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Learning the lessons of 111

NHS England has reported that the 111 telephone service has successfully coped with the May Bank Holiday weekend without major problems. With providers taking on more call handlers in the run up to the weekend the early signs are that the 111 service responded to the vast majority of the 100,000 callers over the weekend.

However, chief nursing officer Jane Cummings acknowledged that improvements were still required before all forty-six 111 services were up and running as expected. Run by a mix of providers including private firms and ambulance services, the 111 service has seen some teething problems. This has resulted in some services being suspended or receiving special help.

Last week NHS England agreed to commission an external review to look at the problems which have beset the introduction of the 111 telephone service; both as a guide to actions required to bring the service up to full strength and as a learning point for future projects. Whilst some areas of the country seem to have experienced a fairly smooth transition, others have been beset with problems including calls not being answered and major delays experienced by those waiting for calls back from medical specialists.

Designed to serve the needs of those who are too ill to be able to wait until they can see their doctor within hours but are uncertain if they should call an ambulance the 111 service is designed to be able to direct callers to the most appropriate service for their needs including GP out of hours, A&E or calling an ambulance if required. This means that the service may receive a wide variety of calls from those who are concerned about their own, or a loved one’s, health and in those circumstances any delay in responding can lead to distress and anxiety.

In fact it’s not just the 111 service which can suffer from delayed call answering. Any call which goes unanswered can potentially lead to frustration on the part of the caller, whether the call is to a health practitioner or not. For those health practitioners who work closely with patients this can cause a dilemma. If the answer a call they may be interrupting an existing treatment but if they ignore the call they risk losing a potential patient or their goodwill.

The solution is to appoint a virtual assistant service which will respond to callers, book appointments, manage diaries and take messages. Appointing a virtual assistant service which specialises in health matters will also pay dividends as the call answerers will be able to talk knowledgeably to patients about their treatments with empathy and attention to detail and will better understand when messages should be marked as urgent. We will be keeping an eye on the NHS England review as well as the progress of the 111 service and will report on any findings which may be of interest to our health practitioner clients.

Guarding your back

In celebration of Chiropractic Awareness Week 2013 the British Chiropractic Association (BCA) has been encouraging parents to take care of their backs. According to the BCA, 79% of people have experienced back or neck pain at some point in their lives with 61% of those being parents.

More worrying for the parent/child relationship, 55% of parents reported that their back or neck pain prevented them from lifting or carrying their child. To help parents to prevent or minimise the effects of back pain the BCA has published some handy advice sheets on their website. The guides cover areas such as posture, stretching exercises, pregnancy, outdoor and indoor activities and play.

As you’d expect the BCA was not alone in promoting the Chiropractic Awareness Week which started on 15^th April. Chiropractors across the UK played their part in promoting the ways in which chiropractic treatments could help to treat or prevent back pain. With NHS commissioning for chiropractic treatments being limited, the majority of chiropractic patients tend to pay privately. This puts an added time pressure on chiropractors who not only have to provide the treatments but also manage their own administration as they care for multiple patients.

Making use of an efficient virtual service can take a lot of the pressure out of the administration burden and enable chiropractors to maximise their time with patients. Services such as telephone answering and diary management help the practice to present a professional image whilst minimising the time spent on administration or having to interrupt treatments to answer the phone. But it is the additional services offered by businesses such as Clinic Appointments which can also make a major difference to time management. SMS appointment reminders have been shown to boost patient attendance whilst digitising patient notes eliminates the time spent in searching through filing cabinets as the patient sits in the waiting room.

One of the BCA leaflets provides handy hints on protecting our backs when on the computer. For busy chiropractors and other health professionals we’d like to add one more item to the list and that is to reduce the time spent sitting down on the phone or computer and let our virtual assistants take the strain.

Innovation Grant for British School of Osteopathy

When finances and funding sit so firmly at the heart of the NHS it can sometimes seem as though every attempt to instil a culture of care is beset by financial restrictions. Not that care and compassion should be affected by finances but it can be hard to provide a quality service when time and energy is spent in scratching around for cash.

It is therefore good to be able to report on the British School of Osteopathy which has recently been awarded a significant innovation grant. Totalling just over £250,000 spread over a three year period the grant will enable the BSO to develop a new service called OsteoMAP.

