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Changing the UK’s Health

Sometimes for change to happen it requires a seismic shift in technology or actions, but on other occasions a series of small individual acts can come together to create something special. That was the idea behind NHS Change day; a time when individuals can make small pledges which could result in significant change for the NHS.

At the time of writing over 450,000 people have made their pledges and with the last pledge date for 2014 still some weeks away the final total is expected to be far higher. Some pledges are designed to support and strengthen local campaigns whilst others have been made on a far more individual basis.

One national campaign which the NHS is promoting through NHS Change Day is the idea of reducing no-shows. With 12 million GP and 6.9 million hospital appointments missed in the last year costing a total of £270m, every person who makes an individual pledge not to miss an appointment in future will be saving the NHS money and improving treatment for themselves and others.

In an attempt to cut down on no-shows NHS practices are adopting a range of measures from reminder calls and texts to encouraging direct booking online. But it is not just health practitioners within the NHS who suffer from missed appointments. Health practitioners across the board from chiropractors to physiotherapists and from beauticians to counsellors all suffer if a patient fails to attend an appointment. And in many of these cases it is not just the taxpayer who loses out but the health practitioner themselves, not to mention other patients who could have taken that vacant slot.

So for health practices everywhere, anything which can be done to cut down on no-shows should be done. Appointment reminders, online booking services, ensuring continuity of telephone answering; all can play their part in working towards a full diary and effective treatments.

The pledges being made for NHS Change day are not just confined to reducing missed appointments. Challenging culture, enhancing leadership, patient safety, improving skills, the list goes on. Some of the pledges are from patients, others from those on the front line or back office who are working to improve the NHS from within and without. From individual pledges to walk more or eat healthily to sharing knowledge and experience with others, the pledges may individually not be earth shattering. But if enough people see the pledges and join in then health care for all could be the winner.

Improving patient outcomes

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know

Donald Rumsfeld’s comments on the presence, or otherwise, of weapons of mass destruction may have passed into folklore but they do encapsulate the dilemma facing anyone who seeks to move away from the tendrils of speculation and into a position of certainty. Particularly so in the field of research where some studies result in ground breaking initiatives whilst others merely confirm unproven but seemingly obvious theories.

For example, a Europe-wide study into nursing practices has shown that a combination of nurse education levels and patient/nurse ratios can have an impact on patient outcomes. Whilst the initial reaction to this report may be to dismiss it as stating the obvious, an already known known; studies such as these are invaluable in both proving the theory and in quantifying the extent of the problem.

So whilst we may have thought that we knew increasing the workload of nurses may lead to poorer patient care, a study which concludes that increasing a nurse’s workload by one patient is associated with a 7% increase in patient deaths can only serve to sharply focus the attention. The report also concludes that in return for a 10% increase in nurses with degrees the risk of patient deaths falls by 7%; something which will be of comfort in the UK where with effect from 2013 all new nurses have to be educated to degree level.

Those working within the healthcare profession have always “known” that the more patients presenting for treatment equals the less time available for each patient and consequently the more likely that symptoms may be missed and care not be provided to the standards expected. But studies such as this one highlight the effect of time and patient pressure. For some the solution will be to educate further, to take on more staff; but when budgets are tight that is not always possible. Finding ways to work smarter, to automate, to outsource the routine, to free up time for patients is the way forward.

Before this study we knew that time and education equalled improved outcomes but we didn’t know to what extent. Now this part of the health service puzzle has moved from a known unknown into a known known and that has planning implications for all who practice healthcare and want to maximise patient outcomes.

Securing payment

Christmas may be the season to be merry but it is also the season when credit cards tend to receive a hammering. To help shoppers the credit reference agency Experian has put together seven tips on managing cards wisely. These include making payments on time, never withdrawing cash on credit cards and keeping an eye on the total amount of credit which you have across all of your cards.

But credit cards are not just for Christmas and used wisely they can be an important tool in financial management, both for purchaser and for provider. Whether spreading the cost of purchase or securing payment, credit cards can be mutually beneficial.

That is one reason why Clinic Appointments are now pleased to be able to offer a secure card processing service for offsite payments. The service accepts both credit and debit cards and can be used as a means of helping to ensure that payment will be collected from clients who book an appointment either online or via a call to one of our receptionists. At the time of booking we reserve a payment amount on the client’s card, with the payment either being taken in full once the appointment has taken place, or in the event of a no-show an amount being debited in accordance with a health practice’s stated cancellation policy. Should the client choose to pay by other means the reserved payment can simply be released.

