The document discusses applying lean principles and techniques in general practices to meet increasing demand. It describes how lean can help practices improve quality and reduce waste to more efficiently deliver primary care. Examples are given of practices that implemented lean tools to create more appointments, reduce staff costs, improve efficiency, and enhance patient experience. The document advocates that practices innovatively redesign processes and work together across the healthcare system to achieve the 2020 vision of delivering high quality primary care.

1. LEADING GENERAL PRACTICE TOWARDS
OUR 2020 VISION:
MEETING THE CHALLENGE OF INCREASING
DEMAND
Chair – Sir Lewis Ritchie, University of
Aberdeen

2. Learning outcomes for this session
• Discuss with general practitioners the application of
lean tools and techniques, aspects of leadership and
team working and practical benefits
• Identify innovative ways to work locally in practices
as part of the whole system to improve access for
patients, prescribing, consultations, safety, and the
working lives of staff
• Hear about the concept of using design principles to
redesign a practice to meet demographic,
professional and business challenges

3. Leading General Practice towards our 2020
Vision
• Use of lean is one way to
release time for Delivering
Quality in Primary Care
• The focus is on improving
quality, reducing variation
and waste at the same time
• Productive General Practice
partnership with RCGP,
QIHub, Health Boards
• Innovate to enable Our 2020
Vision

4. Lean principles and practise
• Whole team
• Leadership
• Culture change
• Day to day measurement

5. What’s it got to do with Delivering Quality in
Primary Care?
Effectiveness Safety
• Removes wasteful steps • Being used by practices
in prescriptions process undertaking Patient
• Brings consistency in Safety in Primary Care
prescribing decisions • Incorporates the
• Helps you work with SafeQuest safety culture
pharmacy and care home assessment tool
colleagues
Person centredness
•Uses the voice of the patient to decide what adds value
•Involves patients in improvement work
•Links to the RCGP patient involvement project
•Supports practices to implement the Patient’s Rights Bill

7. Demands on general practice are rising
• Increasing consultation rates
• Ageing population
• Complexity of care
• Shifting Balance of Care
• Patient expectations
• Reducing demand on A and E and OOH
• Demand will continue rising
Doing nothing is not an option

8. GP and Practice Nurse Consultations in
Scotland
• 2003/4 21.4 million
• 2010/11 23.1 million

9. Go to
your
GP

11. Offers benefits: additional appointments
By reviewing current nursing templates and
appointments a team
• created an additional 10 nurse practitioner and
14 practice nurse appointments a week while
still maintaining an efficient nursing service
• decided that it was not necessary to appoint
another nurse to the recent vacancy the team
had which had a cost avoidance of £15,000

12. Offers benefits: blood testing staff costs
reduced
£3.50
per Nurse
100% of blood
episode
£1.50
tests
per
episode
£1.50
per Phlebotomist
episode

13. The benefits it offers…
Stanley Medical Group, County Durham
• Reviewed their recall system for patients needing routine
drug monitoring
• Applied lean principles to understand the current process
and design an improved process
• Existing “Streamlining thisto inconsistencies, waste and
system lead process has saved us time but the
patient safetyand the patient that we have improved patient
real benefit has been
safety
risk experience, as we are now able
• Results: to offer more appropriate appointments”
Sue Elsbury, Practice Manager
– Patient Safety (faster lead time and higher degree of
accuracy)
– Time (35 hours/month to 0.53 hours/week)
– Patient experience (increased HCA patient facing
time)
– Money (£4150/year)

14. Offers benefits: reduced turnaround times
for reports

15. This front of house team reduced the number
of inappropriate enquiries, redirecting them to
the right team in their practice

16. Offers benefits: more efficient use of
consulting rooms through using 5S tool
Before

17. Offers benefits: more efficient use of consulting
rooms through using 5S tool
After

18. This team reduced the average time for staff
to find prescriptions from 118 to 21 seconds,
by mapping their routes with spaghetti
diagrams and using the 5S improvement tool
in reception

19. Offers benefits: reduced costs through
improving consumables re-ordering
process

20. "PGP is a very productive system to assess our
working life and to improve it with support. It
enables us to review processes and develop
consistency."
Crescent Medical Practice

21. “The experience with Productive General Practice
has been a good one. It has been good to
establish where we were in the first place and
where we want to go and the change has been
fully supported.
It has helped to build a picture of where we want to
be in five years time. We want to make it the
‘super surgery’ that it could be through continuing
to strive for better patient feedback, and
maintaining the drive that we’ve established so far,
because we have achieved some really brilliant
work.
We’re looking forward to the further change that’s
about to come.”

22. Go explore …2 out of 4 work stations
Elmbank SafeQuest
Practice
Shaping Our
Future Crescent
Practice Practice