Access Optimisation Improvements at Tudor Lodge

Using Access Optimisation to address high levels of demand over the telephone, particularly during the “8am rush”.

Setting the Scene

Tudor Lodge Health Centre, a GP surgery in South West London serving 11,000 patients, faced rising demand for appointments and overwhelming telephone traffic during peak hours, particularly the “8am rush.” With 38% of patients speaking a language other than English, it was clear that any solution would need to be inclusive and accessible.

To tackle these challenges, we launched a 12-month project under our Access Optimisation Service (AOS), which included a comprehensive telephony audit and a multilingual patient survey. By conducting in-depth research and involving patients directly in the process, we implemented patient-centric changes, including a virtual assistant, which led to significant improvements in both patient access and practice efficiency.

This proactive approach alleviated pressure on the practice and enhanced the overall patient experience.

The Challenge

As part of their ongoing improvement work, Tudor Lodge Health Centre was aware of several issues they were facing, affecting service delivery and patient satisfaction. The majority of which are reflective of practices up and down the country. Some of the key challenges included:

• Patient demand outstripping capacity
• The “8am rush” led to a poor patient experience and put a strain on limited staffing resources, with the surgery not able to rationalise how many staff they should have taking calls to cope with demand, or any idea if some calls might be better directed out of the main queue
• Patients were facing an average call wait time of 6 minutes, 13 seconds
• Call demand was reaching approximately 8,000 calls a month 
• Patient understanding of what the NHS App could do was lacking, therefore uptake and usage was low
• The practice was facing demands from NHS England to improve the use of digital tools 
• The practice was being offered a number of tools from various suppliers offering ‘Digital Transformation’ but they received little help in implementation.

To address and attempt to fix these problems, we carried out a proactive 12-month AOS to improve patient access and levels of satisfaction.

“Working closely with the X-on team really shone a light on the issues we were facing and highlighted how we could optimise our telephone system for the benefit of both patients and staff. I knew there would be some benefits from the changes implemented but I was surprised at the scale of the improvements and the changes they have had for our team!

Prash Thurairatnam, Managing Partner at Tudor Lodge

The Solution

To better understand the issues at Tudor Lodge, we undertook a full telephony call flow audit and data-driven assessment. This included:

• Call data, incorporating accessing volume of calls inbound vs total missed and abandoned, the average call queue wait time, and the average time for a call to be answered
• Number of online consultation submissions
• NHS App uptake 
• Patient survey outcomes
• Patient access routes.

In addition, we carried out a multilingual patient survey at the surgery. It delivered a 16.5% response rate, with feedback showing that:

• 53% of respondents had never used an online booking solution
• 68% of patients found it difficult to book an appointment
• One patient stated “I was not aware I could book online”
• 70% of patients found ‘Appointments availability’ and/or ‘Wait time on the phone’ to be a barrier to accessing Tudor Lodge during core hours
• There was no support for patients out of hours, leading to a bottleneck in demand during opening times.

Following the audit and patient survey, we implemented a number of changes in collaboration with the Tudor Lodge:

• Introduced streamlined closed-loop call flows (Including an out-of-hours service) 
• Improved digital literacy of staff through specific training
• Implemented personalised call flow and messaging for patients
• Reduced automated texts to a single SMS segment
• Built-in contingencies in case of any unexpected SMS failures
• Promoted patient self-service for administrative needs via the use of digital tools such as the NHS App and AccuRx (a software platform that connects NHS staff and patients)
• Developed effective community signposting to increase patient awareness of the range of options available 
• Expanded self-referral pathways and the adoption of digital tools, including their EDATT software.

The Results

As a result of the changes implemented, the surgery experienced many significant improvements, benefitting both patients and staff. 

Some of the key improvements included:

• Total number of inbound calls decreased by 21%
• Calls that entered the queue decreased by 23% 
• The number of missed calls reduced by approximately 65% 
• Calls for appointments dropped by 48% 
• The number of online prescriptions placed increased by 66% (from 222 to 368 per month) 
• The average call queue time reduced by 50% (from 180 to 90 seconds).
• Increase in self-referrals; 105 self-referrals to Pharmacy First and 205 self-referrals community services via the chatbot 

In addition, patient feedback from a follow-up survey showed:

• 3 out of 5 patients are still finding it ‘very easy’ or ‘easy’ to book an appointment with a GP when needed. Patients aged 55 to 64 find it the easiest to book an appointment.
• Almost three-quarters of patients have now used the online appointment booking system.
• More than half of patients (57%) feel that telephone waiting times have reduced.
• There has been positive feedback from patients about using the NHS App, which has jumped from 55% to 71% use, and the online appointment booking system from 29% to 57% among patients.
• 1 in 4 patients have also tried DOT, the practice’s virtual assistant, which helps them with online setup and using digital tools.