According to the BSO website, “OsteoMAP is designed to support people with long-term musculoskeletal pain, which may be alleviated but is unlikely to be completely resolved by manual therapy alone.” The programme will initially be developed at the BSO’s clinical centre and then rolled out via training courses to students and qualified osteopaths across the UK.

In recognising and developing multi-layered treatments which address the physical and psychological effects of certain conditions this programme should both reduce the burden on hospital services and help the health services to deliver the Government’s aim of a more patient focused treatment regime.

One of the side-effects of this programme is that community osteopaths are likely to become more involved in the treatment of long term conditions and this could add to the patient mix. Those osteopaths who have switched to a more streamlined appointment, diary management and patient notes system may be in the best position to take advantage of this increased treatment requirement.

In effect, the more time which is freed up from administration the better. With phone calls answered by a virtual receptionist the osteopath or other health professional can concentrate on providing distraction-free quality care to their patients. And when it comes to a treatment such as osteopathy or physiotherapy, the less distraction the better. Interrupted treatments can not only be less effective, the very fact of an interruption can cause anxiety in patients leading to muscle tension.

Grants such as that announced by the British School of Osteopathy can only help to drive forward quality care in our health service. Targeted, patient-focused and aimed at providing long term therapies for lifelong conditions; treatment regimes such as OsteoMAP will reduce the day to day burden on hospitals and enable people to live a better quality of life.

Cutting physiotherapy waiting times

A study led by Bristol University professor Chris Salisbury has shown that using the telephone to make initial physiotherapy assessments can cut down not only on missed appointments but also on waiting times. The trial compared the outcome for patients who were offered an initial telephone assessment against those who waited for a physiotherapist appointment.

The study concluded that some patients can be managed entirely by phone but that despite the faster access to treatment, overall satisfaction levels remained unchanged. However, the Bristol University press release did stress that this evaluation was only one element of an overall requirement to examine treatment options for an increasingly elderly and immobile population.

Interestingly Salisbury NHS Foundation Trust has also released a report which shows that using a follow up telephone service can cut down the number of wasted and missed appointments within its urology service. Whilst these are just two examples, they do illustrate the way in which the telephone is playing an increasingly important role in the health practitioner/ patient relationship.

However, the more that patients come to expect telephone communication, the more they will be dissatisfied when phone calls remain unanswered. This poses a dilemma for the health practitioner. On the one hand they are expected to be on hand for patient calls; on the other, they don’t want to interrupt consultations to answer the phone.

The answer is to delegate their phone answering and appointment booking service to a specialist virtual receptionist service. With the receptionist handling calls, making appointments and sending out reminders the health practitioner can concentrate on treating their patients. And if telephone consultations are on offer, these can be booked in the same way as any other face to face consultation. After all, even telephone consultations need to be paid for and managing these in the same way as ordinary consultations via a booking system helps to ensure that invoices are raised and that no income is lost.

Another advantage of offering pre-appointment phone consultations is that the physiotherapist or other health practitioner can gauge the optimum treatment time, meaning that diaries can be more effectively filled, reducing wasted time between appointments. Whether or not patients can be treated via the phone will depend very much on the nature of their problem but what is certain is using a virtual receptionist to answer the phone enables the practitioner to concentrate on treatment in all its forms and that can only be good for the patient and the health service provided.

Fit for the future?

The 2012 Hospital guide from Dr Foster makes very interesting reading. The headline statistics about hospital occupancy rates alone paints a picture of an NHS which is full to bursting. Against an ideal occupancy rate of 85%, the report shows that for 48 weeks a year most hospital trusts have a bed occupancy rate in excess of 90%.

This not only puts pressure on trust staff on a day to day basis, high occupancy levels mean that when a crisis hits there is little spare capacity to meet it. So, the current Norovirus outbreak which according to the HPA is already 72% up on last year is bad news indeed.

Unfortunately for NHS managers the Dr Foster report highlights one major bed blocker that could easily be avoided. Apparently 29% of beds are taken up by “patients whose admission might have been avoided if their care was better managed.” This includes patients who are readmitted shortly after discharge, patients who would have been better treated in the community and patients who could have been seen as day cases.

