Witley & Milford Surgery serves 11,200 patients in the rural Surrey commuter belt. Yet the partners felt under pressure, not in control.
They weren’t providing the service their patients deserved. Dr Dave Triska and colleagues explain what happened from June 2018. Below the video, see the numbers.
Charts on demand volumes, patterns, response times, channel of demand and response, continuity and patient satisfaction:
Witley and Milford charts to 14 May 2019
It was a tweet from a regular GP partner (yes, they’re all special).
It was last Sunday lunchtime. Why then? For fun. For sharing. For sheer joy and pride in work. For having something to say.
It had the image of a runchart, that simple device which is still the best way to show what happens to some characteristic over time, this one monthly from Feb 17 to Feb 19.
Now what’s remarkable about the characteristic is that it’s “Average days waiting to see GP”. That may seem obvious enough to a patient (oh yes, we’re all patients) but this was from a GP.
If you’ve noticed in all the medical press, Pulse, GP Online, BMJ, NHS England and so on they all harp endlessly about the pressures of workload, stress, burnout, early retirement of GPs and so on, but nairy a word about patients.
Now here’s a GP doing data about what matters to patients. How long to get help.
I can almost feel that defence welling up inside you “It’s not the only thing that matters to patients!”. Yes, we know it’s not the only thing, what also matters is the professional care they receive, and for many relational continuity with a named GP. But there’s no point in praising the wonderful professional care which patients can’t actually get.
Everyone knows the single biggest theme in the general media concerning GPs is the time waiting to get help, and in our own surveys of practice staff, the dominant theme is the difficulty in giving patients the help they need soon. Equally, the dominant theme by far in our patient feedback is gratitude for the speed of response.
Yet nobody is measuring the waiting time, what matters most to patients. Where are you NHS England, Scotland, Wales and NI?
We must turn to the story in the data. From Feb 17 to May 19 it starts with a range between 2 and 5 days wait, variable in such a way that stats geeks call “out of statistical control”. Others would say it’s all over the place.
Then it changes completely to a new mean of 1.5 days with random variation of +/- 0.3 days. This is in statistical control.
If you aren’t curious yet, there’s more. Discussion follows where the author Dr Dave Triska of Witley & Milford Surgery is asked what extra resources he needed to achieve this. “Mmmm we didn’t recruit anyone, in face we lost 6 sessions as we changed over due to retirement”
There’s no shortage of GPs here – they’ve saved a whole one.
What about personal care, stress? “It’s a pleasure most days to give people what they need – rarely overrun now even with 30mins with people dotted through the day”
So some patients are getting half an hour. And by the way, we know they achieve 91% continuity, choice of named GP.
People, this is history in the making, I don’t know how it will be looked on in the future but I’m calling it:
Be the witnesses.
01509 816293 / 07939 148618
PS Welcome to see how patients interact with askmyGP on our Bramley Demo Practice.
To experience the GP side, start with our free online demo.
Today’s guest blog is by Dr Hugh Reeve, senior partner at Nutwood Medical Practice in Grange-over-Sands, Cumbria. Not exactly a population pyramid, with 40% of patients over 65 Nutwood boasts more of a population parasol.
Below is his series of almost daily tweets over the two weeks since launch, and I think as the story unfolds you will be moved as I was.
Over to Hugh…
6/2/19 Day 1 AskmyGP. Wow – all today’s work done today. Online take up impressive for day1. Staff coped – 2 said it was best Weds ever! positive pt feedback. Drs slightly frazzled getting head round new system and strange only seeing f2f 30% of usual numbers 😀
7/2 Day 2 @askmygp 89 yr old sent me online message about her shoulder! Our salaried GP cleared all her admin & finished at 5.30-first time she’s left before 6.30 in 3 years. We had 62 new requests for help -phone and online-of these saw 15 people f2f. We’re cautiously optimistic!
8/2 Day 3 @askmygp GPs managed am and pm coffee breaks. 76 problems sorted – 32 f2f and one home visit. 89yr old who emailed yesterday sorted – one phone call and joint injection arranged next Tues. Old system would have taken at least 2 weeks! Next Monday’s rush the real test!
