Health Navigation System

January 2018

A new appointment system at Montpelier Health Centre

As from January 2018 we have been trialling a new appointment system.

The essential changes are that:

  • We have removed the on call triage list.
  • In order to signpost patients to the correct service for their condition they are asked to provide the receptionist with as much information about their condition as possible. This is not a clinical triage, it is a clarification of need and the receptionist is then able to make the patient an appointment with the most suitable clinician to help them.
  • With our new system of working, the aim is that there are always appointments available throughout the day. Patients will no longer need to phone first thing in the morning or phone back the following day to book an appointment.
  • We ask however, that wherever possible, if a patient has an urgent condition that needs assessment, that they still contact us before 11am.

We feel this is a great step forward in being able to offer a more accessible and timely appointment system for our patients. Patient feedback as we progress has been very encouraging. This was especially demonstrated in the week after the Christmas break which is historically a time of high demand for GP appointments, and especially this year with the current flu epidemic.

Over the past six months we have recruited four new receptionists to add to our team. This has also improved our call answering time as we have been able to reduce our call waiting times significantly. The reduction in waiting time is not only because we have employed additional staff, but also call duration has reduced as we have more ‘same day’ capacity to offer patients an appointment where necessary.

Patients also feel reassured that appointments are available to book throughout the day which has meant there is a lower volume of calls at 8am each morning and therefore call waiting time has reduced too.

This new system offers us the capacity to offer more conveniently timed appointments to:

  • Older people
  • People with long-term conditions
  • Families, children and young people
  • Working age people (including those recently retired and students)
  • People experiencing poor mental health (including people with dementia)

It has lowered our waiting time for a routine appointment from 14 days to within 48 hours.

On answering the call and listening to the patient’s request and details of their condition, our receptionists are now trained to ‘navigate’ the call to the correct clinician. This may mean a face-to-face appointment or a telephone call with one of our healthcare professionals:

  • Minor Illness Nurse
  • Student Physician Associate
  • Consulting Pharmacist
  • GP

Or in the case of other minor problems (and flu symptoms with no previous risk from long term medical conditions or other possible complications), patients are signposted to their local pharmacist for advice in the first instance with advice on contacting the practice again within a few days if symptoms have not resolved having initially self-medicated.

We operate a ‘Named GP’ system each morning and afternoon, where urgent queries (but not issues that would previously have been considered ‘triage/ on call’) are overseen by either the Reception Manager or her Deputy. These patients are added to an ‘on screen’ list by the call handlers, the Reception Manager/Deputy review these calls and then navigate to either the ‘Named GP’ for the shift or redirect back to the call handler for redirection if felt inappropriate for the GP to deal with. The Reception Manager and Deputy Reception Manager work opposite shifts to each other to ensure that the Reception/Call Handling team are supervised from 7.30am-6.30pm each day.

We have ‘same day’ appointments which are released at various intervals throughout the day, ie. 8am, 12 noon and 4pm to ensure that we have appointments available throughout the day, as well as telephone slots (and Named GP slots for urgent queries – see above). We also have bookable appointments to book ‘within 14 days’. This means we have approximately 50% pre-bookable and 50% same day appointments available.

This new system is working well. We have plenty of appointments to offer patients on the day, and are able to offer patients appointments well within the 14 day allocation where preferred. Feedback is favourable and we have been able to facilitate patient demand with this new way of working. We have been able to remove a daily 50+ triage /call back patient list every day, offer same day appointments to those that require them, and keep ‘urgent queries’ for the Named GP/On call doctor to a maximum of 5 per morning or afternoon session.

Navigation has also meant that we are able to empower our reception team to take ownership of their role. They are able to add information for the GPs to patient consultation notes to track events, and are encouraged to review consultation notes to enable accurate signposting to the correct destination that is most appropriate for patient needs. They can also generate non-clinical patient letters that do not require GP input, ie. details of patient registration, ie. NHS number and address for the Home Office to lessen demand on GP time.

They also follow up DNA patients at the end of the day, both as a matter of welfare to ensure the patient is safe and well, but also as a tactful reminder that they missed an appointment which could otherwise have been offered to another patient.

The reception/call handling team are enjoying this new way of working, they embrace the challenge of Navigation, and have improved job satisfaction in an improved service for our patients.