Advanced Access
Practices work towards Advanced Access by putting in place access arrangements that are able to meet the needs of every patient whether their need arises the same day or a need that can be addressed in the future without having to hold back appointments, restrict forward booking or release appointments in stages.
Advanced Access is based on a paradigm shift in thinking: that rather than patient demand being insatiable and endless it is predictable and finite. The key is to understand not just the demand for 'urgent' or same day care but the totality of demand. This means that a practice can thereby schedule capacity so that it meets the entire profile of patient demand. By doing so, the practice can operate a system that is able to meet every patient's need to be seen regardless of whether their need arises the same day or relates to a problem that can be addressed in (and therefore scheduled for) the future.
As a result, long waits (delays) no longer need to be a feature of the system and each week begins with sufficient available capacity to meet demand. The safe knowledge that there is sufficient capacity in place to meet demand also means that there is no longer a need for prioritising one group of patients over another (urgent above routine). Instead demand is expected, planned for and met.
Advanced Access also requires the practice to change their thinking about access: it is no longer just about an appointment system but about the way that the practice team functions to meet patient demand for the services they provide. Demand no longer translates to an appointment with a doctor, but to a range of needs that can be met by a variety of skills available through various members of the team. It involves a process of continuous development and improvement.
The advantages of the system are that patients are satisfied because they can book an appointment freely, reception staff can carry out their job effectively, and clinicians experience predictability in their work which gives them a greater sense of control. In addition, the reduction in wasted appointments resulting from DNAs (did not attend) and the changes to the way that the team works mean that hidden capacity appears. This releases time to give the team freedom to develop services in new ways and also enables individuals to address their own personal development needs.
Implementing Advanced Access can be challenging and the ongoing management of the system is crucial for its success. Most practices report that implementation, although sometimes hard work is a rewarding experience and that the benefits of sustaining the system far outweigh the work needed.
Change Principles
The model for Advanced Access comprises five Change Principles. These principles are at the heart of improving access and all five should be explored and implemented in sequence by the practice team to fully develop and implement the system.
- Understand the profile of demand
- Shape the handling of demand
- Match the capacity of the team to the re-shaped demand
- Establish and implement robust contingency plans
- Communicate effectively with patients and across the totality of the Team
Examples of changes used when working towards Advanced Access
Through developing their understanding of capacity and demand, practices have been able to:
- Implement alternative means of accessing health care professionals e.g through telephone consultations;
- Move work to the most appropriate member of the health care team, i.e. nurse, phlebotomist or health care assistant;
- Provide a holistic approach which has helped reduce patient contacts;
- Develop methods of dealing with non-clinical demand, e.g. through separate repeat prescription line;
- Re-organised the practice team 's capacity to meet the variation in demand for appointments;
- Develop plans to deal with holidays, sickness or epidemics;
- Communicate changes within the practices to the patients through posters, leaflets, newspaper articles, letters attached to their medication;
- Involve the whole practice team in the changes;
- Consult with patients about changes and their impact on the patient.