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					                                  Appendix A
Access & Responsiveness Local Enhanced Service

                                  Baseline Assessment

Practice Name                                           PracticeName

Responsiveness                                      RESPONSIVENESS

Supply & Demand                                    SUPPLY & DEMAND

Use of Technology                                     Use of Technology

QOF Exception Reporting                    Analysis of QOF Exception Reporting

Use of urgent care services                Practice use of urgent care services

Improvement Template                              Improvement Template

Please fill in all areas of this baseline assessment under the column Practice Response .
Examples have been provided where available and considered helpful.
The last column - Identify for Improvement is for practice purposes only.
Funding for component 1 Of this LES is dependent upon completion of the baseline and
Practice Improvement Template.
                                    Responsiveness - Patient - Friendly Services - Customer Focus
How strong is your practices' customer Focus?
Practices should respond to both the clinical and non clinical needs of their patients. If you are welcoming and helpful, your
patients will feel valued and your staff will experience greater job satisfaction. In addition, the general atmosphere, in the practice
will improve.          "How-to guide"

Patient Services                                                                                 Practice Response   Identify for Improvement?
What languages is the practice leaflet available in?

How does the practice promote the availability of interpreters and BSL interpreters,
the use of advocates, etc?
Does the practice have the facility to provide the practice leaflet in alternative
formats eg different languages, Braille, audio etc? if so, please explain
Patient Environment                                                                              Practice Response
Can telephone conversations or consultations be overheard in the waiting room?
Do you provide variable height seating?
Do you think the practice environment is comforting and welcoming?
Are there simple things you could do to improve this?
Do you have any art work, poems or other features that help patients to relax?
Is this an area the practice would like support with?

Patient Engagement (refer to p 129 of "how to guide" & p15 of " Using The GP Survey")            Practice Response   Identify for Improvement?
Does the practice have a patient participation group? (p133)
If yes, what issues have been raised and what action has been undertaken?
If the practice has a patient participation group, what is the make-up of the group?
(age/ethnicity/gender/sexual orientation, etc)

Does the group include carers or does the practice use other ways of involving

How did you identify / invite patients to form a group?

Does the practice have a patient suggestion box?

What information is there for patients? i.e. notice board, newsletter, other
communications, etc
Does the practice have a website? If so please provide address
Do you have regular time to discuss patient feedback (not just complaints)?

Is the practice working in any other way to gain patient feedback?
Does the practice monitor NHS Choices for patient comments?
Patient Survey                                                                                   Practice Response   Identify for Improvement?
From the results of the national GPPatient Survey what areas has the practice
identified for improvement?

Does further analysis of these results highlight lower satisfaction in certain groups?
Has the practice discussed results with a patient group?
Has the practice discussed results with staff?
Does the practice undertake any local survey, In addition to the national one?
If so, what ?
What do the results of this tell the practice?
Practice Population                                                                              Practice Response   Identify for Improvement?
As part of new registrations does the practice record patients':
Ethnic origin?
First language?
Any long term conditions or disabilities?
Religion or belief?
Sexual orientation?
Carer status?
Dignity, Respect And Customer Focus                                                              Practice Response   Identify for Improvement?
Does the practice use interpreters and advocates?
What are the issues?
What training have staff and doctors particiapted in the last year around customer
care? E.g . Equalities and diversity, how to handle aggression, communications
 skills, dignity and respect. Please list:

How does the practcie use internal PLS sessions?
                                    Self Check:
How well does your practice do against the top tips for patient friendly services?
(see p89 of A ‘how-to’ guide for GP practices)
                               Tips for customer-facing staff
• Smile. Remember to smile when dealing with patients, both in person and on the phone
• Be personal and proactive. Try to use age-appropriate greetings when possible and always ask how you can help.
• Stay visible. Try to remain available at all times.
• Be helpful. Never say, ‘I don’t know’ without adding, ‘but I can find out for you’.
• Prioritise. A patient standing in front of you takes precedence over someone on the phone.
• Be firm but fair. Don’t let patients monopolise your time if others are waiting.
• Use the support available. Call for back-up support if long queues are forming.
• Stay alert. Try to read body language so you can see if someone needs help.
• Respect privacy. Don’t discuss patients or their treatment in front of other people.
• Stay motivated. Wherever possible, try to give people more than they expect.
• Always be respectful. All patients deserve attention, regardless of their age and appearance.
                                           SUPPLY AND DEMAND (see section 1 of ‘How-to’ guide for GP practices)
                                                                                                   How you might compare against
Good Access is described as :                                                                      some national averages:

patients being able to book an appointment quickly, within a reasonable time frame, and pre        Nationally, the median consultation rate is 5.3 (so, on average, each
book one if they wish;                                                                             patient is seen just over five times in the year) for doctors, nurses and
                                                                                                   other healthcare professionals within general practice.
patients being able to see a preferred clinician if they wish to wait longer for an appointment;
                                                                                                   A convenient rule of thumb is that the median level is approximately
                                                                                                   equivalent to 100 appointments per week for every 1,000 patients.
                                                                                                   However, significant numbers of practices have consultation rates lower
patient access to reliable information about the practice, so that they can make their own         than 4 or higher than 8 so there are very wide variations between
decisions about the access they requier;                                                           practices – you may want to consider why the demands of your patients
                                                                                                   may be greater or less.
patients not only being able to book an appointment on the telephone but by other means,
such as through the internet, e mail TV or by text message;

patients contributing to good access through Patient Participation Groups and other forums;
patients being able to telephone the practice throughout the day.

Response to the prompts below will enable practices to assess where they are against this
definition of good access and national averages.

                                                  Supply and Demand Analysis
                                                                                                   Example ( provided where possible
SUPPLY - Current Availability of Appointments                                                      to illustrate what is required)    Practice Response                        Identify for Improvement?
                                                                                                   Mon-Wed- 8:00am-7:00pm Thurs-Fri-
Practice Opening Hours?                                                                             8:00am-6:30pm Sat- 8:00am-
                                                                                                   Mon-Wed- 9:00am-11.30am and 2.30 -
Surgery times?                                                                                      6.00pm etc..
                                                                                                   mon 6.30 - 8.30 pm. & Sat 9.30 -
Extended GP and Nurse Hours?                                                                       10.30 am.
 The Appointment System:                                                                           Example                                    Practice Response                Identify for Improvement?
Please describe your current appointment system                                                    Mixture of drop in and booked apptms
                                                                                                   or all booked?
Is it simple to understand?
Do patients understand it?
How do patients book appointments?
in person?                                                                                                         Y/N
on the telphone?                                                                                                   Y/N
internet?                                                                                                          Y/N
Does the practice remind patients about appointments? If so how?                                   Y using text system or telephoning
Do any appointments ever not get used? Is this significant?                                        Y/N/ Sometimes
Practice Analysis of Appointment Availability and Capacity                                         Example                                    Practice Response                Identify for Improvement?

what is the availability of same day compared to advance booking appointments?                     60% on the day & 40% pre bookable
                                                                                                   75% of available appointments are
What is the average quarter's uptake for extended hours?                                           used
                                                                                                   Y but offered at receptionist discretion
Does the practice offer telephone consultations? How are these notified? Can they be               or advertised in leaflet bookable
booked for a particular time?                                                                      between 1 - 2pm
                                                                                                   Nurse triage available in the
                                                                                                   mornings or not available
Does the practice triage patients? How is this undertaken?
                                                                                                   extra appointment slots available?
How does the practice develop/ respond to busy days i.e. Monday with the appointment               Nurse triage on that day? Patients
system?                                                                                            booked in following day?
GP Appointments/1000 Patients/ week (note you can look at this per WTE GP)