Just by being asked to provide card details up front, clients are far more likely to attend their appointments; benefitting both the health practice and the patient. And as you’d expect from a Clinic Appointments service, the Card Processing Service is secure. So when your patients cancel their appointments with a flimsy excuse, simply don’t show up for appointments or promise that ‘the cheque is in the post’ you may want to consider secure card processing. It will help you to maximise cash flow potential but more importantly, especially if run alongside our appointment reminder service, you will be helping to ensure that your patients turn up for treatment; benefitting them and their health in the long term.

We continue to look for ways in which Clinic Appointments can help our health practitioner clients to streamline their businesses and maximise patient treatment times. In the meantime may we take this opportunity to wish all of our Clinic Appointment clients a Happy Christmas and a very prosperous New Year.

Booking time

The dawn of the ‘internet revolution’ may by now be lost in the mists of the past but it seems as though at last the benefits of internet connectivity have moved into mainstream living. This Christmas more than one third of all shopping will take place on line with features such as click and collect proving popular.

As we toast the end of the year with internet tills ringing we are also shortly to be waving goodbye to another British institution. The Government has announced that the paper car tax disc is to be phased out. With authorities relying on purely electronic records the move will save time and resources.

In fact way back in the early days of the internet the benefits to be gained from the saving of time and resources were widely predicted but in the intervening period it has sometimes seemed as though all that the internet has done is bring more work. In the early days ‘dial up’ was so slow that many people could get in their cars and drive to the shops faster than they could order goods online. Now thanks to improved internet speeds allied with programmes designed with ease of use and speed in mind, the internet has at last come into its own.

One benefit of this improvement is the way in which health service providers are able to manage their diaries. For the health practitioner the time spent in booking appointments is effectively ‘dead time’; time which is spent away from treatment and time which potentially impinges on another patient’s treatment. That is why practitioners turn to services such as those provided by virtual assistants who can take calls and manage bookings on behalf of the health practitioner.

Now there is a new service available from Callagenix which not only saves the health practitioner from taking calls, it also saves the client from having to telephone. Online booking enables clients to browse and book an appointment at a time to suit them. This quick and simple appointment service perfectly ties in with the general move towards using the internet as the first port of call. The service is flexible and practitioners can choose whether to accept new or existing clients via the online service as well as restrict online booking to certain treatments or to certain times of the day or week. Time saving, easy to use and flexible; online bookings are a perfect example of the way in which the internet can make life better for all.

Time to ski

With Bonfire night safely out of the way it is time to turn our thoughts ahead to the winter ski season. Whilst some forecasters have predicted a harsh winter ahead for the UK in 2013, the Met Office recently took pains to stress that it is still too soon to produce an accurate forecast and accused those who are predicting “the worst winter in decades” of crystal ball gazing.

Whatever the outcome, UK winters are still too unpredictable to guarantee good snow leaving ski enthusiasts having to look elsewhere to get their skiing fix. This means that the annual exodus to the European slopes and further afield is about to get underway.

The first week in November has already brought a good snow covering to some alpine resorts, resulting in predictions of an early start to the season and no repeat of last year’s green slopes. Hopefully the weather conditions will bring good safe skiing but whilst the majority will return safely from their adventures, there will be some who suffer on the slopes and need attention on their return.

It’s not surprising therefore that whilst eager skiers travel outwards, back in the UK physiotherapists and other health professionals are bracing themselves for a busy winter. Broken limbs, strains and pulls are an inevitable consequence of skiing accidents. Add in those whose year-round sedentary lifestyle has not prepared them for the physicality of skiing and chiropractors, osteopaths, and physiotherapists alike are an unforeseen consequence of a winter holiday on the slopes. And if winter in the UK does turn out to be harsh then there will be an additional crop of home-grown injuries to treat.

Hopefully some individuals will have thought ahead, consulting health professionals for pre-ski exercise regimes which will prepare them for a holiday on the slopes. And hopefully some people (particularly the elderly or frail) will have prepared for icy conditions at home, stocking up on essential supplies or arranging for additional support perhaps from a neighbour or health professional. But many won’t be prepared and even if they are, it is impossible to guard against accidents. All this means additional demands on the services of health professions who in turn will need to gear up their timetable to run as smoothly as possible. This includes taking steps to ensure that the time given to treatments is maximised.

All this means that health professionals need to gear up their timetable to run as smoothly as possible. Missed appointments not only means a lack of income but also another patient who will not be speedily treated. Having to interrupt treatments to take phone calls means that treatment may not be as effective as it should be. And if calls are missed then patients suffer and diaries are not as full as they should be.

The answer is to bring in the services of a virtual assistant. With calls answered, diaries can be maintained as full as practicable without patent treatments suffering. Add in an appointment reminder service and no-shows are reduced again helping diaries to be maintained at an optimum level. Skiing can be fun, but when something goes wrong, a speedy return to fitness with quick and professional help is the best way to prepare for the next season on the slopes.

