In this blog, the first of two from Buckingham GP Dr Rebecca Pryse, she takes us through the practical steps to launching a new appointments system split between Same Day and Any Day appointments. Rebecca will be back later in the spring with a second blog looking at how the change has worked.

So it’s the eve of D Day or “s-D-s Day”: the day we launch our new Same Day Service. We’ve had our final partnership “huddle” at our executive meeting last night; we’ve given the final pep talks to the various teams and here we go.

This has been months in the planning for what feels like a military operation. From the Saturday strategy partners meeting one year ago where I led a “we can’t go on like this /something has to change” discussion around our access and appointment systems; to our lead partner Greg poring over stats, models and spreadsheets at his kitchen table to come up with various proposals; to our management team and IT team testing out these proposals against appointment audits and staffing rotas.

In the middle of all this we went through our second merge, a little more “thrust upon us” than the first merge just over a year before that, making us the only practice in town serving about 30,000 patients. This used up a lot of leadership energy but gave us strength in terms of clinicians (we now have 13 partners, 3 salaried doctors and 7 nurses), staff members (we now have 80 staff), population numbers and a third town centre site to work from. This enabled us to move forward in more exciting ways to change our access system.

So we moved onwards taking a proposed appointment system model to our appointments committee. This is a multidisciplinary group of reps from clinicians, management, staff and several patients who have been meeting over the past 10-15 years since we first changed our appointments from completely open access to an advanced access system – quite novel back then. This group meets intermittently to keep an eye on our access stats and patient feedback and to make constructive suggestions for change. Most recently they helped support and test out the introduction of Patient Access to our patients. The new proposal was discussed over several meetings, tweaked and approved.

Next we took the proposal to our annual “State of the Nation” protected learning afternoon. This is an annual whole staff meeting to which we invite the PPG. The new model was presented to the whole team and this was followed by small group work for each staff group to reflect back their hopes, fears and expectations of the system with some useful and constructive suggestions.

So what model did we finally decide upon? We all agreed that there are broadly two types of access required by patients: I need to see a clinician today and it doesn’t matter who I see and I need to see MY doctor or nurse who knows me best and I can wait for this appointment. We also saw a need for signposting patients first to self-care where appropriate and then to the most appropriate clinician for their problem, which does not necessarily mean a face-to-face encounter.

From these principles we have devised an offer of same day appointments (Same Day Service or SDS) or any day appointments (Any Day Service or ADS). Each service will operate from a different site within the town centre. We have calculated the balance of appointments by looking at the statistics of how appointments are currently accessed, proposing that 60% of our appointments will be made available in the Same Day Service. We have also looked to extend the range of clinicians working from this service to ensure the patients are directed to the most appropriate clinician. This means that the SDS is manned by two GP’s called GP1 & GP2, rather reminiscent of Dr Seuss with GP3 on “special days” that we predict will be busier, one or two minor illness nurses or nurse practitioners, with a paramedic to cover acute visit requests and an HCA to provide urgent diagnostics. All our reception staff have been trained as Care Navigators and patients are being asked to give a brief outline of the problem they wish to bring with an initial question of “could this be dealt with over the telephone” being asked or self care advice given as appropriate. Our paramedic and two of our nurses have just completed the minor illness nurse-training course and two of our nurses already prescribe. We have just appointed a minor illness nurse who fulfills her dream of moving from A&E back to primary care.

In our other two sites the Any Day Service will run: the clinicians here will be offering slightly longer appointments which can be booked in advance by patients who benefit from continuity. There will still be some Same Day availability in this service and these GPs will be offering routine, pre planned visits to appropriate patients. It is planned that all urgent and same day work should be absorbed by the Same Day Service allowing the Any Day GP to plan their day more proactively and offer more complex care as needed without being rushed into 10 minute slots. They will of course keep a view of the SDS and be able to offer support if that system is becoming overloaded.   We have recruited a new, additional GP who will start in September. All GPs will work some time in both systems.

In the background all our staff teams have been working hard together to ensure this new system will run smoothly and there is a general buzz of excitement in the practice as sDs-Day has approached, this in itself has felt uplifting to me particularly after they have been through a couple of years of immense change already. So we have all read the protocols and checked the process maps covering all eventualities, looked at the rotas, updated our computer screens ready for tomorrow.

Our practice manager has to be particularly congratulated, as she must be googly-eyed sorting out what has become quite a complex rota. It sounded so simple at the start but when you build in the fact that as well as seeing patients in our three sites, we also run clinics in two boarding schools and one University, we look after 4 nursing homes, we provide one GP session per day to our local community hospital and we are a training practice not only for GPs and practice nurses but for our local Medical school with 2 students in most days seeing patients……… she has politely told us to stop asking if she can sort out any more “tweaks” to her system, just for now, please. But we are keen to work in a PDSA cycle so the snag/learning list will start tomorrow as soon as the front doors open!

Dr Rebecca Pryse is a GP Partner at The Swan Practice in Buckingham. You can contact Rebecca via rebecca.pryse@nhs.net The Practice website is www.theswanpractice.co.uk