sunnybank medical centre

Dr Graham Hillary & Susan Dawrant

SunnyBank Medical Centre

Moving Towards Advanced Access


Organisation at April 2000

6 Doctors 4 Full Time

2 Part Time

Locum Cover

4 Practice Nurses (2.3wte) Recruiting:

Treatment Room Nurse

HCA

Phlebotomist

List Size 9400 + increasing

Clinical Appointments 10minutes

Full Time GP 21.75 hours surgery per week

24.25 hours surgery per week at holiday time

Fully Computerised Paperless


Demands on Time8 Weeks Holiday 2 weeks Study leave

No Bank holiday work Closed Wednesday Lunchtime

In-house Diabetic Clinic Outreach Diabetic Session

ENT Outreach Minor Surgery Sessions

Undergraduate Teaching Training

Acupuncture PCT Meetings

Collaborative Core Training Session

Management Meeting


April 2000• Appointments booked up to 8weeks ahead• Held appointments (Routine/Reserved/Urgent)

• Long queue for routine appointments

• 3rd Available appointment - Average 9days

• Up to 160 - 200 DNA’s per month

• Low staff morale - constant pressure for limited availability

• Patient satisfaction poor

• Duty Doctor always very pressured


Matching Capacity to Demand

• Understand Daily Demand

• Measure requests for Appointments over a one week period.

• Tally Sheet.

• Analyse results

• Average of 20% - 30% shortfall


Review Workload/SystemsPDSA Cycles

• Maximise manpower on days of high demand.

• Monitor follow-up• Delegate to the most appropriately trained

clinical member of the team.• Length of appointments/type of consultation• Reduce DNA rate


Working Smarter not Harder• Match the Team to the work

• Expand the role of the Nursing Team

• Nurse led Specialist Clinics

• Treatment Room Nurse

• HCA’s

• Phlebotomist

• Salaried GP

• Locum Cover


Increasing alternative forms of Access

• Telephone Consultation

• Trialing the System (PDSA Cycles)

• Evaluation & Review

• Implement & Trial New System

• Re-Evaluate

• Monitor


Increasing alternative forms of Access

• Telephone Consultation.• Routing patient to other healthcare professional

where appropriate • Group Consultation (Smoking Cessation Clinics).• Outside Agencies Clinics - Benefit Advice/Cancer Support Team • NHS Direct • Self-help - other agencies• Video/Leaflets/Booklets for patient use.


Appointment System for GP Bookings

• Highest Demand/Maximum Capacity • Monday - No pre-bookable appointments.• Tuesday - Friday • 50% of appointments are bookable up to 3

working days in advance. • A GP can override the booking policy• Telephone Consultations

• Duty GP would triage request for appointment once availability exceeded.


Advertising the Changes

• Communication Across the Team

• Reception Team inform patient when taking appointments.

• Practice Leaflet

• Handouts available in reception

• Flyer included in routine correspondence

• Call Display


Unblock Future Capacity• Commenced New Appointment Booking

System from Jan2001.

• Diary Planned and New Appointment System implemented.

• Existing Diary not extended beyond Christmas.

• Over Christmas & New Year no prebookable appointments for any GP.


Evaluation - PDSA Cycle

• Initially no appointments may be booked more than 3 days in advance.

• Concerned about creating an artificial backlog.

• Evaluate after a 6 month period • Increase the booking time to 7 days in

advance.• Unequal spread of demand across clinicians


Appointment Availability 2001

• March-Spare Capacity in the System 92% of the time.• September-Spare Capacity in the System 97.5% of the time

• Spare availability not always utilised– patients’ preferred time option– choice of clinician– timeframe available to book appointments


Organisation at October 2001

6 Doctors 4 Full Time

2 Part Time

1 Salaried GP 8 Sessions per week

Long-Term Locum 4 Sessions per week

6 Practice Nurses (3wte) 3 G Grade 2 F Grade 1 D Grade

2 HCA (1.5wte)

Phlebotomist (Extended Role of Receptionists)

Training Reception Members to undertake HCA Role

List Size 9600 + increasing

Clinical Appointments 10minutes

Full Time GP 18 hours surgery per week

21 hours surgery per week at holiday time

Fully Computerised Paperless


DNA’sPreviously 160 - 200 per month

• March 38• 29% GP Booked Reviews

• 26% booked on same day

• 5% booked 1 day in advance

• 24% booked 2 days in advance


• September 40• 8% GP Booked Reviews

• 53% booked on same day

• 13% booked 1 day in advance






Conclusion• It Works• Match manpower to demand (holiday/sickness)• Routing the patient to the most appropriate member

of the team.• Increased accessibility • Reduced DNA’s • Less harassed staff• Patients have stopped playing the system• Positive feedback from patients/staff/clinical team• Empty slots


• Sunnybank Medical Centre 01274 424111

• E-mail [email protected]

• National Primary Care Development Team

• E-mail [email protected]

mailto:[email protected]

sunnybank medical centre

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