to other patients so it’s worked out quite good.
>>Dr Farzana Hussain: So I was fortunate to be invited to a local practice in the area,
which is a much larger practice than mine and they’ve just changed their appointment
system, because their current system wasn’t really meeting their patient needs or their
clinicians’ needs. And they’ve just been using the new system for about four weeks
and I had a chat with the practice manager and she had never heard of the plan, do, study,
act cycle. And while she had done some planning she was a bit nervous about how the new appointment
system was going to work.
So after the practice manager and I discussed the plan, do, study, act cycle, the practice
has now put this in their action plan and they’re going to be studying the number
of appointments that are taken on the day and those that are being pre-booked and how
they are being pre-booked whether that’s on the telephone or online. And then they’re
going to act accordingly and see how many appointments they need to release on the day
and how many are available beforehand, and which method patients prefer rather than coming
in to book or online.
And it was really lovely for me to share some of my learning with another practice so that
it would really impact more patients and not just my own practice. And it was lovely to
see the practice manager smiling and it actually felt really good to know that we’d achieved
something because general practice is busy and it’s really nice we can help each other
with these tools.