OK, you’re forgiven for thinking I wrote DNA rate, and you were expecting to read about how to reduce Did-Not-Attends, perhaps a mix of clever texting apps and a patient blame-fest of warnings, charges and excommunication. No matter, although we have shown that DNAs are a system problem, not a patient problem, and if you change the system, DNAs disappear.
I wrote DNH meaning Did-Not-Help, the patients who are told by reception, “Sorry, nothing left, call back tomorrow. And make it on the dot of 8, I should, we’re very busy.”
No clinical systems measure this, NHS England would rather ignore it, no political party understands it or has the method or means to deal with it. The various prescriptions of “waiting time targets” or “8-8 x 7 day opening hours” aren’t based on examination of the evidence, so the diagnosis is wrong and the treatment will fail.
We collect the evidence through our Datalog audit, real time, patient by patient, we have n > 300,000 from over 200 practices, and the average rate is… 12%. Yes, it’s roughly twice as high as the average patient DNA rate, and it’s not caused by patients but by GP practices and systems. The highest we’ve measured in any practice is a staggering 31% of demand turned away.
I’ve worked with enough GPs to know that the vast majority joined the profession to help patients, so the data may come as something of a shock, but something which should move us to action. True, there’s a small but powerful minority who seem to take a different view, maximising profit by minimising service to the point where they just escape being caught. Sometimes they do get caught.
But we are concerned with the vast majority, those working hard to provide excellent patient service. Getting GPs to work harder is a sure fire vote loser, I think you know that. So the answer is giving them the method and means so that they can work much more efficiently, dealing appropriately with all demand and feeling in control.
Our task in fulfilling the vision “to transform access to medical care” is working out ever better ways to make this happen. We know that dreaded phrase, “Call back tomorrow… ” is uttered around 100,000 times per working day in the UK and our manifesto is to eliminate it.
You will vote many times in your life. Make your vote count.
You will live only once. Make your life count.
Founder, Chief Executive, GP Access Ltd
PS Exciting to report that the next little piece of that road is now in place, two way secure messaging between GPs, their staff and patients. It enables more efficient use of GP time by not always having to find phone numbers and hope for an answer. Spoke to one user yesterday who already loves it after sending 3 messages! It’s built into askmyGP Transform and Improve.
PPS as election guide I defer to the inestimable @jtweeterson
“It’s lovely not being shouted at 24/7”
Receptionist Karen’s first comment to me was both startling and predictable. Her Somerset practice launched their demand led system two weeks ago, and since then she has been able to help every patient. Three weeks ago she and her colleagues were turning away one in five patients (we measured it) but they have moved straight into the super league, with a median response time from the GPs of 26 minutes.
The GPs love it too, but I find they are more buttoned up and try to find at least one thing to grumble about. “I’ll be home early so will have to put the kids to bed,” said one.
That didn’t take too long did it, or seem so hard? It was four weeks of preparation, to abolish the old system and start the new.
So why aren’t we hearing about this from the commentariat? I get a stream of dismal blogs from Nuffield/King’s Fund/Health Foundation (why don’t they just merge, it would save all those personnel transfer costs?) wringing their hands about how hard it is to change anything.
Another one today on General Practice at Scale, is it working? Yawn. Fiddling with structures, the obsession of policy makers who should get out more and ask “WHAT WORKS?”. Instead we’re told,
“Motivations… centred on a desire to offer better access…
Most strikingly, what the survey revealed was just how long enacting change can take – at least two years to even begin to achieve what they’d set out to do.”
Useless. And no measure of performance is even offered. This is why Deming said that motivation is fine but worthless on its own. The question is “By what method?”
Method is central to our work and it’s so repeatable now that the outcome is binary: either the practice decides to change, and it all happens within a month, or it doesn’t, and nothing much happens at all, ever.
But method is not static, we are continually learning and having to adapt. Another Midlands practice told me yesterday they are learning lots from having a GP in reception, sometimes even taking calls from patients, and their performance is rocketing while demand is falling.
I’m not going to call it a trend yet, but if you are a demand led practice you’re probably enjoying the sunshine dividend today. Have a great weekend.
PS Learning a lot from askmyGP users too, with over 1200 episodes and 130 patient feedbacks on the new system, 55 suggestions from staff, a terrific response. We’ve already put dozens into service and next week’s plans include one for low using practices (they will get an email notification of an online demand) and one very much anticipated by high users.
GPs have been emailing patients because it’s convenient – but it’s not secure and poorly controlled for IG and patient safety. From next week those on the Transform programme will be able to securely message patients in a two way conversation. It’s going to be another huge time saver. Will let you know how it goes.
On cloud 9, or, “In a state of blissful happiness” is perhaps a little overstating it, but we are delighted to be on the government’s G-Cloud 9 Procurement Framework from 22nd May.
Phrases like “procurement framework” tend to bring me back down to earth with a bump, but I think this one could mean something really good, and I quote from the gov.uk Digital Marketplace:
“Buying services through frameworks is faster and cheaper than entering into individual procurement contracts.”
