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CAMHS won't see you now

Interesting new slant on patient access

Forty-eight-hour access has

worked well for

Dr Jim Sherifi's practice, but has also thrown up some oddities – for example it tends to be younger patients who get through

to see the doctor

It is rare for any new initiative such as GMS2 to be implemented without teething problems. Unexpected issues are often raised requiring modifications. So it is with the guiding principle of 24- and 48-hour patient access to primary care health services contained within the new GP contract.

The policy is further complicated by the imprecise definition of what is considered to be an 'emergency', 'urgent' or 'routine', and the difference in meaning these words have to patients and doctors.

In addition there is confusion about exactly what constitutes an 'enhanced patient experience' in primary care. Can this state be obtained through improving patient access to a health care adviser, for example.

Our practice introduced 48-hour access one year ago. With the flexibility granted through PMS we facilitated the introduction by taking on additional staff, opening more phone lines, updating the appointments software, changing surgery appointments allocations to include blocks of appointments that are released on the day of use and significantly altering the patient/surgery interface.

The latter was achieved through the training of receptionists in handling appointment requests, focusing on the patient's declaration of the need to be seen and increased handling of 'grey' requests by a nurse practitioner with subsequent direction to the practice nurse, paramedic or doctor.

Although the system has superficially worked well, on annual review it was noted by several doctors that the proportion of young adults seen in surgery with minor problems had increased.

Although this may be partly accounted for by those with chronic diseases being managed in nurse-led clinics, the general feeling of all staff involved was that younger patients, more familiar with instant access in all walks of life and more adept at using the facilities offered in modern telephones, were more efficient in phoning and persistent in stating their need to be seen that day.

Conversely the elderly tended to delay accessing any service and were more easily put off by engaged phone lines or being interrogated about the need to be seen that day. A process of Darwinian selection seemed to have been started by our policy of immediate access!

Mind you, any discrepancies in accessing surgery appointments tended to be rectified in the surgery itself. Young adults had problems that could be dealt with quickly, allowing more time to be spent on the elderly with more complicated medical conditions.

Thus time management of the surgery as a whole seemed to be more efficient than previously.

However, this might be jeopardised by another aspect of 'enhanced patient experience' in the contract – that of

10-minute appointments for all.

First we intend to retain the flexibility present in consultation times, giving to each according to their need while retaining the basis of health education implicit in the 10-minute rule. In order to formalise this further we shall trial the use of five-, 10- or 15-minute appointments as chosen by the patient and successfully piloted by a number of practices elsewhere.

Second a practice website on which is placed personalised information for the handling of common conditions from warts to head lice to sprained

ankles may meet the requirements of the contract without placing too much pressure on face-to-face interactions.

Third we plan to capitalise on the increasing familiarity of the young, and 'silver surfers' with the internet by offering an electronic

service for simple requests (prescriptions) and advice.

In doing so we would also be anticipating another element of the NHS Plan – the increased use of telemedicine!

Jim Sherifi is a GP in Sudbury, Suffolk

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