Using data in a more meaningful way has enabled a large practice based in Hull and York to improve distribution of workload, increase efficiency and better meet the needs of its patients.
Haxby Group, which has 10 branches, a 50,000-patient list size and 23 partners, started to review and analyse demand in November 2015 as part of an initiative called the Proactive Project. The project was aimed at making GP workload more manageable and improving service delivery.
The practice employs advanced practitioners such as paramedics, nurse practitioners, and clinical pharmacists to handle growing patient demand and reduce pressure on GPs so they are freed up to focus on patients with more complex conditions.
Aims of the initiative
GP Dr Michael Holmes, a partner at Haxby Group and RCGP clinical lead for general practice at scale and QI Ready, explains the practice was keen to ensure that both clinical and non-clinical workload was being distributed appropriately among those teams, the right services were being provided in the right places and to assess whether there might be any spare capacity.
‘We are used to using data to manage our contracts and trigger payment but as many colleagues are now suggesting, we felt there was a level of detail we weren’t capturing that would help us continue to innovate and shape service delivery.
‘There are not going to be enough GPs in the future to continue to deliver the service currently provided so we have to look at different ways to improve efficiency. We were motivated by the work NHS England are doing to support this.’
Data was collected from six of the practice’s surgeries in York around administrative workload, task allocation, the demand and number of appointments offered of all types, how appointments were booked, the number of appointments used and the number unused according to the population of the practice.
The information gathered was placed into a monthly dashboard and analysed to reveal trends and patterns and provide a greater understanding of how the practice works.
Changes the practice made
The insights gleaned have led to some key changes being made, says Dr Holmes. These include:
- delegation of administration tasks to non-medical staff,
- delegation of blood test results to healthcare assistants,
- increased delegation of chronic disease management to the pharmacy team,
- the development of an advanced clinical practitioner-led, urgent care system in October 2016.
‘Around 70% of our letters are now filed by a member of the admin team. The system has well governanced protocols in place and undergoes quality assurance checks. That in itself saves 15 hours of GP time a week since we receive on average 2,300 letters a week, all of which used to be dealt with by the doctors.’
The data analysis also revealed inconsistencies in the way the practice was offering appointments across its sites, which meant that some patients would have to travel to another surgery in order to be seen.
Dr Holmes explains: ‘We have been able to respond with a redistribution of appointments across the different surgeries to spread the workload and reduce the need for patients to travel to different sites.’
Future proofing the surgery
In addition, the results identified areas of spare capacity. ‘For example, we found there was free capacity among our healthcare assistant team so we trained some of our senior HCAs to take on tasks like dressings, ear syringing, and some aspects of QOF review, which, in turn, freed up nursing time to take part in the urgent care service. Its impact was felt throughout the clinical team.’
The changes made in the York surgeries have been replicated across the group, Dr Holmes adds.
‘This project was not about saving money in the short term. It was primarily about future proofing what we are delivering, offering better access for patients, and making GP workload more sustainable.
‘Working at scale has enabled us to release clinical and non-clinical leadership time and provide the financial investment to make better use of our teams and spread the workload. These are not easy changes but we will reap the benefits down the line.’
The practice’s patient participation group has been involved throughout the process and kept informed of the findings from the data analysis, says Dr Holmes.
Reactions to the changes
‘We have been trying to explain why we are introducing new practitioners and communicate the message to patients that it’s ok to see them, that they deliver a quality service and GPs are involved in their training and supervision.
‘We are finding that patients like to see them and come back to see them. Some even specifically request to see a paramedic, for example, rather than a GP.’
Staff have also responded well to the changes, says Dr Holmes. ‘We are an innovative practice and they enjoy that. They recognise the challenges involved but have supported us and responded really well.’
To date, the changes made have centred on using staff in a different way to maximise efficiency. Looking ahead, the practice wants to build on that by more fully harnessing technology to deliver further improvements.
‘We currently encourage patients to book online appointments and register for online access to their records so they can, for example, access blood test results. We would like to see more take-up of that,' says Dr Holmes.
‘We know from the data that 10% of all phone calls we receive are to request blood test results so if more patients can get those online instead, it would reduce the volume of traffic.
‘We are now working as part of an alliance of practices in York, Nimbuscare, and are keen to develop the use of e-consultations across the city,’ Dr Holmes adds. ‘It is about responding to what patients want.’
- More information on this project is also available at the RCGP’s Supporting Federations Learning Network at https://federations.rcgp.org.uk/