BACKGROUND: -Patients are frustrated by a lack of access to primary care -In general practice, we feel pressurised by seemingly unassailable demand ‘We can’t carry on doing the same things’

Our GP practice has previously attempted various quality initiatives, with patchy success. Our breakthrough: Considering how Sir Dave Brailsford’s British Cycling Team’s winning ‘marginal gains’ concept (e.g. ref http://goo.gl/L0Y6rk) might be applied to healthcare. We have led ‘marginal gains’ at our practice by organising around an innovative new web portal which helps notch-up gains in patient-self care and streamlined consulting (Please view www.sycamorehousesurgery.co.uk)

INNOVATION: From April 2014, using Brailsford’s insight that there isn’t one ‘killer improvement’ for productivity success, but rather, marginal gains across the board are necessary, our urban Midlands general practice talked to our patients and fellow primary care providers.

Our approach: Activity centred around a bespoke webportal. We have led productivity through:

1. Encouraging marginal gains in the following areas: Promoting self-help in researching diagnoses/management options to patients: Championing the use of shared decision-making tools: Encouraging patient self-service in booking appointments and full records access: Integrating a WebGP offer to allow the 24/7 opportunity for patients to ‘offload’ their concerns to our service and for non-native English speakers to take their time to express their concerns: Inviting patients to book directly with open access services without the need for GP appointment and referral.

2. We’ve adopted an evidenced-based approach to leading web-portal implementation, based upon principles derived from the fields of e-learning and instructional design (e.g.reference http://goo.gl/t9GaiC )

3. Patients were integral in helping to design the web portal, it’s iterative development and ideas for encouraging uptake.

4. Throughput to the portal is ‘nudged’ (ref http://goo.gl/IljWuL) via: -Texts to patients when they book an appointment, encouraging self-service via the web portal and the ability to cancel via text -Posters in the surgery and wallet cards which are actively used by receptionists and clinicians to suggest patient self-service.

5. Our practice’s innovation has captured the imagination and it forms the kernel for the pan-Birmingham Prime Minister’s Challenge Fund application:48 practices:365,171 patients.

IMPACT: Evaluation is continuous and ongoing key findings:

  • Positive patient feedback on ‘feeling empowered’ in understanding the full range of services
  • Captured informally and also as part of our Friends and Family Test surveys (uploaded to http://sycamorehousesurgery.co.uk/feedback/your-feedback )
  • 166 appointments saved by patients cancelling via text over the last three months following text prompts which signpost to open access services, so freeing up capacity
  • Empty urgent care appointments during Christmas and New Year 2014 – this is highly unusual
  • Released capacity allowing us to move from 10minute appointments in 2013 to 15minute appointments in 2014
  • Team meetings shifting form reactive to anticipatory care

About the Author:

Dr Jagdeesh Singh Dhaliwal
A medical advisor, director and facilitator with wide international experience in the public health services, corporate and education sectors and proven expertise in influencing and directing corporate and clinical management, governance, education and strategy Particular interests and expertise lie in supporting new technologies and the specific leadership task of opening up mindsets, encouraging redesign and making connections between technology innovators and healthcare practitioners and their organisations.

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