Collecting data for a high-level view of clinical demand
The practice team at Ravenswood Surgery in NHS Tayside wanted to understand the types of appointments that patients were requesting when calling the practice, what options they were offered, and whether there were opportunities to reduce demand on GPs by signposting patients to other services. One of the GP partners also explained that in addition to scheduled appointments, a lot of GP workload is generated by messages passed to them from the reception team. To get a high-level picture of clinical demand, the practice decided to focus their data collection exercise on both patient requests coming to the administrative team by phone, and an analysis of messages being sent to GPs.
Developing the data collection tool
Two practice teams used different data collection tools: one for the administrative team to record the number and type of patient requests requiring clinical action, and another for GPs to record the number and type of messages they receive and dealt with on a daily basis. Each tool was a manual tally sheet that staff filled out throughout the day. The practice team initially considered recording their data directly onto Excel spreadsheets, but it was easier for staff to record the data onto paper tally sheets over the course of one week.
The practice team decided on the following types of requests for the administrative team’s data collection sheet:
- Doctor telephone.
- Doctor face to face.
- Emergency telephone.
- Emergency face to face.
- Home visit.
For each patient, they would also record, if applicable, what alternative option the patient accepted, to investigate whether patients were receiving what they wanted. This demand collection sheet is pictured below.
The collection sheet for GP messages provided a table for GPs to record the following information for each DocMan message they received:
- Date of the request.
- Day of the week it was received.
- Time the request was received.
- Is there a clinical review request?
- Outcome of the request (for example, same day appointment needed, safe to see patient in 2-3 days).
- If there is not a clinical review request, is the request urgent?
- Could another person or service have dealt with the request?
The back and forth of getting the tool right was really important. We needed the space to tailor it into a tool that’s right for us, even though it took some time to get it right." Practice Manager
Collecting the data
The administrative team found the collection tool to be useful, although they found it was sometimes challenging to keep on top of data collection during busier periods. However, they were confident they had captured most of their demand.
Analysing the data
The practice’s administrative and GP data was transferred from the paper tally sheets to Excel spreadsheets. The data was entered into an Excel data dashboard which allowed them to visualise the data and look for trends. The data dashboard includes one tab for administrative staff and one for messages for GPs.
On one side of the Admin worksheet is a pareto chart showing the number of requests received for each category, divided by morning and afternoon. A dropdown menu at the top allows the user to look at data for each individual day or the entire week. On the other side of the tab, a heat map displays how many patients were provided the service they originally asked for and how many accepted an alternative. The orange and beige squares indicate where patients received what they originally asked for. A graph below the heat map has a dropdown menu which changes the graph to show the number of requests generated from each category individually.
The GP tab provides a summary of the number and type of messages received by GPs. Multiple graphs on this tab address the following:
- What are the types of messages?
- How does message workload vary across the week?
- How do other messages vary across the week?
- How do urgent requests vary across the week?
- How do clinical review requests vary across the week?
The majority of requests dealt with by the administrative team were for a non-urgent or emergency telephone consultations with the GP, followed by the other category. The Practice Manager reflected that if they were to repeat the exercise, she would add a category for prescription requests and messages to GPs. The data also shows that most patients received the service they initially asked for. According to the GP data, many messages required a same-day clinical review, and many of these messages appeared on Monday or Tuesday.
These findings have helped the practice team begin to consider and discuss a number of issues. The practice team felt that a week’s worth of data collection was sufficient and said they would highlight to other practices that any days of data collection they can manage to fit in can be helpful, even if a practice is very busy. The results confirmed some of their suspicions/theories about demand and activity within the practice, and they will spend some time considering whether this data supports the changes they are planning or have already made. Although they have not yet developed new change ideas, the act of collecting the data inspired them to look at their current systems and start brainstorming potential improvements.
[The data collection] reinforced what we thought and will help us look at whether we can tweak things to help, or do we need more doctors on certain days." Practice Manager
There will be a lot of looking backward and forward at the data… This is a starting point, it’s not giving us everything we need but it’s given enough of an idea, particularly around GP messages." Practice Manager