Telephone reminders

We’ve written before about the way in which telephone reminders can help to cut down the number of no-shows but it is always a pleasure to be able to report on a practical example. Earlier this year the Great Western Hospitals NHS Foundation Trust introduced a reminder service for those with outpatient appointments.

Since the reminder service started the trust reports that no-shows have reduced by a third and the trust is therefore expanding the service to its physiotherapy departments. Using a mixture of texts and automated calls the trust decided to adopt the appointment reminder service as a way of cutting down on the 39,871 appointments missed in 2012.

In announcing the extension of the service the trust’s deputy general manager responsible for outpatients told the Wiltshire Times: “The reminders seem to making a real difference. I hope that patients find the service helpful and it makes it easier to cancel or rearrange. If we know a patient won’t be attending, we can offer the appointment to someone else. By making sure all of our appointments are used, we can see more patients and patients will be seen sooner.”

Patients who fail to show up for appointments are not just a problem for NHS trusts. Health practitioners everywhere from osteopaths to physiotherapists and from beauticians to specialised health clinicians all need to run with as full a schedule as possible if they are to remain competitive. Not only can missed appointments lead to delays in treatment times for the patients concerned and others, for those who rely on the appointment to generate income, every gap is a loss. The Wiltshire trust estimated that for them each missed appointment cost some £108 and the opportunity cost charge can easily be higher for those in private practice.

It is hardly surprising therefore that telephone appointment reminders are increasingly becoming a necessary feature of health practice. This writer has received reminders within the past few months from their optician, dentist and doctor, all of whom have adopted versions of the reminder system. Set alongside a virtual assistant service which can also take calls and arrange bookings, even the smallest of health practices can move towards a fuller diary with fewer no-shows. This in turn means that health practitioners can keep their prices competitive whilst maximising both their income and patient treatment times.

Taxing times

From time to time HMRC decides to set up a task force to investigate the tax affairs of a certain business sector. For example in the past it has reviewed car dealers in the Midlands and fast food outlets in London. Now it is the turn of health professionals to come under the spotlight.

Announcing the initiative on 7 October, HMRC have given health professionals until 31 December to sign up for the campaign and until 6 April 2014 to pay any outstanding tax. By doing so they will face far lower penalties than if they fail to sign up and HMRC subsequently discover amounts of unpaid tax are due.

Doctors, dentists, nurses and social workers are not covered by the campaign but the HMRC announcement highlights other health workers who they will be looking at including:

Physiotherapists, occupational therapists, chiropractors, osteopaths, chiropodists, podiatrists, homeopaths, dieticians, nutritional therapists, reflexologists, acupuncturists, psychologists, speech, language and art therapists.

Whilst the vast majority of health professionals will already have their tax affairs in order, the campaign is a reminder that being a health professional is not just about treating patients. Managing diaries, booking appointments, invoicing and collecting fees, ordering supplies and preparing accurate accounts all take time out of the working day. Larger practices may have the benefit of a team of back-office helpers but health professionals working in smaller practices may find themselves juggling patient time and treatment time to the detriment of income and professionalism.

That is when the services of a virtual assistant can come in handy. Appointing a virtual assistant service to answer the phone, manage the diary, book appointments, invoice and file patient records can free up valuable time both for patient treatments and to provide some free time at the end of a full day. Of course there are some tasks that a virtual assistant won’t be able to perform, such as being there to receive medical supplies, attend CPD training or complete tax returns but with time freed up from other tasks, at least the health professional will not be under as much time pressure when other tasks need to be completed.

In announcing their latest initiative, Marian Wilson, Head of HMRC Campaigns, said “I urge health and wellbeing professionals to take advantage of our quick and straightforward way of bringing their tax affairs up to date. Help, advice and support is available.” Full information including a video and direct phone number is available via the announcement on the HMRC website.

Reaching out

A study in the USA has revealed the benefits of automated telephone calls for patients with hypertension. Taking a sample of 64,773 hypertension patients, half were sent a recorded phone message inviting them to have their blood pressure monitored at a clinic whilst the rest received no such invitation.

After four weeks it was found that 32.5% of those who had received a call had controlled their blood pressure against a base of 23.7% for those who had not received a call. Although researchers did not collect data on measures taken by patients to control blood pressure it is believed the calls played an important part in raising patient awareness.

Certainly this study mirrors the findings of other surveys in the way in which patient care can be improved by a simple call. Whether by encouraging patients to have a check up or replacing costly health visits with a simple call, the telephone is increasingly playing its part in enhancing health care.

One particularly successful way in which phone calls are being brought into the front line is in reminding patients about their appointments. Whether issued via automated phone message or by text, a simple reminder can make a substantial contribution towards reducing the number of “no shows.”

