In a recent Practice Index webinar, we heard how one GP practice – St Lawrence Surgery in Worthing – has found a way to eliminate the dreaded 8am rush of patient calls.
Jo Wadey, Practice Business Manager at St Lawrence Surgery, and Dr David Stokes, a GP partner at the same surgery and Clinical Director for Central Worthing PCN, explained how their creative new triage system means the practice is now able to see more patients, increasing patient satisfaction and giving GPs more time to deal with patients presenting with complex needs. This helped the practice receive an Outstanding CQC rating in their recent inspection.
Here, we share just some of the key takeaways from the session. More information, including the nuts and bolts of how the triage system works, can be found on the webinar recording, which is available to watch on demand by clicking here.
- Doing nothing wasn’t an option
The surgery was suffering from the ‘please call back tomorrow’ disease that so many practices struggle with. That was leading to an enormous amount of unmet and unknowable demand sitting in the system as patients were being asked to call back. At the same time, the surgery was doing an awful lot of telephone triage, trying to deal with the emergency demand on the day.
“I could also see anecdotally that, because we work with so many different clinician types, including ANPs, paramedic practitioners and pharmacists, quite often patients were not necessarily being booked in with the most appropriate person first time,” said David. “That in itself was leading to a huge amount of duplication of effort.”
On top of all this, receptionists were feeling abused, so the option to retain the status quo simply wasn’t acceptable.
- Change management was vital to success
Taking any practice to a completely different system requires a big change management programme. You need to take your entire team with you and to do that you need to have a very clear vision of what that might look like, including the benefits that the entire team will enjoy. Jo and David explained how they worked hard as the champions of change, encouraging all of the relevant members of the practice teams to come together to design how the triage system would work.
Framing the problem was easy, explained Jo and David. Being able to show the practice team a vision, and then being able to show them how that could change their lives, was trickier. Get this part right, though, and you achieve the buy-in. Then it’s a question of making sure that the key people are involved in any change, working through the potential challenges that exist, and constantly tweaking the system until it works.
- Decision fatigue needs to be avoided
One of our main learnings is that you have to be aware of decision fatigue. It’s definitely not right for a GP or any other clinician to be in the triage room all day. It’s a full-on environment and you need to learn when to give your clinician a break and ask someone else to take over.
“Our reception team know very well that if I’m getting stressed, I might get a bit sweary, and they’ve got permission to tell me to take a walk,” explained David. “At that point they’ll swap me out for someone else. This is really useful for longevity and preventing burnout.”
Generally, at the practice, the doctor who starts first thing in the morning is swapped for someone else at coffee time and a nurse practitioner might then go in, or another doctor, so that there’s a three to four-hour pattern.
- Keep the faith when it comes to unmet demand
“Clearing the unmet demand was always the scary thing when we were planning the triage system,” said Jo. “We didn’t know how much demand was out there, so for us it was very much about having the faith to pre-book appointments ahead.”
According to David, you need to have some confidence in the fact that this is going to save you time in terms of not having people bouncing back to another clinician. He explained, “You’re going to be able to increase your continuity of care by putting patients in with someone they’ve seen about this problem before, which is clearly more efficient and is what general practice has done forever; we lost a bit as it all got horribly busy, and people’s working patterns shifted.”
David continued, “You may feel like you’re going to lose a front-line clinician for an entire day doing this role, but you’re going to be able to deal with a lot of needs very, very rapidly.”
- Data provides rich foundations
Practices looking to adopt the St Lawrence model need to go in with their eyes wide open – and that means utilising data.
The surgery looked at their appointment data, the number of people who were coming back, the telephone data to see the number of people who were calling day after day, and then worked out which patients were booked in with one type of clinician, who were subsequently having another appointment. They also used the change management process to collect information and identify what the practice’s ideal skill mix would be, meaning that when a patient is being given an appointment, the ideal clinician can be allocated, according to availability.
- Don’t forget the patients!
A critical element of success is ensuring that patients understand the changes within the practice and the positive outcomes they will see.
To make sure this happened, Jo led a big communication drive, partly through the really active patient participation group at the surgery, who were involved with some of the system planning. “They were really helpful in getting the message out into the community,” Jo explained.
“We’ve got a Facebook page with about two or three thousand patients on it. We also announced the plans through the website – just as many ways as we possibly could. Patients are on the telephone for longer, but when they know they’re more likely to be dealt with there and then, rather than having to call back, they’re fine about it.”
- The system is scalable
When asked if the successful triage system being utilised by St Lawrence Surgery (with 16,000 patients) could be scaled up or down to work at other practices, David answered, “I’m sure this system could work for most sized practices, although I suspect very small practices will often cope well anyway, because they’ve often got more continuity.
“You might not quite reap the benefits if you haven’t got that broad spread of different clinicians and professionals, but I still think that the number of things that you are able to deal with at the front door, so to speak, more than makes up for the time you take out of the clinic, regardless of practice size.”
- Wait! What about the new GP contract?
The new GP contract has suggestions about booking patients two weeks in advance, which won’t have much impact on this triage system, according to David and Jo.
David commented, “The devil will be in the detail in terms of how the new requirements are measured or what’s expected, but I suspect we’re pretty much there in terms of our access anyway, because of this system. Patients would generally be booked in within two weeks – three at a push. If it’s three, it’s because they’re after a specific individual who may be on holiday or whatever.”
- Staff morale and teamwork have been boosted… as has retention
Staff retention is much, much better following the introduction of the new system, according to Jo: “I would say the Patient Services department still has the highest turnover out of the entire practice, but certainly the new system has made a positive difference. The need for the constant ‘phone back tomorrow’, ‘phone back tomorrow’, ‘phone back tomorrow’ conversation has been replaced by the offer to help there and then (in most cases) and as a result there isn’t nearly the same level of abuse – today it’s a rarity, whereas before it was an everyday occurrence. If there is an incident, we’re very quick to jump in, helped by the fact we’re together as a team.”
The new set-up is proving to be positive for all the teams and they are enjoying the variety in their roles. People aren’t so isolated; they’re not just churning through consultations and it has been positive in bringing the practice together.
If you missed this brilliantly engaging webinar – or you want to listen to it again – the good news is that the recording is now available on demand. Access the video below, then sit back and imagine how you can make that 8am rush a thing of the past.
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