Understanding demands on clinical time
Yell Health Centre
At Yell Health Centre in NHS Shetland, the practice team wanted to collect data that would enable better understanding and management of patient demand that required additional GP action or attention. To do this, they focussed on non-appointment-related tasks assigned to the clinical team. The practice uses the EMIS electronic patient record system. EMIS includes a task-assigning function, which allows the administrative team to send tasks to GPs for various reasons, such as a patient request for a phone call or a medication review.
As they are located in a rural area, patients are usually able to get an appointment quickly. However, the locum GPs who staff the practice often come in to find many tasks waiting for them, which can occupy a lot of their time on top scheduled patient appointments. Therefore, the practice team decided it would be useful to manually track the type and number of these requests and obtain a high-level overview of this ‘unseen’ demand on the clinical team.
Developing and using a demand collection tool
As the EMIS system does not allow users to go back and look at tasks retrospectively the practice team agreed that the administrative team would record the data manually on a paper tally sheet when each GP task was added to the system. The team had already created categories of requests within EMIS to keep tasks organised, and these were included on the manual tally sheet. The Practice Manager gathered the administrative team together to discuss the data collection categories and processes before it began and collectively they decided upon the following 12 categories, with each category split into three subsections: Urgent, Non-urgent and Routine.
- Acute/Re-authorise Prescribing.
- Med 3 Fit Note.
- Medication Review for Chronic Disease Management/Long-Term Conditions (CDM/LTC).
- INR Reading (for patients taking Warfarin).
- Phone Call Request.
- Medication Review (non-CDM/LTC).
- Atrial Fibrillation Review.
- On the Day Requests (e.g. need urgent referral, need urgent prescription because medication has run out).
- Non-routine Appointment Request.
- Key Information Summary Review.
The administrative team was keen to get started and found the data collection easy to do. Over the course of one week, they placed a tally sheet at each reception desk in the morning, followed by a new sheet for the afternoon. The Practice Manager then collected the sheets periodically and entered the data into the data collection tool, which was found to be “straightforward and easy.” The administrative team felt was very manageable task.
They [the administrative staff] were great and they just set off doing it... They were really happy to go with it and fill the data collection sheets in." Practice Manager
Analysing the data
After the data collection was complete, the data was entered into a special Excel data dashboard. This dashboard is an interactive data display with pareto charts and bar graphs. It shows which categories generated the highest and lowest number of GP tasks, divided up by morning and afternoon. Buttons along the top of the dashboard enable the user to look at data for the entire week or at each day individually.
According to the data, a majority of GP tasks were generated by patient requests for acute or re-authorised prescriptions. The practice team were not surprise by this, as data collection took place in December, and this is when many people request prescription refills to cover them over the holiday period. The practice does not have its own pharmacist but the practice team are expecting to receive additional pharmacy support soon. They reflected that this data collection activity would support them to assess the value of this additional resource.
In the meantime, the practice team considered an immediate improvement opportunity by signposting patients, where appropriate, to contact the pharmacy on the mainland for certain requests which could then be delivered to the island in one of the three deliveries Yell receives three pharmacy deliveries per week from the mainland.
The practice would consider doing another data collection exercise once they have a pharmacist in post to evaluate the impact of added pharmacy resources. The practice team felt that a longer period of data collection would provide an even fuller picture of clinical demand, considering the practice is staffed with primarily locum GPs. They think it would also be useful to separate acute from re-authorised prescriptions for future data collection and to direct the acute prescriptions to the pharmacist. The data collection tools provided can be used again to explore these issues by simply adjusting the fields to the relevant categories.
In order to capture everything, you’d probably need to do a month’s data capture to get a true picture of what it’s actually like." Practice Manager