9/2 One of my partners told us of the incredulity and gratitude of a patient who was seen in surgery one hour after sending an email for a non-urgent problem.
Anyone that needs a physical examination we arrange to come in and see us – the same day they contact us , or visit at home. We now also get tests/xrays etc done first and then see people. Previously we phoned about 25% of pts and saw 75%, early results we see about 30% now.
Our access not bad at all but as you know continuity a real issue. Early signs are it could really help this.
11/2 Day 4 @askmygp – best Monday in 13 years at Practice. Gobsmacked! Pt with ?intracranial bleed after HI 10d ago-sorted CT-pt wanted routine appt, 10d wait on old system. Colleague spent 40 mins with pt who burst into tears at reception, she still left at 4.45pm with clear desk!
13/2 Week 1 @askmygp A revelation! 373 contacts of which 71% by phone and 29% online- this for a practice where 40% patients 65 or over. Of these we saw 30% f2f. Staff love it – no more telling pts no appt. Feedback from pts so far almost totally positive No downsides yet! I’m 😄
Pt feedback from pts at our Practice using online service @askmygp in week 1. Amazing Wonderful Excellent Brilliant Worked perfectly Professional Quick Instant Superb Astonishing First class modern service Time saver Reassuring Good technology. This is surely what it’s all about😀
14/2 Real test for new @askmygp system today. One GP sick leaving 1.5 GPs to do today’s work. Real benefit of no full surgery to rearrange-just one person booked in. At end of day all work sorted. One GP had 48 contacts 40% f2f, said still better than when crisis hit under old system!
15/2 No signif downsides as yet Peter. However have to make sure enough capacity available each day and understand the predictable demand for each day of the week otherwise the system will grind to a halt.
20/2 2 wks @askmygp. Getting used to system and love it. Pts seem to as well 34/37 online users think it’s better. 33% of all contacts coming in online and increasing by the day. More time to follow things up, phone people with results etc. Waiting time for a routine f2f appt <1 day!!
We still have work to do adjusting to a radically new way of working. Also fair bit of preparation beforehand. But so far gone better than we expected!
We book very little in advance now, starting the day with near empty schedule and as far as possible deal with today’s work today. At present we see f2f about a third of people who contact us and deal with rest either on phone or online.
Thanks Sam. Have never fallen out of love with general practice but was definitely very jaded. Now in my early 60’s and feel like the embers are starting to glow and real energy returning. Sounds a bit corny I know but true. This will keep me working – because I want to 😀
“Private providers could grab unlimited share of GP consultations online” runs the heading in GP Online.
“Babylon GP at Hand given green light to expand NHS services into Birmingham” – to the usual outcry from BMA.
“All patients to have the right to video and online consultations by April 2020”. Have I got the right April? Why is it always April?
Let’s look at what GP at Hand have actually done in their 18 months of operation. At a cost of blanket advertising around the capital, they have recruited just 40,000 or one in 200 Londoners to their video-led service. I hardly think this merits the cries of barbarians at the gates.
But as we know people are led by feelings much more than facts, and all the headlines are designed to scare you.
They want you to feel threatened, that your livelihood is at stake.
They want it to “feel like” extra work – because anything ordered by the government must be extra work.
They want you to “feel like” you are being bullied into change, you’ll have to be different, and you don’t want it to be different, you didn’t sign up for this, and what do they know about your real work?
It’s a shame because very few GPs have considered the possibility that with the right design, digital first could enable you to be a better GP, providing a better service for patients with less work.
A practice we’ve worked with for eight months now is Witley and Milford, and some of their GPs were discussing the outcomes on Twitter this week. They are one of our fastest operators, with a median time to complete patient requests of 48 minutes (that’s all demand acute/routine whatever, and that’s completed, not just first response). They are also one of our highest for continuity, with 94% of patients who made a choice being helped by their chosen clinician.
All they have done is understood demand and flow and organised themselves around those principles. With over half their demand arriving online, they are a digital first practice, and it’s a joy to be a GP or a patient.
Many sage commentators tell us of the trade off that must inevitably be struck between Access and Continuity. I tell them Witley and Milford.
