Launch day at a practice is something I always look forward to, yet not without a twinge of nervousness – things can go wrong and a difficult day dents enthusiasm which takes time to recover.
Special circumstances at Larwood in Worksop, Bassetlaw were that they had a two week average wait to overcome, and at 32,500 patients were the largest single practice we’d worked with. Their patients were also used to a walk-in service which was abolished with 1 week’s notice, on the same day (simple message, this is the one system now, it has to work).
Well the phone system fails to go over at 8.30 as it always has… 25 patients turn up unaware of the change… but it would have been 100. A small team from management is in the waiting room guiding patients, being helpful and kind, explaining the system.
The start feels a bit chaotic, with queries from GPs trying out their view of online demand for the first time. But work is being done, and by lunchtime we have the first patient surveys – 81% say the new system is better (27/33) and smiles are breaking out.
I hand over the blog to Dr Steve Kell, because he can communicate and all I can do is watch with humbled awe as the week unfolds in tweets.
Steve Kell @SteveKellGP
Quite a day. Changed practice systems today, introduced @askmygp and all patients who contacted the practice dealt with today. Great team.
Hi. AskmyGP – online and telephone access, huge change but great feedback from staff and patients.
Massive change management task but all patients dealt with yesterday, blank screen again today. Fingers crossed.
2 days into full system change to @askmygp:
Really impressed. Different feel to day
Job satisfaction and service ⬆️
Wait – gone
Day 4 of @askmygp – all patients seen so far if needed. Skin problem for 2 years, seen within 20 minutes of submitting message online. ?
Week 1 of @askmygp. Exceeded all expectations. Job satisfaction, responsive and one of the best weeks I’ve had as a GP in 18 years.
Have been doing @askmygp 1 week and never had better access AND better continuity. All my patients can speak to me and see me if needed.
The last word is from an anonymous patient, one of 417 who got help online with askmyGP, about 20% of demand in week 1 at Larwood. It surprised me:
“I like this service as it is more personal between me and the doctor . Also it gives the doctor more chance to look at records so they know what has been done in the past . This means I don’t have to wait time trying to explain.”
Relief. The humans are in control, not the computers.
This page is not for patients, who must find their own practice website to use askmyGP.
If GP workload is your prime concern I’ve got great news: you can cut it by 10% without fail in just four weeks. Simply take 3 appointment slots off your daily template. Boom.
You can even claim some high-minded motive, reducing GP burnout, decision fatigue, keeping away the worried well, timewasters and so on. Your receptionists will have to turn away a few more patients, but they are used to that.
Don’t worry, you’ll be no worse than some other local practice and the CQC won’t notice – they have no way of measuring what you’ve done.
The only folk who will suffer are some of your patients, the unlucky ones, but they don’t have a voice anyway.
If so please unsubscribe, we can’t help you.
There are plenty of others who promise to reduce your demand, divert your patients, make them wait longer, travel further, see someone they don’t want to see at a time they don’t want to go. Much of this is taxpayer funded. Links on request – they just don’t have any evidence that it works.
Want something better for your patients?
Before we begin any change programme we ask the partners a few questions, one of the most revealing of which concerns their ambition for patient service.
Very few admit to “Never mind, it’s all about the money”. A few say “No worse than others locally”, “A bit better than we are” or even “Top quartile performers”. The vast majority go for “The best we possibly can be.”
We can work with them, because they have the inner fire to carry them through what could be tough in the early weeks, as you get used to dealing with true demand.
You will be much more efficient from day one. Typically you will deal with 60% of demand remotely and we measure this (though below 50% the efficiency change is marginal, many are soon even higher. The latest hit 65% in month one.)
Don Berwick, mindful of the need to provide excellent care with finite resources, says “Efficiency is a moral imperative.” It’s far more important to study efficiency than workload, because you can do something about it, now, without waitiing for handouts from someone else, or worse taking it out on patients.
But what about the workload? It’s related but a different question. A big factor is the amount of unmet need pre-launch. We measure this too, with the average at 14%.
The highest we’ve ever seen is 32%, and before that practice launched last week I warned that it was going to be tough. Talk about inner fire – Sue the GP principal told me on Thursday at 5pm that something wasn’t right, she had free appointments right now and time to do other things.
We can’t make absolute promises on workload because of the variables, though GPs continually tell us that they feel more in control.
Our laser focus is on efficiency, never a final answer, always improving, sometimes in leaps like the one from telephone triage to digitial triage, sometimes in tweaks like the half day session plan (ask me how it works, very neat).
Our promise is to help you become as efficient as possible, so you can give the best possible patient service.
Dr Chris Peterson of The Elms, Liverpool, 5 years on:
“It’s more efficient, but it exposes unmet demand.
It’s completely liberating!
We are delivering demand lead care, not capacity constrained. We have no one waiting to see us.”
Can you say that every night when you go home?
Dr Philip Lusty writes:
“I’ve just witnessed a miracle and it happened in Portadown…
Portadown, a large town in Northern Ireland has had significant negative publicity lately with the threatened closure of a neighbour general practice leaving this month 5000 patients without a GP and potential list dispersal. The stress and strain this has put in all those involved in trying to provide solutions and the neighbouring GPs who fear a list dispersal and worry about domino effect is very palpable within the area. The patient population are in fighting spirit as they demand a solution from local government that protected their much loved GP practice and maintained service where they were familiar.