Right, so there’s one agreement set up between the Crown Commercial Service and us, following all the OJEU rules and thoroughly tested for compliance with all the relevant standards: NHS IGToolkit, Clinical Safety standards for software SCCI 0129/0160, secure hosting and communication on N3, you name it, all the painful, boring but essential stuff.
Yes it has been painful and I pay tribute to all the GP Access team and our partners who have done such a grand job in getting us there. It is right and proper for the process to be thorough as patient safety and information security are paramount. We have seen too much lately of what can go wrong, yet we must not lose sight of the great benefits that technology can enable for our health service.
In the first couple of weeks we’ve seen over 700 patients use the new askmyGP to get help online. One emailed Concord practice at 9.14am last Monday, a time when patients in most practices would still be hanging on the phone, trying to get through. She already had her problem sorted by the GP and just wanted to say thank you for the outstanding service.
Now that’s what really gets me on cloud 9.
PS Do explore our new askmyGP website, where all the services under What We Do are on the framework. One of the requirements of G-Cloud is that you can’t raise your prices for two years, which we weren’t planning to do anyway, but it means we can guarantee that if all you want is the online consultations Start package, it’s 25p/patient/year plus vat, and that can be fully funded by the ring-fenced GP Forward View allocation to CCGs.
PPS The application process did have its lighter moments, my favourite being where you have to agree to the statement that “all the above statements are true”. Unbeatable logic.
What an exciting week in NHS IT! Sorry I’ve been hiding for a month but we have all been intently focussed on launching version 2 of askmyGP. It draws on our evidence from 46,000 patient episodes in version 1, but the software and delivery mechanism are all new.
So if I said the rollout of the new system went exactly to plan, all pigs were fed and ready to fly, you’d call me a liar and you’d be right.
We were ten days late going live and patients had to go back to the telephone. We had one of those unexpected problems that got through all the testing and didn’t appear until the real world stomped in. We had to spend the weekend fixing it.
Then it worked. Already we’ve had good feedback from the first 300 patient uses, and some great suggestions from the first 7 practices which we have already implemented.
So what’s new? I won’t do too much detail for now but the step in thinking is all about flow. We know about demand, we know it’s predictable and very nearly flat (BMA refers again to “soaring demand” in its manifesto. They haven’t bothered to measure) but we know there’s no simple way to cut demand (we’ve tried like everyone else, and it doesn’t work).
The demand is the demand. But we can do much better if we make it flow, from entry to completion. The new askmyGP is designed exactly to enable that frictionless flow.
Delivered not on NHSmail but over N3, the new system is designed for greater security and reliability…
And then of course Wannacry happened… we switched askmyGP off on Friday night as a precaution but found no evidence of any incursion, so came back on Saturday lunchtime. Already a couple of dozen patients have entered demands at the weekend. They know not to expect help until Monday, but that helps the practice smooth out the morning rush on the phones.
Aha, the beauty of being open all hours, but not there all hours.
Can’t wait to tell you more, it is so exciting, but it’s getting late.
PS Not one but two practices complained to me that demand has been very low the last couple of weeks. I put it down to three causes.
1. Weather. In a demand led system, you get the immediate benefit of the sunshine dividend. If you’re booked up three weeks in advance, you never notice.
2. Randomness. Knowing your average demand and planning capacity for a bit more means that most days are less busy than planned.
3. Anxiety demand has dropped – both practices launched six months ago and patients have got used to the idea that there’s no need to plan illness in advance – the GPs are there when you need them.
Happy days! Now try getting Pulse to publish that.
“A year ago in February 2016 we took the plunge and embarked on GP Access. The time between making that decision and going live was barely 4 weeks, but in that time Harry and his team analysed our data, gave us information about staffing levels, leaflets and publicity for our patients and training for staff.
Since then we haven’t really looked back. It is fair to say that some of our patients have taken longer than others to get used to the system, but now mostly they all understand how it works and comply. We do still get the occasional walk-ins, but manage these effectively. Our DNA rate has also dropped dramatically.
We have developed our own way of using the system, which is unique to us – but that is the beauty of the concept.
From the point of view of our patients, in particular those who ring in the first couple of hours of the working day, by mid-morning most will have spoken to the Doctor of their choice and be coming to the Surgery either to have a face to face consultation with a doctor, nurse or to have investigations carried out prior to a GP appt… Or at the other end of the day, those phoning after 4pm have been called back and seen by 6pm if that is what is needed!
We often get remarks about the lack of patients lingering in our Waiting Room and it was interesting that when the CQC came to inspect us only a couple of months after we had embarked on the new way of working, they were most disappointed not to find anyone who had waited ‘hours’ in the Waiting Room to interview opportunistically. I think it came as quite a shock to them!”
Michèle Hole, Senior Receptionist, Millbrook Surgery, Castle Cary, Somerset.
See what a Millbrook patient wrote in the local paper in June 2016.