01509 816293 / 07939 148618
“Oft as by winding Nith I, musing, wait”
Given the day I couldn’t resist a line of Burns (the river Nith rises in Ayrshire), and this one captures a favourite mood of mine, musing, waiting, the moment rich with possibility.
Then something happens.
Dr Barry Sullman is one of those infectiously enthusiastic people who is an absolute pleasure to work with. As you will see, he has gathered around him an equally joyful body of staff. We just couldn’t stop them talking and the hardest part has been editing this down to just under three minutes. It could have run for hours.
He talks about quality, service and sustainability.
He talks about the calm, relaxed atmoshere, going home smiling.
About efficiency, saving the first year costs two or three times over (and that’s in only nine months).
I showed this to a visitor who said others might think it’s a spoof – why would people say that and who is paying them?
The truth is very simple, Barry is a regular paying customer, the same as anyone else. What’s more, he has turned down a competitor product offered by the CCG, for free.
Yes, there is a select band of GPs who are capable of making their own business decisions as independent contractors. When they see something which gives their patients better service, at lower cost to the practice, and with a return on investment of 300%, they know what to do.
Are you one of that happy band?
Just check again whether you really want what Barry has.
Right now, free, see how GPs such as Barry run their day, with 50 randomised, anonymised patient requests. It takes about 15 minutes.
Apply for your Digital Triage Experience and then invite your partners.
What are you waiting for?
PS Barry wrote to me last Monday: “Had a really hard day today. Made breakfast for 2 children. Took them both to school. Got back and did some work. Went to the chippy for lunch with the wife. Relaxing cup of tea and started my face to face 3pm.”
Then on Thursday: “I have been listening to what makes a job fun or awful. I think the constant interuptions at work make it so stressful. With askmyGP I can stay at home – a place of zen like peace and tranquility. Then come to the surgery for a short focussed session. This is a great system – and it’s getting better.”
Shotts, North Lanarkshire. Small town and surrounding areas, ex-mining community. Traditional, somewhat deprived area.
Dr Sue Arnott, full time single hander GP. Team consisting of 8 session ANP, practice nurse.
“We were looking to do things completely differently”
As well as hearing the story, you may like to see the data.
Today’s blog is by a patient, with permission and reproduced here in full. It’s the longest comment we’ve ever received and while it followed a normal request from a patient to his own GP near Ely, the vision takes flight.
“This new system will make the most enormous improvement to NHS healthcare and waiting lists at both Health centres and A and E there has been for many years.
The many advantages are obvious and predictable. It will greatly enhance the chances of speaking directly to your GP as soon as possible IF the patient has a potentially serious, or possibly life-threatening condition and even more important will allow the GP more time to read a carefully thought out email of the condition the patient is worried about.
It will also allow the GP to filter out timewasters, or people expecting Antibiotics for a virus, with the expectation that it is all they need and completely missing the whole point of why and where there are prescribed and therefore further reducing the effectiveness of antibiotics and the increasing resistance of viruses to them.
As a result, the waiting times for an appointment will be more responsive to the apparent severity and urgency of the individual patient’s condition and allow the GP to carefully analyse and make informed decisions on priorities regarding urgency, or non-urgency of face to face appointments.
Expectations and confidence amongst young parents in their local health centre will gradually rise, rather than immediately adding to the long list of worried people turning up and waiting in line for hours at A and E always wanting immediate attention from hospital staff who neither know them, or are aware of particular people who worry, perhaps too much, about their children’s possible health problems.
Given the constant and continuing limitations and financial constraints on the NHS in general, and healthcare centres in particular, this will prove to be one of the most considerable improvements to the healthcare system there has ever been! Great idea, hope every other NHS medical centre follows your lead.
9th October 2018”
This week marks seven years since I registered GP Access Ltd, aiming to make it easier for patients to get help from their own GP, and easier for GPs to provide that help. While we had the germ of a method from pioneering GPs including Chris Barlow and Simon Coupe, I knew that if we were to survive it would be through things not yet invented in 2011.
It hasn’t been easy but sometimes there’s a shaft of light, and Mr Tiley’s unsolicited comments encapsulate so well what we do that he deserves his own blog.
