The Elms Medical Centre, Liverpool

picture4Patients in Liverpool are receiving better care, and doctors are enjoying more control over their work, thanks to Dot Community Health.

The Elms Medical Centre, based in Liverpool, changed over to Dot Community Health after hearing about its impact in practices around the country.  With a staff of 25 including six doctors, the Elms is a medium sized practice, with a challenging case load supporting the needs of a demographic leaning heavily towards deprived inner city Liverpool, serving a population of 8500 (weighted population 9700).

Chris Peterson, GP Principal at the Elms since 1990, said Dot Community Health has turned the Elms’ service around, since introducing the new system in April 2012.

“In Liverpool we do not believe in having secondary care do our work for us and we do not believe that the NHS is sustainable if they do. As such, the access to a GP is paramount. “

“The old fashioned appointment system is reliant, in the main, on patients and receptionists deciding who gets an appointment with the doctor. Couple that with ever increasing patient demand and expectation, and you have GPs struggling to deliver enough appointments to satisfy patients.”

“By the beginning of 2012 my own practice was in exactly this position. Despite increasing numbers of clinical sessions, we seemed never to be able to satisfy the demand. The vast majority of our patient complaints related to access issues.”

“So we started exploring further investment in clinical capacity.”

“My practice encountered Dot Community Health after I spoke to Dr Sara Cowell and learned more ….and we introduced the new system in April. Rather than simply ‘running faster’ we have discovered a very real solution to the appointment issues that confronted our practice. We now have a zero day waiting time to see a doctor.”

“The Dot Community Health system has allowed us to map out very clearly our need for clinical capacity throughout the week. Of course clinical examination is an essential part of reassurance for some patients and this is an entirely valid use of a GP appointment. We have realised that we do not need more doctors to service the demand of our patients; we just need to manage that demand differently.”

“The vast majority of our patients prefer the system as they can get sorted out that day. Generally our doctors enjoy the system because they are able to use their time efficiently and ensure that people seeing the doctor really needed that eye to eye contact. Because we are sifting and sorting patients’ needs via the telephone we can ensure that the patient gets to see the same doctor when possible, hence our continuity has risen to about 90%….and our receptionists love Dot Community Health because they can always offer a solution to patients requests for help. “

“We have cancelled planned investment in capacity as we have realised that it would have been misplaced”

Chris Peterson of The Elms said that making the change to the Dot Community Health system is relatively easy.  “Having advised our staff and patients of our pending change, we stopped booking appointments after our agreed start date. After five months of the new system, I now believe it is the future for GP appointment systems.”

“We have discovered that less than 50% of our calls result in the need for a face to face consultation.”

Shortly after the Elm’s conversion, doctors noticed that the persistent patient complaints about access stopped, with 70% of patients stating they preferred the Dot Community Health system.

Whilst Chris is a strong advocate of the Dot Community Health system, having experienced the benefits first hand, he acknowledges that it is a very different to traditional appointment systems in UK General Practice.  It is Chris’s belief that triage is most effective when performed by the most experienced clinician.

“We have discovered that some GPs are less fond of telephone consulting than others, and we have tried to accommodate the wishes of the GP workforce by actively managing this situation.”

“There is an element of uncertainty to the day’s work load, and doctors need to flex up with the demand, however that demand becomes quite predictable after a while.”

“For the Dot Community Health system to be effective, practices need to have a good understanding of their telephone demand, and telephone answering capacity must match demand.”

Chris concludes: “The sustainability of Dot Community Health lies in the control regained by the practice.”