The appointment system and relevant local practice survey was regularly discussed at each PRG ‘face to face’ meeting providing the group with a continual update of patient responses and offering all involved an opportunity to consider what actions needed to be taken. The ‘virtual’ group were asked and able to comment on the local practice survey findings using email, via feedback forms on our practice website or via social media networks.
These local practice survey discussions occurred at PRG meetings held on Wednesday 27th March 2013, Wednesday 2nd October 2013 and Wednesday 15th January 2014.
The completed local practice survey for 2013/2014 was presented to the ‘face to face’ PRG at a meeting held within the practice on Wednesday 15th January 2014 by Joe Icke (Practice Manager) and Lucy Jones (Deputy Practice manager).
Riverside Surgery and the PRG felt the priority issues arising from the initial review following the introduction of the new appointment system were whether it was a valuable use of GP time phoning patients back when the patient had already telephoned the surgery. The PRG felt it was often an unnecessary duplication of work for a system that was already under considerable strain.
Feedback from the second local practice survey concerned patient confidentiality and privacy issues when receiving calls from the GP. Working environments and waiting around for a return telephone call from the GP was seen as a barrier to receiving appropriate care from the new appointment system. Some members of the PRG had also experienced the difficulty of this issue and had been unable to take a returned call while at work whilst others preferred the option of receiving telephone calls in the privacy of their own homes without the need to make a special journey into the practice to see their GP.
Feedback from the third local survey concerned patients’ frustration at being unable to book an appointment in advance. They felt the system was preventing them from seeing their GP and telephone consultations were not always appropriate. A member of the PRG, that had not used the system, felt the GP would deal with them over the phone rather than see them and that serious problems could be missed. They were also concerned about patients who would have great difficulty in having a telephone consultation e.g. those who were hard of hearing.
It was agreed, from feedback from the initial local practice survey, patient’s complaints etc. and subsequent PRG meeting, that an alternative should be introduced that would alleviate duplication of workload for the GPs.
In June 2013, Joe Icke (Practice Manager) along with Janet Turner and Sharon Stratton (Senior Receptionists) worked together to develop a GP ‘assistant’ process to help the GP to manage their patient workload better.
As Riverside Surgery operates a personalised list for patients each GP develops knowledge of their patients’ history and can usually determine whether they needed to see the patient or can deal with the problem over the phone. By using a receptionist ‘buddy’ they can direct the receptionist to book the patient an appointment, give out a result, book a blood test etc. and avoid unnecessary duplication of phone calls. This was put into effect in July 2013 under the close guidance of Senior Receptionists, Janet Turner and Sharon Stratton, who monitored its progress.
Following feedback from the second local practice survey, patient comments etc. and PRG meeting it was agreed that more consideration of patient needs should be made regarding privacy when receiving phone calls from GPs in potentially difficult environments.
In September 2013, Joe Icke (Practice Manager) and the GPs discussed altering the appointment template to allow for patients to be contacted at specific times more suitable to their personal environment i.e. after 4.00pm for school teachers and empowered receptionists to ensure this information was obtained from the patient.
A new appointment template was drawn up by Joe Icke (Practice Manager) and Lucy Jones (Deputy Practice Manager) and rolled out for use in September 2013.
Joe Icke (Practice Manager) and the GPs met in early January to discuss how the new appointment was working and to consider all the feedback from the PRG, patients and staff.
Criticisms, survey results and patient feedback were all taken on board, with the outcome being that there was a need for more pre-booked appointments and more help to be offered for patients who have problems receiving telephone calls from the doctor i.e. those who are hard of hearing, being at work or having privacy issues.
On 8th January 2014, Joe Icke (Practice Manager) and Lucy Jones (Deputy Practice Manager) developed a new appointment template to allow patients greater flexibility in the healthcare they receive from their GP. This was rolled out for use on Monday 13th January 2014.
This new system strives to be a hybrid of both the old appointment system and the Doctor First® system. It incorporates both telephone consultations and more appointments (including pre-bookable appointments). The practice receptionists, guided by the Senior Receptionists (Janet Turner and Sharon Stratton), have been tasked by the GPs to signpost patients to the most appropriate type of consultation i.e. to see a Healthcare Assistant/phlebotomist for a blood test, speak to the results team for a test result or see a practice nurse for a diabetic/asthma check etc. This involves the entire reception team being empowered by the GPs in asking for information from the patient to be able to appropriately guide the patient.
Any ‘red flag’ appointment requests i.e. a child with a high temperature or patient with chest pains would immediately require an appointment with the doctor, without exception.
Each day Riverside Surgery has a ‘duty’ doctor who deals with telephone consultations and any emergencies that may arise. They also distribute the daily workload and home visits as needed.
Riverside Surgery’s GPs openly acknowledged patient and PRG feedback. They agreed the need for change and felt that to ensure their daily workload was manageable they would need supplementary help for the duty doctor.
In January 2014, following the introduction of the new appointment template, Lucy Jones (Deputy Practice Manager) was tasked to arrange additional daily GP cover through the use of locums in order for the duty doctor to manage their workload more effectively.
At the PRG meeting in January 2014, Riverside Surgery’s PRG members were invited to comment on all the local practice survey findings, asked if they agree with current actions or if they would propose an alternative solution.
A discussion followed re the benefits of the Doctor First® system as against the old system of booking appointments and having to wait several days or weeks to get an appointment.
Following the discussions of the outcomes of all the local practice surveys Riverside Surgery asked the PRG members if they were happy with the proposed changes and to consider whether they would do anything differently.
The PRG member that had previously found it difficult to take telephone calls at work had been impressed by the changes implemented and had received a ‘call back’ from the receptionist with an appointment time to see their GP which avoided wasting the GP’s time calling them back and removed the problem with privacy.
The PRG member that previously had not used the system and was concerned about the GP using the telephone consultation to avoid calling them in for an appointment had subsequently needed to use the service but had been seen by their GP and was extremely happy with the treatment they had received.
It was agreed that Riverside Surgery should continue with the proposed changes and any further comments or ideas could be raised either at the next PRG meeting or passed on directly to the practice staff for consideration, via Lucy Jones (Deputy Practice Manager), and cascaded to all other members of the PRG.
Riverside Surgery also asked its PRG for suggestions for the next local practice survey to be considered and brought to the next ‘face to face’ PRG meeting for discussion.
The PRG also discussed how the fact the Riverside Surgery had listened to patients viewpoints and had proactively reacted to complaints and criticism by incorporating new ideas and adapting its ways of working in order to benefit their patients. It felt this positive action should be promoted widely across the practice population and the wider community to show that patient voices are listened to and action has been taken.