Case studies
The Kakoty Practice, Barnsley
Category: 1.1. Access: back to basics
The Kakoty Practice, Barnsley
This is a Personal Medical Services (PMS) practice (since 1999) of around 6,100 patients. It is an urban location split evenly over two sites. The population is classified as high health need. There are four full-time doctors and three full-time-equivalent nurses. Additional substance misuse and services for asylum-seekers and refugees are provided - both are high attendance client groups.
Objectives
With this population, access to medical services has to be good, and below are our key objectives:
- to have adequate capacity in place to offer patients an appointment quickly;
- to have processes in place to predict where this may not be possible;
- to provide a variety of access routes;
- to educate patients in how to use our services effectively; and
- to reduce did not attends (DNAs).
How we succeeded
Our initial task was to gauge the problem of not being able to offer patients same or next-day appointments. The first stage was to introduce capacity and demand monitoring. We also began the process of monitoring the third available appointment measure. This only took a few minutes for an administrator to complete. The monthly findings supported whether our changes were working.
We used the PDSA (Plan, Do, Study, Act) cycle to evaluate and refine changes. For example, we changed times and length of surgeries on different days to minimise DNAs and unused appointments. We introduced internet appointment booking and auto-text patient reminders and found this greatly improved the level of DNAs. We published newsletters to inform patients of when we were making changes and how to get the best from the appointment system. Now we are aware of when our high demand occurs and plan for it.
Tips
- Successful delivery depends on owner 'buy-in'. The whole team have to want to achieve it, and all have to be open to changing their working practices.
- Accept monitoring as a way of working, not a quick fix, then managing demand becomes an integral part the process.
- Involve everyone within the team and listen to them. The receptionist taking appointment requests will know about high demand and how patients perceive the service.
Tips
- Communicate your aims to patients - if they know how much it matters, then they will be more likely to engage.
- Stay with it - unexpected absences in small organisations can spoil the best of systems. By preparing staff in advance in how to deal with these situations you can alleviate service pressures later on.
- Share your successes - access monitoring is a standing item on our team meeting agenda. We discuss and share access issues, which promotes cohesive working across the team.
Contact
Marie Hoyle
marie.hoyle@nhs.net
