16 June 2009
Practices Poole Resources to Achieve Extended Hours Access DES
with SystmOne
When the Department of Health's 2007 Patient Survey reported that 16% of patients were unhappy with practice opening times, an 'Extended Hours Access Direct Enhanced Service (DES)' came into operation, with every GP practice obliged to provide services beyond their usual opening times.
A group of four GP practices in Bournemouth & Poole PCT have been using SystmOne to achieve their extended hours quota since November 2008. Heatherview, Madeira, Rosemary, and Herbert Avenue Medical Centres operate within the same catchment area of Poole and have all migrated to SystmOne within the last twelve months.
Healthstone's Directors, L-R, Dave Peirce, Mike Mimms, Pam Braid, Jeremy Ramsden
Jeremy Ramsden, Practice Manager at Madeira, says, "We wanted to, collectively, offer our patients a service that went beyond what was specified in the DES so we came up with a proposition for the PCT. We formed a limited company called Healthstone Medical to provide GP and nursing services from 9-5 on a Saturday for all patients in the locality. We alternate the service between the two larger sites, Madeira and Heatherview."
In order to achieve the Extended Hours Access DES individually, these practices would each have to stay open for between 1¾ and 4½ hours more per week. With the service provided by Healthstone, all patients registered with the practices benefit from an additional 7 hours of GP and nursing services per week."
The Healthstone Saturday session is run using eight clinical and reception staff who can come from any of the practices in the group, or indeed can be brought in as locums from elsewhere. Jeremy added that he was pleasantly surprised at how quickly locums had learnt to use SystmOne considering that it is not the clinical system they use from Monday to Friday.
The advent of the GP Systems of Choice scheme has been a catalyst in enabling the Healthstone practices to achieve the sort of linked-up working that they have long aspired to. Dr Bettley-Smith, a GP at Madeira, says, "The idea of linking up the practices came before the thought about what system to use. When GPSoC came along, we were shown all of the available systems and SystmOne was the one that did what we needed."
"We can only do Extended Hours with SystmOne," says Jeremy. "When we started, only Madeira and Heatherview were on SystmOne so we used paper forms for patients from the other practices. Now we're all on SystmOne, it works well; it's ideal for us. The GP practices use the GP module and Healthstone uses the Out of Hours module. The service is easily accessible by the patients - they phone their usual practice and request a Saturday appointment which is booked using the remote booking facility in SystmOne. The linkage between systems is fantastic - we provide a seamless service with all patients' records available when they come in."
Dr Bettley-Smith adds, "With SystmOne, I can see that my patient was seen at Healthstone on a Saturday, and I can see exactly what happened. If a patient goes to Out of Hours, I have to wait ages, maybe three or four days, to receive the details of the episode from their system. With SystmOne, the information is there instantly."
Healthstone isn't just a service for emergency appointments as Mike Mimms, Rosemary's Practice Manager, explains, "It's a GP service but on a Saturday. As well as GP appointments, we do home visits and nursing services, and we want to expand to do more disease management. People can pop in for their asthma review or diabetes checks after they've done their shopping on a Saturday."
One of the key topics that needed to be discussed before the service began was how to approach recording patients' consent to view their records. "With most of our staff registered as patients themselves at one or other of the practices, there was some concern about who would see their record," says Jeremy. "In addition to our standard confidentiality agreement, we set up a new one for all staff to sign stating that they would only access the records of patients they were caring for. We have also added a line to all our promotional material telling patients that by making an appointment for a Saturday, they are giving consent for the staff working to have access to their clinical record."
The service began in November and has been growing in popularity ever since. By mid December, all four practices were live on SystmOne and the number of patients seen began to increase. In the period from January to March, the service saw an average of 330 patients a month.
The four practice managers involved in Healthstone share the administrative duties of running the service. Dave Peirce, Practice Manager at Herbert Avenue, is the resident statistician. He says, "Of every 100 people we see on a Saturday, if the service wasn't there, six would have attended A&E and a further 39 would have contacted the Out of Hours service. So we're reducing the numbers contacting the urgent services quite significantly. The other interesting thing to note is that we have far fewer DNAs for our Saturday appointments than we do during the week."
The Healthstone project didn't come without its concerns - Rosemary Medical Centre's greatest fear was that patients would leave the practice to join Heatherview or Madeira, where the Saturday sessions are held, but Mike says, "This just hasn't materialised - genuinely ill people aren't bothered if the GP they go to isn't their usual one."
For others of the group, collaborative working provides more security - small surgeries like Herbert Avenue with just 3500 patients are increasingly vulnerable. Being part of Healthstone gives them a chance to protect themselves from pressures to merge or close.
Changing to SystmOne has allowed business processes to be analysed and changed for the better across all of the practices. Dr Alastair Ponton at Heatherview is keen for staff to embrace the system. He says, "Using SystmOne is a culture change and we need to educate staff to see that. We're getting a lot out of the system and I'm now getting into the nitty gritty that will really speed things up for us. I don't understand technology but I am interested in workflow and so I'm looking at ways of improving our workflow, which in turn will improve our Caldicott Guardianship."
SystmOne isn't the end of the story for Healthstone as Heatherview's Practice Manager, Pam Braid, explains, "We want staff to be able to work in an integrated way across all practices. We do that at the moment to a certain extent, for example, Heatherview's IT manager is available to help any of the practices with SystmOne questions, and any of the receptionists can work at the Saturday clinic or cover shifts at other practices. Through time, we want to work more and more as one organisation. Next, we want a new phone system that patients can use to access any of us as well as the Saturday clinic, and we want to set up a Healthstone website."
Mike concludes, "We all do the same LES/DES work so there's no reason why we can't share what we do with each other. We want to do more collaborative working, sharing about 50% of the work within Healthstone. If we all worked together using the same systems, we'd be in a stronger position if we wanted to bid for tenders or take over other services. We're looking forward to much more collaborative working, utilising SystmOne, in the near future."
The Healthstone Saturday scheme is now out of pilot and is a permanent fixture for patients in the locality.
Chris Bennett, Development Lead for Primary Care IT in NHS Bournemouth and Poole says, "The transition process to SystmOne was smooth for all of the practices. It has enabled them to work together as a single clinical organisation to improve patient care. If other practices in Bournemouth and Poole wish to consider SystmOne as a solution, please get in touch with the PCT IT team who will help with the selection process and transition."
