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:
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 😀
“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.
Increasingly practices ask us how others use askmyGP, so we have collected here examples with agreement to be in the public domain.
Please be aware that they are all busy GP practices so have not committed to answering in person an unlimited number of queries. They are all different in some respects from your practice, yet they all share common features of a registered list of patients whom the GPs are committed to serve.
They are all on a journey of change, which started with Pathfinder – could you be ready?
Concord Medical Practice – 14,500 suburban family practice, north of Bristol. SAPC poster.
Central Surgery Oadby – 8,700 suburban Leicester. Presentation given to the CCG. Webinar with Dr Chris Thompson Online Consults – Our (very short) Journey of Change
Balaam St Surgery – 5,600 East London practice, blog post of interview.
Witley & Milford Surgeries – 11,200 rural Surrey, two sites. Dr Dave Triska @dave_dlt tweets as launch unfolds. This 45 minute recording could change your life: Witley and Milford launch, as it happens – Dave Triska interview.
Every practice will work out their own mode of operation, and with our help can seek to optimise effectiveness and efficiency. Each of the above sees between 30% and 80% of demand arriving online and their numbers are part of over 70,000 patient episodes managed through askmyGP in the first year of version 2.
“My costs have shot through the roof” says Barry with a chuckle. “It’s the school holidays and I’m taking the family out to restaurants every night” (a list follows, burgers, pizzas, curries). Barry Sullman first made contact with us on 28th Feb and I met some of the family on a video conference because Sunday was the only time he had a minute to spare. He was working until 8pm and secretly wanted to finish at 6pm so he could rejoin the human race. To be on the safe side he told me 5 but I didn’t promise. Two weeks since launch he tells me he’s going home at 4. Except for Thursday when he phoned me at 1, from home, complaining that his salaried GP had nothing to do most of the afternoon, one patient booked at 3.45. So he’s changed his plans to recruit a GP and instead will take on an ANP to run the shift until 6.30, CPR trained, as he’ll refer appropriate patients and his work is done by 4. That should pay for a few nights out. He impresses upon me the difference between telephone triage (which he’s tried) and digital triage: now he doesn’t spend ages on calls which are really non-medical. Reception have done them, or he’s emailed a message. So he’s not drowning or suffocating. He’s prepped for the consultation, may have looked up previous notes. He’s impressed by what the patients write, quite detailed, even helps with the non-English speakers. He’s choosing who to see face to face, no more, and it’s all done today. He doesn’t have to up type all the symptoms, just copies into the clinical system. He has gone straight to 70% of demand arriving online, which is 250 per week, and it’s ever so simple how they’ve done it – while not forcing anyone or shutting the door for those who can’t. Patients are happy, reception is peaceful. Barry epitomises the GP who is self reliant, independent, committed long term to his patients, business oriented and decisive. But his Balaam St practice is different from yours – deprived East London, young, multi-ethnic and many non-English speakers. Maybe your practice is more like Joanna’s: prosperous, elderly, all speaking the purest Somerset. They launched this week too, having just lost a GP partner and another on holiday. With a quarter of their capacity removed, and costs saved, they’ve transformed the service in a single week, all patients sorted. Had to scrabble around to find things for the locum to do on some days. She tells me “We couldn’t have done it any other way. This is infinitely better.” Barry, Joanna, dozens of others: big smiles. You? Feeling overwhelmed, helpless perhaps? What is the difference between them, their practices and you? Nothing at all, just that they made a decision and got on with it. Kind regards Harry Longman
A week later on 27/4/18 a GP in a Welsh practice emailed these questions:
Could I ask you first how long since you launched the system ?
As with any change to our appointment system, there is always a honeymoon period, then the rot sets in again, I wondered if you felt any loss of efficiency the longer you run AskmyGP?
And some more specifics:
1)How did you/ do you manage ‘walk-ins’?
2)Was there any backlash against loss of the GP early morning slots for working folk?
3)Do you work with Nurse Practitioners? We have three who see a lot of our minor illness.
4) Can you give me examples of which appointments you do allow to be booked at reception ( CDM? Nurses?)
PS: One other thing in common, both practices invested in Pathfinder and then Transform themselves. They didn’t wait around for months or years hoping the taxpayer would pay for them. PPS: My colleagues and I absolutely love the work we do with practices like the above. But do spare a thought for us at this difficult time. My least favourite activity is the essay writing contest which is NHS England’s Dynamic Purchasing System for Online Consultations, a Sisyphean task as meaningless as it is mindkilling. If I may use an analogy, our Digital Transformation Strategy Engagement Delivery Leads go to a gallery and see an inspirational painting. A painting can’t be painted without paint, so they think it’s about paint. They specify the paint in finite detail, colours, hues, formulation, viscosity, non-toxicity and so on, with which specification all suppliers must comply. By Monday at 12:00:00. They are surprised however when the outcomes are revealed – instead of a series of Leonardos, Picassos and Monets, the precisely implemented procurement process has produced brown walls.