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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 15th 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.

Physiotherapy, an essential part of dementia care

The National Institute for Health and Care Excellence (NICE) have published a new quality standard which aims to support people to live well with dementia.  The aim behind the standard (QS30) is that “a person-centred and integrated approach to providing care and services is fundamental to delivering high-quality care for people with dementia.”

In addition to acknowledging the importance of carers in the treatment of those with dementia the standard also looks at every aspect of a dementia sufferer’s care including leisure, health and relationships.  The standard also highlights the need for individual choice and control to be at the forefront of any programme especially when planning and evaluating services.

One element of the standard also looks at the importance of those with dementia and their carers being able to access “services that help maintain their physical and mental health and wellbeing.”  Whilst some of these services naturally include access to general practices and nurses, the list also includes care services such as hearing therapists, chiropodists and physiotherapists.

The Chartered Society of Physiotherapy (CSP) contributed to the development of the dementia standard with particular advice being sought from the network of physiotherapists who work with older people (Agile)*.  In commenting on the standard Agile chair, Janet Thomas, said “The dementia guidance we saw certainly had a different feel to other NICE guidance, with the emphasis shifted to the day-to-day living aspect of dementia care, and this is very important.”

With a growing body of evidence supporting the theory that “a healthy mind in a healthy body” is not just a saying but a vital component of wellbeing in later life, there is certainly something to be said for helping dementia sufferers to stay as active as possible.  Hopefully this means that those involved in physiotherapy and other related services will see a greater call on their time as they work with carers and those with dementia to help to provide an integrated holistic management programme.

Taking steps to reduce administration time, such as by managing diaries and storing patient records electronically, will help to maximise treatment time and hopefully enable physiotherapists to take their place at the forefront of this new approach to care.


Harnessing the power of technology

Speaking at the Healthcare Innovation Expo 2013*, the Health Secretary, Jeremy Hunt, outlined the way in which innovation is to be used to drive the NHS into a future where it is “freed from the shackles of top-down bureaucracy.”  Giving the online seat booking innovation which transformed the air industry as an example Mr Hunt bluntly stated that “while they innovated, we stagnated.”

In a speech which touched on the Francis Report, culture and values as well as regulation and systems Mr Hunt highlighted the care and compassion which is at the heart of our health services.  He also called for patients to be put in the health driving seat.

One of the key practices which the Health Secretary believes needs to be implemented to transform the health service is the move to electronic patient records.  Giving examples of ways in which patient care can be improved by the use of electronic records, Mr Hunt said that a paperless NHS will have “massive implications for improved patient safety, genuine patient empowerment and self-management as well as scientific research.”

Of course it is not just the NHS which will benefit from electronic records.  Health practitioners both within and outside the NHS can find that electronic records will make a sizeable difference to their working patterns.  For example, the Clinic Appointments patient records service is already helping practitioners to streamline their operations.

With patient notes, documentation and X-Rays all available at the touch of a button the health practitioner no longer has to spend time in filing or searching for records.  This means more time spent on patient care and less chance of errors creeping in if important documents are mis-filed.  Combined with the Clinic Appointments’ virtual receptionist and diary management services the secure patient records service helps every health practitioner from a sole practice to a multi-unit facility to provide a streamlined and efficient service.

Health services in the UK are going places and those who are at the forefront of innovation and streamlined technology will be best placed to make the most of the new vision.  Putting patients first, innovating, bringing fresh thinking to health care; all these are on the Government’s radar.  The Health Secretary closed his talk, as we do this article, with this quote from Bill Gates “Never before in history has innovation offered promise of so much to so many in so short a time.”


Handing power to patients and professionals

As the fallout from the Francis Report continues to echo around the health sector it was refreshing to note an event recently which was purely aimed at innovating health care rather than indulging in recriminations.  Think tank Reform got together with Imperial College’s Institute of Global Health Innovation to draw attention to some of the positive innovations around the world which we may be able to learn from within the UK’s health sector.

Acknowledging that innovation can be defined in many ways, the event focused on three fundamental innovations which could improve the quality of care and patient outcome throughout the health service; workforce innovation, self care and personalised medication.

A shift towards personalised medication is only possible thanks to the leaps which science has taken in understanding the human genome.  With a greater understanding of personal risk factors comes the ability to target treatment on an individual basis.  We are already starting to see the benefit of targeted treatments in areas such as cancer and as our understanding grows the potential for more effective treatments is limitless.

