How we increased our appointment capacity by 50%

Dear Dr Clay,
I found your article very interesting and would like to know how can get copy of the tools you mentioned.
I do have a concern re: my own practice and as to whether this model will be useful, as we have extremely high number of patients over 75 years with multiple morbidity and also large numbers in care homes and nursing homes including EMI.
Also things somewhat different in Wales where I practice. Any patient who phones the surgery prior to 10.00am is guarenteed an appt same day, regardless of urgency/necessity of being seen that day and not sure how your system would address this' Welsh Access Policy.' Once surgeries full, all those still phoning before 10.00am have to be seen and are shared out as 'extras' amongst GP's. They all know their 'rights' to be seen if phome timeously so not sure how this could be addressed. Would value your comments Thank you

Excellent article. It shows the value of really understanding your practice as a system, and demand from the patient's point of view (why do we assume that a patient wants to physically see a doctor?). Also the value of putting expertise at the point of first contact, thus providing in many cases the advice, support and reassurance that is all many patients require. I wonder how much the NHS as a whole could save if such principles were universally applied?

Dear Dr Breese
To get a copy of the tools visit www.productiveprimarycare.co.uk
We have seen the model used in practices similar to yours and it works well. Even with patients with multiple morbidities, sometimes they don't wish to be seen they just need advice and this gives them a route to get that advice without having to put themselves to the trouble of visiting the practice. If they do need to vist (or be visited) the time released by the other 2/3 of patients that don't want to come in means that you will have more time to help the ones who do.

You will find (though it's hard to believe when you work in a standard system) that the freed-up time enables you to see any patient whenever they want to be seen so the notion of 'urgent' and 'routine' doesn't apply. It is after all, only a tool that we use to decide on when we will wee a patient. The key to this is balancing your capacity with the 'shaped' demand that Dr First gives you. That matched capacity and demand needs to be DAILY basis rather than a weekly one. The key is: 1)Remove your backlog first; 2)do today's work today. There are many techniques to achieve this but the Dr First technique is the least stressful and most cost effective one I've so far found. Don't be tempted to book patients ahead unless they want to be.

Remember; YOU ONLY HAVE TO BE ONE DAY BEHIND FOR EVERY DAY TO BE A BAD DAY. Better to have a busy day than a busy week!

In answer to the 'how much the NHS could save' question.

Our practice, we have found out, has the lowest over 75 years A&E attendance of any practice in the East Midlands. We have also discovered that Admission to hpoospital from A&E is directly correlated with admission to hospital. We estimate that if every practice in the UK approached the same level of A&E attendance and hence hospital admission it would save the NHS / commissioning budgets >£1.3billion per year!

Sorry that should read: "Admission to hospital from A&E is directly correlated with A&E attendance"

system only works if triage/telephone encounters actually replace a surgery, not just added to it but it sounds good. Are there any indemnity issues with doing so many telephone encounters?

I found this article very interesting, especially because we have been using a very similar system for several years. we have one doctor triaging all the calls and slots in all the other docs surgeries for them to be slotted in for a call or face to face appt if the triaging doc cant deal with it directly.

The issue with this system is that its geared towards acute work and the spanner in the works is the follow-ups, chronic condition patients, and regular visitors. They will again begin to fill up many slots in advance.
The system may also encourage more patients to walk in rather than ring as they begin to realise they can/will be seen on the same day anyway. Very frustrating with 'minor problems' and requires ongoing patient education, which we already do.
t