Nurse Appointments/1000 Patients/ week
HCA Appointments/1000 Patients/ week
Non Attendance                                                                                     Example                                    Practice Response                Identify for Improvement?
Does the practice have a policy for patients who do not attend scheduled appointments at           Follow up letter sent or patient
the practice? What does the policy entail?                                                         telphoned
What percentage on an average week DNA?
Do you know who the patients are?
Are there any repeat offenders?
What does the practice do to avoid DNAs?
Does this work?
Please make responses below when the results of the practice's audit of patient
demand has been analysed:                                                                          Example                                    Practice Response                Identify for Improvement?
Are there days of the week where there is a much greater demand than the appointments              typically mondays
you have available?
Does the number of appointment requests significantly outnumber your total appointment
Do/ how often do patients need to ring back for appointments ?
Are you holding too many same-day appointments back so that a lot of patients can’t pre-
book an appointment? Do you need to adjust the ratio between the same-day/pre-bookable
How do you cope with holiday times or sickness?
How many follow ups do GPs have per week?
Do you make sure that Mondays are avoided for follow ups?
Skills Mix - does it match demand?                                                                 Example                                                                     Identify for Improvement?
Does the right person see the right patient?
How do your patients know who they need to see?
Are there follow ups that could be done over the phone or by the nurse?
Do you know who uses the surgery the most? E.g. elderley patients or families with young
Do you know who uses the surgery least?
Work Load analysis? see p23 of "How To Guide" if you would like to take this forward
Do you have the right staffing levels to answer the telephones? (see p 13 of "How To Guide")
Is the demand for telephone consultations higher than supply? ( see tab on technology if you
would like to look at the capacity of your telephone system)
USE OF TECHNOLOGY to achieve a healthy and relaxed environment                    see section 3 of A ‘how-to’ guide for GP practices
Your telephone system or reception are the first point of contact that a patient has
with your practice. How well this system works can enhance the patient journey or disrupt it.

General practice has the highest level of computer use and IT literacy of any part of the NHS,
and the UK’s General Practice IT is amongst the best in the world .
A number of hardware and software packages which deliver tangible improvements to patient
services are available to practices.                               Developing general practice: Listening to patients, BMA
Patient services.                                                                                             Practice Response
Does your practice have self-service check-in screens?                                                        Yes/No
Does it plan to?                                                                                              Yes/No
Does your practice have electronic display systems?                                                           Yes/No
Does it plan to?                                                                                              Yes/No
Does your waiting room have health monitors and surgery
pods?                                                                                                         Yes/No
Does it plan to?                                                                                              Yes/No
Understanding your telephone system ( see p71 of A ‘how-to’ guide for GP practices)
Please complete the Checklist below. This is a requirement for the LES and any application for improvement grant to support
costs of a new telephone system.
The Basics: completion is a requirement
1. Does your system have the capability to offer call transfers?                                                Yes/No
2. Does your system allow you to put callers on hold?                                                           Yes/No
(a) If Yes, can you record information about the practice?                                                      Yes/No
3. Does your system offer call waiting?                                                                         Yes/No
4. Does your system have the capability to store numbers in an internal phone                                   Yes/No
5. Does your system offer voicemail answering machine?                                                          Yes/No
(a) If Yes, can you record your own generic outgoing message as a practice?                                     Yes/No
(b) If Yes, can you record your own individual messages on separate extensions?                                 Yes/No
6. Can you purchase an add-on answering machine if your system does not offer
this as an internal feature?                                                                                    Yes/No
7. Does your system have the capability to provide an IVR (interactive voice                                    Yes/No
response) as an add-on module or do you already have IVR?                                                       Yes/No
8. Does your system have the capability to offer a variety of numbers/extensions
that external callers can call directly (direct dialling inwards)?                                              Yes/No
9. Can you purchase Headsets (wired or wireless) for your current system?                                       Yes/No
10. Does your practice have a switchboard phone or master phone to transfer calls
to others in the practice?                                                                                      Yes/No
11. Do you have a current maintenance contract?                                                                 Yes/No
12. Have you considered adding an additional line to your telephone system?                                     Yes/No
(a) If Yes, then have you got enough members of staff to man the additional
line(s)? See p for detailed description of how to check staff levels                                            Yes/No
If you have answered NO to most of these, then you may need to consider investing in a
new telephone system.
More advanced features: completion is optional
You may not need to answer the following to understand your current telephone system but
answers to these questions could help you if you are looking at future innovative solutions.
13. Does your current system have the facility to offer caller line ID?                                         Yes/No
14. Does your current system have the capability to integrate data and voice?                                   Yes/No
15. Do you have several locations that will be using the same phone system?                                     Yes/No
16. 16. Does your system have the capability to use Voice over IP as an
overfl ow option?                                                                                               Yes/No
(Please note: This means that your phone system can allow calls to come through via broadband
at peak times when all telephone lines are being used – this will avoid engaged tones.)