Personalised medication does in part require a buy-in from the patient in understanding the risks of certain life styles and family traits and the next step is logically to encourage patients to take more responsibility for their care.  Self-diagnosis, arranging appointments directly with health professionals such as physiotherapists, managing self-treatment programmes is a step forward in understanding for patients but it will help to streamline the health service and target care where it is most needed.  For example, a patient with muscle or ligament damage needs to see a physiotherapist or osteopath straight away and making them travel the health nurse/doctor route first is a waste of resources and time.

This leads on to the third and most important change which the UK’s health services desperately needs, that of workforce innovation.  Doing away with rigid hierarchies and instead focusing on the individual patient means doctors, health care workers and support services all providing a flexible individual service.  Beacon Health Strategies, working with the poor, elderly and mentally ill in the USA has done just that. Over three years the flexible approach has reduced emergency hospital appointments by 60%, reduced suicide rates by a half and got 44% into work.

Innovation within the health sector won’t be easy.  It will require a sweeping away of the old hierarchies and a combined doctor/health professional service which is flexible and focused on patient care.  Those health professionals who have taken steps to outsource telephone answering, diary management and patient records and who are therefore able to maximise the time which they spend on patient care are in a perfect position to step forward into the new innovative, personalised era.

Going paperless

The Health Secretary, Jeremy Hunt, has set out plans for a paperless NHS by 2018.  In a speech to the Policy Exchange the Health Secretary said that a series of milestones would mark key stages towards the eventual goal.  These include hospitals being able to accept electronic records by 2014 with 2015 seeing electronic referrals in place.

In advance of the announcement a report by PwC suggested that over £4 billion could be saved within the NHS by better use of information and technology.  This includes automatic referrals, e-prescriptions and the smart use of technology increasing the time clinicians spend with patients thus leading to a reduction in waiting times.

This latest drive towards a paperless NHS has been broadly welcomed with the only scepticism coming from those who suffered from the failure of the previous attempt by Labour to bring in a centralised NHS system.  This latest initiative avoids the “monolithic system” pitfalls by enabling health providers such as GP Practices and hospitals to commission their own systems which will merely be required to share records with other systems.  This means that health providers can develop, store and manage records in a way which suits them, subject to central sharing protocols.

There is no doubt that digitising records can save time and money.  For example, the John Taylor Hospice near Birmingham has more than doubled the time clinicians can spend with patients simply by using laptops.  But the drive towards a paperless NHS can also benefit others within the health care sector.  Software such as that offered by the Clinic Appointments patient records service is already helping health practitioners to digitise their patient records.  This means that records can be accessed 24/7, there is no time wasted in finding or sorting records and with clinical notes, x-rays and invoices all centrally handled the health practitioner can spend more time on treating patients.

Combined with the telephone answering and diary management service this means that while an osteopath or physiotherapist is treating one patient the Clinic Appointments team can take calls, book appointments and the health practitioner can then call up the next patient’s details at a touch of a button.  With faster administration time and no more worries about losing patient records in fire or floods clinicians can concentrate on what they do best, treating their patients.

A culture of compassion

Following a number of high profile reports into the standards of care within the NHS the Prime Minister has announced a package of measures which are aimed at raising the standard of care provided by health services.  Alongside measures such as improved training for dementia carers and a defined career pathway for care assistants comes a vision for strengthening district nursing.

The attention grabbing element of this new package is the introduction of a “friends and family” test which will encourage patients to report back on hospitals.  Designed to be in place from April 2013 the test will then be gradually rolled out over the rest of the health service.

The measures have been broadly welcomed by health bodies with the NHS Confederation chief executive, Mike Farrar, saying that “we have got to ensure that a culture of compassion is running through the veins of every place that provides care, no ifs, no buts and no exceptions.”  But whilst greater training and a renewed emphasis on care and compassion is a major step forward, there still remains the twin challenge of providing patient care whilst coping with the day to day paper work and interruptions.

A survey of social care workers in 2012 revealed that just 15% of time was spent in face to face meetings with clients with the rest of the time taken up with paperwork, phone calls, travelling and other meetings.  If that figure were to be reflected across the health sector then there is precious little time available for patient care.

This time challenge is one which is not simply confined to those working in the NHS, but is also a problem for those providing other health services such as physiotherapy and osteopathy.  For them, every minute spent on paperwork and answering calls is a non-earning minute which is spent away from patient care.  This is where the services of a virtual receptionist can make a difference. With calls being diverted to a virtual receptionist the clinician can concentrate on providing treatments.