The report does conclude that efficient hospitals can deliver good quality care but that areas such as missed hospital appointments, unnecessary admissions, a lack of weekend care and keeping patients in too long (or conversely discharging them too soon) all need addressing. The report also highlights the number of follow up appointments which could easily have been replaced by a quick phone call or visit to a GP.

When looking at outpatient appointments the report also says that “both primary and secondary care providers can take measures to improve the proportion of patients who attend hospital outpatient appointments.” We have previously highlighted ways in which some providers are taking steps to address this issue, using simple methods such as sending appointment reminders by phone or text.

Patients failing to show up for appointments is an issue for everyone working in the healthcare field. For health practitioners who charge their patients direct, a no-show not only prevents another patient from being treated, it also costs the practitioner in lost revenue. That is one reason why an appointment reminder service can pay for itself in reducing no-shows and keeping treatment rates high. Allied to a virtual receptionist service which can take calls, make appointments and even manage patient records, a health practitioner can concentrate on treating the maximum number of patients and providing good quality care.

Combining therapies

We are constantly reminded about the way in which regular exercise can improve our overall health. Now researchers in America have published the results of a survey of 10,000 people into the benefits of exercise, for those taking statins to lower cholesterol and prevent heart disease.

The researchers found that middle aged people who take regular exercise, such as 150 minutes of brisk walking or cycling per week, are 50% less likely to die in the next ten years than those who take statins and don’t exercise. Those who combined exercise with statins were 70% less likely to die in a ten year period than those who simply took statins.

The results add to a growing body of evidence on the way in which even modest amounts of exercise can help to lower cholesterol and prevent diseases such as diabetes from developing. In commenting on the study, Natasha Stewart, senior cardiac nurse at the British Heart Foundation told the Daily Telegraph that the results showed that combining exercise and statins could “provide a winning combination to further improve your heart health, with higher intensity exercise possibly offering more protection.”

It is generally recommended that anyone with high levels of cholesterol or who has lived a sedentary lifestyle take advice from a health practitioner before starting on an exercise programme. This may not necessarily be the local GP, with many GP practices offering support services for a range of conditions. As with any health issue it is important to call on the service which is most appropriate and indeed the NHS Choose Well campaign is designed to help patients to choose the service which will meet their needs.

The aim of the Choose Well campaign is to free up A&E departments to concentrate on those who have a critical or life-threatening need whilst ensuring that all patients receive speedy treatment. For health practitioners such as osteopaths and physiotherapists this may result in patients taking more responsibility for their treatment and calling direct for appointments.

This is where a virtual appointment service such as Clinic Appointments can come in handy. With Clinic Appointments’ trained receptionists taking calls and making appointments, health practitioners can maximise treatment times whilst eliminating missed calls. So, whether you are treating patients who have responded to Choose Well and made appointments direct or coping with the aftermath of a sudden rise in exercise by the middle aged, you know you can concentrate on what you do best without worrying about diary management or missed calls.

Prevention is better than cure

A disturbing report in The Lancet reveals that during the swine flu pandemic of 2009, preventative attitudes in the UK fell far short of those in countries such as Mexico, Argentina, Japan or America. For example whilst 89% of Argentineans washed their hands or used sanitizer more regularly during the outbreak, only 53% of Britons did the same.

A similar pattern was seen in respect of covering up coughs and sneezes and avoiding hugging or kissing friends. The conclusion from the research is that Britons are less likely to adopt protective measures than people elsewhere. This has implications in respect of the way in which information on disease is disseminated.

In response to the belief that good hygiene habits are best instilled in the young, Global Handwashing Day on October 15^th will take place as the centre piece of a week of worldwide hygiene-based activities. Top of the agenda is an attempt to set a world record with schools across the UK all taking part in a hygiene lesson at 10am.

Of course, hygiene is not just confined to schools and the public at large. Health practitioners know only too well that hygienic practices form an essential ingredient of the customer experience. Whether treating a client for back pain, providing a beauty treatment or simply providing a consultation; if the ambience and surroundings are wrong then the treatment will suffer.

One of the key ingredients to providing a good client experience is to give the client the surety that your attention is solely focused on them. This means taking steps to ensure that consultations aren’t interrupted by telephone calls or other distractions. Using a virtual receptionist service means that calls are answered and appointments booked by the receptionist service without the need to interrupt treatments to answer the phone.

