Collecting data to understand clinical demand in general practice
Lour Road Group Practice
Lour Road Group Practice in NHS Tayside wanted to know if they could manage their current demand more effectively and efficiently, or whether they needed more resources to meet patient demand. They decided to further investigate demand on the practice clinical team.
The aim was to obtain a clearer picture of the volume of demand on the clinical team and to allow the practice to assess whether current clinical capacity was sufficient. Focusing on clinical activity kept the project focused and manageable and would lay the foundation needed to look at demand on administrative staff later. To achieve this, they decided to ask both administrative and clinical staff to keep track of the type and number of patient requests coming in requiring clinical action, separated by morning and afternoon to compare demand at different times of the day.
Developing the data collection tool
The practice team generated a list of the most common categories requiring clinical action. They then used two separate data collection tools: one for the administrative staff and one for the clinical staff. Each tool was a paper tally sheet on which staff members could mark down the number of each type of request. To keep things as simple as possible for their busy practice team, they decided on the following six categories of demand for the clinical team to keep track of:
- Calls generated from DocMan (consisting mainly of requests generated electronically from secondary care, for example, referrals and results).
- Appointments generated from telephone triage.
- Calls generated from patient messages.
- Calls generated from prescription messages.
- Attached queries (given in person).
- Urine sample testing/prescribing (for nurses only).
The data collection tool used by the administrative team included the following categories of direct patient requests:
- Book a same day appointment (with subsections for telephone appointment given, face-to-face appointment given, or appointment not given).
- Book a future appointment (with subsections for telephone appointment given, face-to-face appointment given, or appointment not given).
- Speak to a GP (subsections for calls from consultants and calls from patients).
- Arrange a home visit.
- Ask about a prescription.
- Ask for something else.
For a full picture of clinical demand, they also recorded the number of pre-booked appointments (made before 8am each day), and the total number of appointments booked per day (counted from the previous day). Tracking the number of patients who called for an appointment and did not receive one provided an initial high-level indication of the numbers of patients being offered alternative options.
Collecting the data
After the week of data collection, the Practice Manager and lead GP reviewed the data and discussed their experience. The Practice Manager was concerned that unexpected staff absences had made for an atypical week that could be misrepresentative. However, it was agreed that it was not uncommon for a practice to have staff absences and that testing over the full week had helped create some balance in the data, even when some days were unusually short-staffed. The Practice Manager had given all practice staff daily reminders about keeping up with their data collection and the lead GP reported that it had been easy for her to keep up with the task over the course of the week. One GP had found it difficult to stay on top of their data collection during the day, but had been able to go back and fill in the sheet after the fact.
It helped them to see it by saying it would help the practice in the long run." Practice Manager
In terms of filling in the form, it was quite easy. It wasn’t an issue at all." General Practitioner
Analysing the data
The data was entered onto a specially designed data dashboard which visualised the data. The spreadsheet contained separate tabs for data collected by the administrative team, GPs, and the nursing team. On each tab, a pareto chart shows the number of each type of request, by time of day, with the ability to look at requests over the entire week or for each day individually. These charts showed the team, which types of requests created the most, and the least demand.
On the administrative staff worksheet, additional bar charts on the right-side display same day and future appointment requests divided up by whether a patient was given a telephone appointment, a face-to-face appointment, or if they did not receive an appointment. The practice team could collect data again later and easily input the latest information into this same visualisation tool. They also reflected practices could also easily customise this same dashboard to suit their own needs by inputting different categories of requests.
The Practice Manager and lead GP reviewed the data in depth. The data highlighted a few important things. First, it confirmed they did in fact have more demand than their current clinical team could reasonably handle. They considered contracting additional GP locum hours. The lead GP was optimistic that this would help free up her time.
Second, they were surprised at the number of prescription requests coming in. They noticed that some prescription requests could have been dealt with by the administrative team instead of being passed to a GP, and that they could tackle this by providing staff with some extra guidance and training to build their confidence around managing prescription requests. They agreed the training could be delivered by the practice’s Reception Supervisor by reviewing a selection of the most common requests and developing guidance for the reception on which ones require clinical input and which can be handled by the administrative team.
Finally, the data highlighted that the nursing team received a high volume of urine samples from patients, many of which were not formally requested by the practice team or wider services. The practice will investigate this further through an audit to identify the practice’s urine sample request pathways and how many samples are dropped off for each category.
From the results of this initial rapid data collection exercise, the practice team would like to do a similar data collection exercise on requests dealt with solely by the administrative team. Despite initial concerns about the effort involved in collecting data, the practice found it very beneficial and were keen to adapt the data tools developed to explore their practice demand and workload further.
We found things we weren’t aware of so we would no doubt find things from a data collection targeting admin activities." Practice Manager
At first you think ‘I don’t have time for this,’ but after you get your head around it, you think ‘this is not that bad.’ And now we’ve found out all these things we can change and improve." Practice Manager
Thanks to the team at HIS. We found data collection for this project fairly straightforward and the results have given us things to think about moving forward and potential changes/improvements are already being implemented." GP Partner