Improving services through patient co-production

Dr Sue Goodfellow, West Quay Medical Centre, Barry, Wales 

The problem

We ran a standard capacity-based appointment system, which was accessed by telephone. A patient survey indicated very high satisfaction with clinical advice and treatment, but poor access to appointments, and difficulty with relational continuity with their known GP.

We also had a traditional primary healthcare team (PHCT) with GPs and a full nursing team, but felt this needed to be expanded to include other skill-sets and be less doctor- centric.

We were not adhering to the Principles of Prudent Healthcare, especially' Equity of access' and 'caring for those with the greatest health need first'.

The Bright Idea

We worked with the Patient Participation Group (PPG) to make necessary changes, initially focusing on communication with patients via traditional methods, and by social media, and then on changing the access from capacity based, to demand-based.

In August 2018, we launched online access to clinical advice for all appointment requests for GPs and Advanced Nurse Practitioners (ANP). Effectively this put the most senior clinicians on the front line of triage, to ensure those patients with the greatest health need were dealt with first, and also so face to face appointment time was used appropriately, and with the most appropriate health care professional.

The team was expanded to include a pharmacist, plus more Advanced Nurse Practitioners and a minor illness nurse.

The project is still in its early stages, and the next part of this will be to further alter the skill-mix of our PHCT to closely align with the needs of our patient population.

The impact

  • Patients: Much improved patient satisfaction, and feedback so far. Patient reported outcomes for continuity and ease of access are improved.
  • Staff: Prudent use of all our human resources, with us adhering to the principle of 'only do what only you can do'
    Better job satisfaction for staff from reception to Clinicians, as we feel we are offering a better service and using our skills appropriately
  • Practice: We are a beacon practice for others within the cluster (central Vale), who are watching out progress closely.
  • We have gained recognition for this with me as a Bevan Exemplar, continuing to deliver this project in 2018/19

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