With a handy always on view diary system the health practitioner can see appointments at a glance and keep control of their day whilst maximising treatment times. Add in appointment reminders and invoicing and even more time can be spent on treating the patient.

In a time when effective diary management can make or break a health practice, using the services of a virtual receptionist can help to prevent no-shows and minimise empty hours. Working alongside the health practice, the virtual receptionist helps to ensure the client experience is a pleasant one and that is the first step on the way to an effective cure.

Proactive phoning

A trial of a new telephone system has found that contacting patients by telephone can help to spot early warning signs as well as cut down on unnecessary hospital appointments. The study into patients with Chronic Obstructive Pulmonary Disease required patients to input answers to a series of questions using their key pads with the results being analysed by doctors.

This regular contact not only alerted doctors to patients who needed urgent attention it also eliminated the need for some three hundred unnecessary hospital appointments, saving both time and money. Regular contact also resulted in patients being more aware of their condition, enabling them to be more proactive in self-management.

In a way this trial is another step forward in the growth in understanding of how health professionals can use telephone services to improve patient interaction and fill appointment books. Simple measures such as sending out SMS appointment reminders can not only improve the client attendance rate but will also prompt clients who cannot attend appointments to cancel in good time. This enables practitioners to re-fill appointment slots and maximise time spent on treatment.

Similarly, taking steps to ensure that calls are answered helps to foster the client relationship. We all lead busy lives and tend to steal moments from our day to carry out tasks such as making appointments. If the call is not answered the chances are that the need to phone will slip from our minds for some time or that we will simply telephone elsewhere. This is where a virtual receptionist service can be so valuable. With the virtual receptionist ensuring that the call is answered on behalf of the health practitioner there will be no chance that the client will phone elsewhere or that an urgently needed treatment will be postponed.

Whether they be osteopaths or chiropractors, beauticians or physiotherapists, the one thing all health practitioners have in common is the need to maximise time spent with patients. Interrupting treatments to answer the phone or blocking out diary time to remind patients of impending appointments is simply not a viable option if the practice is to run to its potential. Calling on the services of a virtual receptionist service means that calls are answered, appointments made and reminders sent without taking up practice time. And with easy to use diary software which is visible 24/7 the use of a virtual receptionist doesn’t preclude the practice making follow up appointments at the end of a treatment session.

Balancing the Health Budget

The news that the Health Minister, Andrew Lansley, has had to intervene in the running of the South London Healthcare NHS Trust has acted as a wake up call across the health sector. The trust, which reportedly is running at a £1m per week deficit, may have to be put in the hands of an administrator tasked with turning the deficit around.

A further twenty trusts have reportedly declared themselves to be financially unsustainable in their present form. Whilst some have put their difficulties down to the cost effects of building new premises under the auspices of the private finance initiative (PFI), others seemingly have more complex underlying financial pressures.

The action taken by the Health Minister is the first step in a process which was laid down in section 65 of the National Health Service Act 2009. If the full procedure is followed and an administrator appointed they will have to produce a draft report within 45 days, followed by a consultation period of 30 days and a final report 15 days later.

Irrespective of the outcome, this intervention has highlighted the continuing financial pressure facing all those providing health services in the UK. From large NHS trusts to a sole osteopath, the challenge to control costs and maximise income is the same. For the smaller health practitioner the need to balance costs and income can prove to be a juggling act between time spent in treatment and time spent on business matters.

Taking appointment booking as an example; the more time spent on patient treatment, the more income generated. But how do you juggle the need to be with a patient with the need to be available to answer the phone and take a booking? This is where a dedicated health practitioner virtual receptionist service can play a vital part. With a virtual receptionist answering calls, dealing with routine queries and managing the diary, health practitioners can concentrate on providing treatment for their patients. Add in an appointment reminder service and the number of no shows falls, helping to keep income levels strong.

We can’t claim that a virtual receptionist service is the panacea which solves the NHS funding crisis. However, for those working in the health sector from physiotherapists to beauticians and from massage therapists to health clinics a virtual receptionist may just be the first step towards balancing the budget.

0800 0789333 info@clinicappointments.com

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