A few metres away at a neighbouring practice where I work, Riverside Portadown, with just under 14,000 patients, the Health and Social Care Board kindly supported our involvement to participate with askmyGP pilot. They had already kindly granted us a list closure following a shock resignation of a partner last June that left us struggling to survive with list size 2,500 per FTE. With further resignations entering into 2017 we faced the real possibility of adding to the problems of Portadown by handing our contract back if unable to rescue our practice, as we had failed to recruit sufficient GP cover to make us feel safe and secure. All the negative vibes have been successful at encouraging young GPs to avoid the area making it even more difficult to recruit.
Preparing to launch askmyGP and overnight change our system felt like our last stand at trying to survive as a practice, bit like the 11th round in a Rocky Movie. Entering into the 11th round we have had some serious knocks this year and been on the floor several times. We have entered into the last round exhausted and beaten and like some of the best Rocky movies, it looks like askmyGP has paid off giving us the tools to get back on our feet again and are punching back with force!!
Everything Harry said would happen has taken place. We had never any need to worry about the change. But what Harry doesn’t fully understand is that in Northern Ireland we never truly believe what we hear and often we expect the worst as part of our personality and when things go right we often wait for everything to go wrong. I know I’d have colleagues reading this now skeptical saying “too good to be true..what’s the catch…” We can be a pessimistic bunch! Plus we seem to have our fair share of skeptics in Northern Ireland “Oh it would never work here our patients are too old..too young…too rural…too many foreigners… etc etc.” I have heard every reason from the skeptics!
Now 5 days into askmyGP I definitely have witnessed a miracle and that is from day 1. There is joy back in my working life again, I have a spring in my step and everyone around me share in the same happiness and success of this new change. A miracle has surely occurred on Monday 11th January and all we did was launch askmyGP overnight!! It did take almost one year of discussion, convincing and then over one month planning the change but it was worth it as all the skeptics (which there are many) have been silenced, and everyone and I mean everyone is very happy…yet some are still waiting for that tsunami.
I am so glad that I and my partners had faith in Harry Longman’s experience and knowledge as he coached us over our fears of change helping us to take the initial steps this week. All the planning and discussion has paid off in spades and to see everyone more relaxed, and doctors saying they have got their joy back of practicing medicine is highly rewarding for me. The reception staff no longer have to face the daily “sorry there are no appointments left for 3 weeks” and all the emergency appointment are gone at 8.40 am and yes sometimes our patients have been known to get verbally aggressive upsetting my staff. No one seems to have been that annoyed by anyone else this week!! The pressure had come off and stress levels are at their lowest.
The “On-call” doctor no longer has to face the 50 plus contacts per day to triage on their own and decide where and when to see them as there is nowhere left and all your colleagues are too busy to help buried in their own same 15 patient surgery that runs same time every day. Now the demand is faced together as a team who collectively take responsibility of the entire days’s work load and everyone feels equally valued. There is time for lunch and on Tuesday I noticed at our pre lunch team meeting with doctors that this went on for about 45 minutes as we just enjoyed the new experience of calm and started to converse sharing other ideas of how to drive the practice forward. No one was in a rush. I now have time to empty my bladder as much as I want, time for coffee break and also time for lunch, plus I am getting home earlier and far less stressed. The change is immense.
The patients are amazed at how easy they get access and are equally delighted that they do not need to attend the practice unnecessarily when something can often get managed easily on the phone. Harry did say we would manage 60% of our contacts on the phone on our first day and when we made our calculation we managed exactly 60%, not 1% more or less on day one. In three days this improved further and last look we had managed 70% of our phone contacts. Our patients are so happy they have offered to write in to congratulate us on our achievements. The praise from our patients this week has been such an encouragement to us as they too value the service they receive from their GP and are only too aware of the stress many of us have been under.
I am 100% wholly converted to no pre booked appointments, manage all your demand in one day. In the current climate of dissatisfaction within the profession, GPs threatening to hand contracts back to HSCB, it is nice for once to have a good news story where other than the money to fund the expertise of Harry Longman and his team there has been no cost to the practice thanks to the funding from HSCB. The first person who introduced me to the concept of askmyGP was Bride Harkin, one of the assistant directors of commissioning in Northern Ireland, when she sent me an e-mail during my time as GP on her local commissioning group. Bride wanted to take all the credit if this week had been a success!! There is a revolution taking place and I urge all politicians and policy makers to take note and wake up and see some of the positive contributions to health care that can happen and I urge you all to listen and follow Harry Longman in his quest to change how we can operate.
I have witnessed a miracle and a rebirth in our passion for delivering a high quality service again for our patients. Time is our most precious resource for caring and now I feel more in control to give that time appropriately to those who most need it and show Care with big C that one of my old partners used to talk about in a previous role.
Like Rocky Balboa I think we’re now well off the ropes, bit battered by experiences, but you know what I think we’ve lost some of that pessimism and we might just attract that new doctor we need now to the practice. If that happens not sure where can stop us.
Harry thank you so much for your patience with us as we took our time to consider our options. Bride I know you’ll read this and what can I say but you are one of the many excellent examples of good leaders I have witnessed within my time at Health and Social care Board and I think you deserve some of the credit!! Can’t forget Margaret, Sloan or Keith either!!
Things can only get better!!