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One fifth of GP appointments avoidable, finds NHS England audit

A fifth of GP appointments are potentially avoidable, according to an audit funded by NHS England.

The audit tool, developed by the Primary Care Foundation, has been used by more than a thousand GPs in nearly 350 practices since it was first launched in 2015.

The data collected as of May 2018, revealed that 20.5% of GP appointments could be avoided, with the most common reason being that another clinician in the practice could have seen the patient.

But this is lower than the 27% figure NHS England quoted in the GP Forward View after a very small early pilot of the audit took place in 2015.

Henry Clay, director of the Primary Care Foundation, told Pulse that the latest figure reflects a broader range of GP opinion about what is an avoidable appointment.

He said: ‘What the clinicians do is at the end of each consultation, for the period they’re using the tool, they categorise the appointment broadly into whether it was potentially avoidable or not.

‘But particularly for those are potentially avoidable, how it might have been dealt with differently. Clearly there’s a degree of subjectivity in doing that.’

The initial audit of 56 GPs between January and June 2015 for NHS Alliance’s Making time in general practice report found that 27% of appointments could have been avoided.

But Mr Clay said: ‘We may have slightly, in picking people who are willing to answer when we were doing the making time survey, have got enthusiasts rather than anything else.’ 

He added that those who have taken the audit since ‘are probably being a bit more careful about the framework in which they’re working now … and maybe setting some bounds on the scope that may not have been done by early people’.

Following the intial audit, NHS England funded the Primary Care Foundation to roll it out more widely in the past six months, but Mr Clay was unable to disclose how much had been spent on the tool.

The audit found that of the avoidable appointments 7.5% could have been seen by another clinician in the practice, 4.1% could have been met by another local service, while another 4.1% ‘should not arise if system works’.

But Mr Clay cautioned that not all 20% ‘could or would be avoided in a future world’.

He said: ‘We all know there are plenty of cases where patients may come to a GPs three or four times before he or she starts to pay attention to the fact that the GP says actually, you really should see the nurse about this.

‘It takes time for people to behave differently and you’re never going to catch everyone in advance.’

However, he said the data provide 'information for a discussion within the practice as to what they might do differently, whether that’s their internal, operational and clinical processes or whether it’s about collecting information to suggest to the CCG’ new ways of working.

Dr Arvind Madan, director of primary care at NHS England said: 'We are already working with practices and other stakeholder partners to expand the ways in which practices can work differently to manage workload. Having this data will help stimulate local conversations within practices further and encourage engagement in the Time for Care programme.'

Readers' comments (17)

  • More like 50%

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  • Took Early Retirement

    Certainly a lot more if one includes the social detritus that medicalizes itself.

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  • Dear All,

    "with the most common reason being that another clinician in the practice could have seen the patient."

    Excellent, lets have that "another clinician" specified, because unless i am mistaken our nurses, HCAs, physios, phlebotomists and counsellors are already maxed out.
    Or is this research responding to a political agenda?
    Regards
    Paul C

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  • It's more than 20%.

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  • About 25% due to failing hospitals imho!

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  • Yawn yawn default “see your GP “ yawn

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  • So we're offering 20% too many appointments. Let's try the reduction next week and screw this 60 hour week.

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  • Tantalus

    It would be more than 50% with the introduction of a £5 charge.
    Like plastic bags
    Just saying

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  • that is not bad given that public have direct access. I am sure similar stats can be found for most jobs. Trouble is , if you see a noctor, for 20 mins, then they can"t manage it, it goes to a GP for 10 mins ie total 30 mins. This is common and cancels out any gains.

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  • Bornjovial

    This is a retrospective decision. What we need is a prospective trial of triaging into alternate practitioners and then see how many they are able to manage and what proportion is reverted back to GP`s.
    One should also look at vicarious liability.
    I have come across patients with unusual presentations like a heartburn which was a acute MI (in a 40 yr old lady), a sore throat which was acute leukaemia, an "asthma flare up" which was Eisenmengers reversal, 2 shoulder pains which were lung malignancies etc. Admittedly these are rare but the medical negligence costs will have to be weighed up against the saving. 1 significant missed diagnosis would offset years of savings by offsetting workload to alternate health professionals and GP`s carry the vicarious liability now.
    Obviously if the government underwrites all medical negligence then this becomes more interesting.
    The "doctor as a medicine" concept is also lost but some patients prefer 20 min with the nurse rather than 10 min with GP partially offsetting this.

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  • As Tantalus writes, half would vanish if an appointment cost as little as £5.

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  • "As Tantalus writes, half would vanish if an appointment cost as little as £5."
    or if they actually had to pay for the prescriptions for OTC drugs.

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  • Sounds like a typo. Should read only one in five appointments actually required

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  • This probably demonstrates that there isn’t that much scope to take work away from us as it will never be the case that all this 20% can be diverted without any input from us. Even with an achievable 10% diversion rate that brings a day of 40 x 10 min appointments down to 36 which is hardly going to suddenly turn around the recruitment issues in GP.
    There clearly needs to be more of us whatever it costs and defining a long term sustainable workload for the whole of a career is the only thing that will save GP.
    Some kind of activity based contact has to be implemented with an ability to turn away work.

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  • It is miserable. I know it’s not the money but let’s be honest fighting this incessant s**t storm and taking home two or three times what it is now at least would make the long days more bearable; but at least there’s more money for the front line ie A&E and Hospitals. Primary care doesn’t really do anything anyway.

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  • Ed - agreed, most of our job is useless but very occasionally there's someone that really did need to see a gp. It's just a shame you have to deal with 30 patients with trivia and have sapped all your energy before that one patient that deserved to be seen knocks on your door

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  • Beware the token charge for services to try and curtail demand. If you read the excellent freakonomics book you realise it can lead to an ever higher sense of entitlement. Our services will be respected when paid for at the full market rate

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