This has two benefits. Firstly it encourages patients to attend booked appointments and secondly it encourages them to notify the health practice should they be unable to attend for any reason. With an early warning of a cancelled appointment the practice has the chance to book in another patient; thus benefitting the practice, the patient and boosting the overall level of patient care.

In our ever busier lives, it is inevitable that we will forget appointments from time to time and an automated phone or text message can be that vital memory jogger which we all need. Health care practitioners from opticians to physiotherapists and even vets are using messaging for everything from a reminder to pick up some new medication or book a check up to reminders about appointments which have been made. For example this writer received a text from their vet recently reminding them to pick up a fresh batch of worming medicine for a pet.

In summary, phone reminders can save “no shows, they can ensure patients receive the treatment which they need and they can help to keep health practitioners busy at all times.

Papering over the cracks?

The Government has announced a funding boost of £500m to help to relieve pressure on the worst hit A&E departments. Statistics have revealed that one million more people attended A&E in the last year compared with three years ago and this, particularly over the winter, has resulted in a virtual melt down of some services.

The funding is aimed at helping hospitals to prepare for the forthcoming winter and is designed to reduce or eliminate the “pinch points” which can so badly affect A&E services. This should enable A&E patients to be treated promptly and provide alternate care pathways for those who currently see A&E as their only care option.

Hospitals which have been identified as being most affected have been invited to submit their proposals for funding. These proposals may involve Accident and Emergency departments directly but could also cover areas such as taking steps to minimise hospital admissions from care homes by providing local specialists, increasing hours at walk in centres or pharmacies or increased social care provision or the provision of more services away from hospitals.

In announcing the proposals the Prime Minister, David Cameron, said:

“The additional funding will go to hospitals where the pressure will be greatest, with a focus on practical measures that relieve pinch points in local services. By acting now, we can ensure doctors, nurses and NHS staff have the support they need and patients are not left facing excessive waits for treatment.

Whether this new measure will be successful in reducing winter waiting times will be a matter for the future but it has to be said that it has not received universal acclaim. The Alzheimer’s Society commented that “while today’s proposals could bring short term benefits, they will do little more than paper over the cracks,” and their comments were echoed by the BMA and others.

However, this is but one stage in an overall plan to provide continuity of care within the community, thereby reducing the pressure on hospitals. This includes a £3.8 billion fund to “focus on joining up services, so that health and care services work more closely together, keeping people healthier and treating them closer to home.”

In the long term this will provide opportunities for health practitioners such as physiotherapists and osteopaths to provide higher levels of care outside the mainstream hospital system. Those health care providers who have streamlined their services to maximise patient treatment time are in a strong position to benefit from this new health care ethos and to provide increasing levels of care continuity to their patients and the community in which they serve.

The Olympic legacy – one year on

On 21^st July sporting stars joined 15,000 runners to commemorate the anniversary of London 2012. With 2,500 adults and children racing round a family friendly 1.5 mile track, the remainder of the runners tackled a 5 mile course which wound around the Queen Elizabeth Olympic Park.

The National Lottery anniversary run was started by Sir Chris Hoy whilst athletes such as Victoria Pendleton and Paula Radcliffe joined the mass runners cheered on by family and friends. Finishing on the Olympic athletics track itself every runner who completed the course created their own special memory to treasure and add to the host of positive memories of the Olympic and Paralympic games.

The run is not the only way in which the games are being remembered. As part of the legacy programme sports clubs across the UK have offered and continue to offer special taster days and extra coaching to tempt people to take up or return to sport. The ongoing success of these programmes can be seen with increased numbers of cyclists on our roads and a heightened level of competition enjoyed at many sporting events.

But the legacy is not just about competition and the true legacy can be seen in those who are enjoying sport as a means of keeping fit. Inevitably this results in an increase of sporting injuries as old joints and muscles are coaxed into working that little bit harder and those who once gaily set off on a run without any preparation discover the importance of stretching.

For physiotherapists, chiropractors, osteopaths and other health practitioners the sporting revival therefore carries the potential for an increased caseload. But in order to benefit from this legacy potential, health practitioners may have to optimise their working time. One option available is for activities such as diary management, client notes management and appointment reminder calls to be outsourced to a virtual assistant service. With phones diverted and day to day practice management outsourced, health professionals can concentrate on maximising patient treatment times.

The Queen Elizabeth Olympic Park is due to open its doors fully for business in the Spring of 2014. When it does it will offer many more opportunities to participate in sport. In the meantime there are lots of special events, taster sessions and trials taking place across the country for those whose appetite has been whetted for Rio 2016 and beyond or who just want to take up the challenge and get a little fitter.

0800 0789333 info@clinicappointments.com

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