What is the make and model of your telephone system?                                  Name/Model
How old is your current telephone system?

Does the practice accept type talk calls?
Does the practice accept text messages to book or remind
about appointments?

How many phone lines are there per 2,500 patients?
QOF Exception Reporting

Brighton and Hove have the 5th highest levels of exception reporting
across the country.

This section is to follow and will provide a detailed profile of practice exception
reporting. Practices will be asked to study this and consider if there are any ideas
they can trial to reduce levels of exception reporting.
Use of Urgent Care - ensuring the whole
system works effectively and efficiently

URGENT CARE a practical guide to transforming same-day care in general practice (May 2009)
The above is a reference to a very helpful document produced earlier this year by the Primary
Care Foundation on urgent access to GP services. it has been supported by both the Royal
College of General Practitioners (RCGP) and the British Medical Association’s General
Practitioners Committee (GPC). It provides some really useful practical recommendations on
improving access and managing demand. It focuses on three simple questions concerning
care for patients who contact their practice with an urgent need:

 Will they get through?
 Will they be identified?
 Will they be seen rapidly?
Practices are encouraged to look at this report at the link above. The recommendations are
the result of intensive work with primary care professionals, including research into best
practice, a survey of GP practices, face-to-face interviews and workshops in five very
different PCT areas

The PCT will be providing a detailed profile of the practices' use of urgent care ( for example
A&E and Walk-in Centre) in the New Year. Practices will be asked to study this and consider
if there are any significant trends or patterns in the data. Also if there are changes that can
be made to the practices access profile that will impact on the patients' use of urgent care?
e in general practice (May 2009)

er this year by the Primary        "The principles of good urgent care
ported by both the Royal
 sociation’s General                        We thought it important to articulate some key
ical recommendations on            principles.
e questions concerning             They aim to capture common-sense logic around the
                                   process for urgent cases.
                                   These principles place a high priority on patient safety for
                                   all calls or visits to general practice. They assume that
                                   in most cases the patient or carer is in the best position
                                   to assess the urgency of the case before any clinical
he recommendations are             assessment, sometimes supported by assistance over
 g research into best              the phone from practice staff.
 shops in five very                We recognise that:
                                    Clinically urgent cases are rare
                                   Practices must follow a process that is rapid and not
 urgent care ( for example         overly resource-intensive.
to study this and consider         Our case studies demonstrate that high-quality care can
re are changes that can            be achieved without imposing a burdensome process
nts' use of urgent care?
Annex 2 : Improvement Template

          Access & Responsiveness Enhanced Service: Practice Improvement Template

 1. Vision – statement describing ambitions for quality of customer care at this practice

 2. Brief outline of the main issues identified from the baseline assessment:

 3. Proposed solutions & ideas to improve customer care and areas identified above including:

            Patient Engagement & feedback initiatives:

            How to improve and maintain patient survey results with all areas showing improvements:

            Actions that will improve areas identified in the baseline assessment:

 Note: from this and in discussion with the practice team targets can be set for the delivery plan
 4. Communications: how will practice population be informed and feedback sought from them? (NB
 this needs to include hard-to-reach groups such as infrequent and non -attenders)

 Note: this should form an objective in delivery plan

   5. Staff development: what actions or training needs to be in place to ensure improvements can be
   delivered by the whole team

Note: this should form an objective in delivery plan

6. What are the potential barriers to this work? What are the potential enablers?