His practice, Staploe and Cathedral, launched on Monday and in five days has seen a complete transformation of their service. The wait to contact a named GP has dropped from weeks to minutes, and despite unplanned GP leave they have coped with all demand on the day.
Well done and thank you.
This was launch week at Witley and Milford Surgeries, serving 11,200 patients in Surrey. Dr Dave Triska is their change leader and it seemed best to record it in his own words. All I’ve done is copy everything he put in the public domain, on Twitter @dave_dlt:
He starts on Weds 6th June:
Currently in the middle of the best working week of my career with @askmygp
Third day with @askmygp . Every single person who wanted to see me did. Had lunch, tea breaks. Saw colleagues. More relaxed seeing patients. Held fort alone for PM, no dramas.
Day 4 with @askmygp . Demand easing off now, clear slots throughout the day. No one turned away
Day 5 of @askmygp. Demand dealt with (its Friday!) by 0920. Oldest user 91.
@askmygp day 5. Quickest response 30s today, having mid morning catch up with my team. Patients happy, staff happy. No wait.
Day 5 @askmygp . Patient seen and sorted for painful condition within 30 mins contacting surgery. “I didn’t believe it could be true, I’m converted”
Day 5 @askmygp . Lunch eaten. Catching up with patients I need to, because I have time.
End of 1st week with @askmygp. Busy but manageable, all patients helped. New way of working to get used to but thrilled practice team and thrilled patients
Usually it gets better so things are looking pretty good so far!
We keep talking about a (very short) journey of change, and immediate benefits, so it’s very encouraging to us when people tell their own story like this – though there are bound to be bumps too.
Funny how GPs are always asking us whether they can visit somewhere or speak to someone and we do our best but… there are limits.
So I’m doubly delighted that Dave has agreed to join us for the webinar next Thursday 14th June at 1pm.
I’ve scratched the previous agenda on (boring but important) return on investment and we’ll hear about how it feels on the front line at the head of the peloton.
Sorry to mix metaphors but I’m trying to combine former Army medic and mad cyclist references!
Anyway, it will be real, immediate, warts and all. Lots of folk have told us they get most value hearing direct from GPs.
Click below to book now:
Webinar Thursday 14/6 1pm: Witley and Milford Launch – as it happens, with Dr Dave Triska.
PS Now much more detail on a 45 minute webinar recording
Want to get started now? Pathfinder: Could you be ready to change?Practices in the north west, Wales and London have started the process this week.
Last week’s webinar, Dr Chris Thompson pres to Leics CCG
This time yesterday I was in Plaistow, East London and while Cockney rhyming slang is spoken in these parts, you are as likely to hear any of a dozen East European or South Asian languages on the street. It’s quite deprived and extraodinarily diverse.
I was visiting Balaam St Surgery. As anyone knows in general practice, it is pandemonium first thing in the morning when the phones go over. So here’s what Nihul on reception told me:
“We only had three phone calls between 8 and 9 this morning”
That dog and bone just lay there.
Practice manager Divya came out to ask what was not going on. This is week 7 and the numbers have subsided as they keep giving out the same message:
“Do you have an email address?” – yes
“Do you have a smartphone or internet?” – yes
“Can I tell you about a shortcut to get help from the GP?” – yes
Then they show them the practice website, click askmyGP and take it from there. 80% of demand is now online.
Barry Sullman the GP was working from home that day for family reasons, had all 25 askmyGPs directed to him via VPN and messaged or called them from the home office, bringing some in to see the GP on site.
He tells me Monday – Tuesday are hard work, Weds was fine, he looks forward to Thursday – Friday. This has never happened before. He’s saving money, doesn’t need locums any more, takes the kids to school.
While Pulse moans on about GPs turning patients away, Barry is recruiting patients. He keeps telling me “It’s digital triage. There isn’t the strain of telephone triage. This is the future of the NHS.”
The thing I find difficult is that when I report what they are telling me in their own words, people say it’s too good to be true therefore it isn’t true.
That’s really sad, because while GPs are sitting there moaning and disbelieving, their most profitable patients are turning to GP at Hand to get a service far worse than what Barry and his team are providing from their own local surgery.
Spend 5 minutes in reception when it opens tomorrow morning and see what you could say goodbye to.