“Did you see Question Time last night?” This question was to change the direction and focus of the next 18 months of practice life for one general practice in Epping!
During the last election campaign there was a pivotal point in which the focus shifted from the war in Iraq to 24 and 48 hours access in general practice. The question concerning booking an appointment with a GP asked of Tony Blair just happened to be by one of the patients from Limes Medical Centre in Epping, Essex, who were suddenly thrust into the spotlight.
Access and demand management have always been key issues at the practice, which cares for 16,000 patients in leafy, suburban Epping, Essex. After the media attention had faded they decided that tinkering with systems was no longer possible and an overall review of how patients access the services that the practice offered was needed.
The practice had three aims – to ensure that it offered the right service to the right patient at the right time; to keep staff motivated and satisfied; and above all, to ensure that the system facilitated patients who need to be seen quickly.
“Our philosophy has always been one of inclusion,” explained Tareq Abouharb, GP Principal at the practice, “so we knew that if we were to tackle the many issues that access raised, we needed the involvement and commitment of the whole practice team.”
In order to facilitate this project the practice assembled a project core group, consisting of a project lead, a manager, a GP, a nurse and a receptionist. After much research and information gathering, including weekly meetings, speaking to other practices, studying all various PCT and DH guidelines, and interviews with all staff, patients and others customers of the practice, such as the district nurse team and PCT staff , the tenants of a robust access pathway emerged.
Of course the process wasn’t that simple. In order to implement it the practice spent many hours in clinical and nonclinical team development sessions, identifying training needs within the team, and implementing operational changes. Teams would need to work differently so time was set aside to look at rotas, team structures as well as identifying a strategy to launch the new system.
Hardware needed to be updated, including the telephone support programme. Explanatory documentation had to be prepared. A meeting was set up with the PCT to present how the practice hoped to run the new system, detailing preparation and breadth of sign up. The PCT were very supportive of the change, and enthusiastic to the point of talking about potential applications in other areas of the patch.
But finally Limes Medical Practice was ready to launch the new system, and it proved an instant success. Eighteen months on from its conception, the practice has put together a list of the key improvements brought about by this new system:
- Acute and chronic care pathways are now clearly identified.
- Skill mix within an already innovative practice has been taken to the next level and the boundaries yet again challenged.
- Patients are happy that they can book follow-up appointments with their clinician up to six weeks in advance giving them excellent continuity of care.
- The number of duplicated appointments has been reduced.
- Staff satisfaction levels are up.
- The number of patients complaining about the system verbally and in writing has reduced.
- The new coordinating role for healthcare assistants built into the practice’s chronic disease appointment management saves both clinicians and patients time, and reduces duplication in managing multiple overlapping chronic disease areas.
“We feel that the timing of these changes could not have been better for us as a team,” commented Dr Abouharb. “We are now ready to face the increased competition in the marketplace knowing that we have robust and safe systems for our patients. We can now identify our unique selling points and have a platform to look at extended hours. No project of this nature ever really has an end and no doubt we will continue to make changes along the way.”
The improvements that Limes Medical Practice have made to their patient access made them a clear candidate for the “Practice of the year” award at the 2008 MiP Awards. But will they win? Winners will be announced at the MiP Event at Birmingham’s NEC on 8 October.