With diary management and patient records also being taken care of, the percentage of time spent on patient care can soar.  More time means the ability to provide full treatments to more patients; it means less of the “next please” and more holistic treatment of the person not just the symptoms.  In short more time means that clinicians can step up to the culture of compassion demanded and in the process help to take health services to the next level.

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.

Reducing “no shows”

A recent NHS report revealed that 1 in 10 hospital appointments in 2011 resulted in “no shows”.    This adds up to a staggering 5.5 million missed appointments and costs the NHS £millions each year.  Even if each patient has a genuine reason for missing the appointment, missed appointments have a knock on effect across the NHS.

In announcing the “no show” figures, the then health minister, Simon Burns, said “It is important that people realise that not turning up for their agreed appointments means other patients’ care might be delayed.”  Although the figures were down by 250,000 on the previous year they still have a significant impact on NHS services.

Hospitals are starting to employ a variety of methods in a bid to reduce the number of those who fail to turn up for appointments.   One project in Bedfordshire cut missed appointments by 30% simply by asking patients themselves to write down the appointment time and repeat it back to the receptionist.  Other health providers have started sending reminders to patients by text or e-mail whilst Newham University Hospital doctors now check up on their diabetes patients via Skype.

The problem of missed appointments also affects those in the private healthcare sector.  However with many services such as osteopathy and physiotherapy operating as via comparatively small practices, health practitioners can be torn between the options of treating patients or spending time in administration.  This means that inevitably patient appointment reminders are not sent, raising the chance of missed appointments.

Whilst some private health practices have a policy of charging patients for missed appointments these fees can prove hard to collect and may endanger the patient/practitioner relationship.   There is no point in trying to collect a missed appointment fee if that means missing several other fees in the future.

This is where a virtual receptionist service comes into its own.  Answering the phone, making appointments and sending reminders via text or email, the virtual receptionist service takes the appointment strain, leaving the clinician free to maximise patient time.  Interestingly a study in 2008 showed that those in the 20-24 age group are the most likely to miss appointments followed by the 25-29 and 15-19 age groups. The most tech savvy groups are therefore the worst offenders and a reminder system which takes advantage of text or e-mail could therefore have a significant effect.

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.

Scoring Service Levels

Following a nationwide GP Patient Survey in 2011, users of the NHS Choices website are now able to compare the service provided by differing GP Practices.  Underlying data measures a range of factors to produce an overall GP Practice score out of 10.

The Department of Health has responded to BMA fears that the scores fail to take account of challenges faced by individual practices or areas by confirming that this will be considered when the data is published.  For patients, the main benefit of the data will be to enable them to compare GP performance within their immediate location and therefore choose a GP Practice which meets their needs.

For those interested in delving deeper into the statistics, the overall score out of ten is broken down into varying areas including the levels of service provided as well as clinical experiences.  This broad approach recognises the growing swell of opinion that good levels of health care start with the experience patients have when trying to contact the healthcare practice and make an appointment.  Indeed, Patients Association chief executive, Katherine Murphy, told the BBC that the Patients Association helpline “is seeing a trend of increasing complaints about GPs, covering a number of areas, including difficulties obtaining an appointment, complaints about behaviour of reception staff and other factors that affect their overall experience.”

Of course GP practices don’t have a monopoly on the need to constantly juggle clinical and administration time.  Other health professionals such as chiropractors and osteopaths also have to manage the twin demands of being easily contactable whilst maximising the time given to treatments.

One answer to this dilemma is the use of a virtual receptionist service.  With telephone answering and diary management outsourced to trained health receptionists; clinicians need not worry about receiving a low score for contactability or professional image.  Add in features such as appointment reminders, invoicing and managing patient records and health professionals can concentrate on providing the high level of service that their patients require.

The use of a virtual receptionist service also brings a revenue benefit.  With ease of contact comes a fuller diary and with appointment reminders comes a reduction in no-shows.  This helps to increase income at a cost which can be as little as the equivalent of one new client each month.  Whilst this latest NHS scoring initiative is confined to GP Practices, other health professionals can learn from the GP experience.  Using a virtual receptionist service may just be the step change needed to improve service levels alongside revenue and patient care.

Contact us today to discover how Clinic Appointments can help your clinic. Book your free demo call now to learn more.