This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

GP practice forced to stop patients booking appointments in advance

A GP practice in Carlisle has stopped allowing patients to book appointments in advance because of the immense pressure it is facing.

Fusehill Medical Practice has introduced a telephone triage system, with a doctor speaking to all patients before they can book an appointment, and appointments only available on the day.

Partners at the practice have said that they have had trouble with the pre-bookable appointment system, and recruitment problems are worsening the situation.

It is the latest practice to do so, following a similar measure being taken by a practice in Swindon.

Dr Charlotte Asquith, a GP at the practice, told the News and Star: ‘We have not made these changes lightly and have given a great deal of thought as to how we can safely manage the needs and expectations of our patients in very difficult circumstances.

‘Our pre-bookable appointment system has become unsustainable with patients ringing at 8am day after day only to be told “there are no appointments left”.’

‘This is a concern because serious conditions could be missed. In response, the practice has taken the decision for a doctor to triage by telephone all requests for medical advice.’

Health checks for long-term conditions can still be booked in advance. The system also aims to reduce DNAs, as the practice currently has around 40 a week.

Dr Asquith added that recruitment problems are worsening the situation: ‘When I joined the practice in 1997 there were six doctors for 8,400 patients. Today, despite nationwide repeated attempts to recruit more staff, there are just three doctors, one of whom is on leave due to bereavement, to care for 8,600 patients.’

Dr Geoff Jolliffe, interim clinical chair of NHS Cumbria CCG told the News and Star: ‘There is a national shortage of GPs. The reality is that general practice has to change to be able to meet a growing demand, and patients will have to get used to some changes, whether it’s the way appointments are made, or seeing other clinicians including the practice nurse.’

Abbey Meads medical group in Swindon is also only offering same-day appointments for a trial period to counteract ‘a high number of patients who are not attending pre booked appointments,’ according to their website


Readers' comments (10)

  • Not sure why this is making headline - sounds like "doctorFirst" system being sold by a private firm which has been around for several years.

    Not my choice of method though

    Unsuitable or offensive? Report this comment

  • Sure some older patients would not mind paying a few quid to see a doc of their choosing at a convenient time. Everybody happy. When will rules change?

    Unsuitable or offensive? Report this comment

  • I wonder how many partnership positions were advertised by this failing surgery to address their recruitment crisis. They cannot just expect to get some Salaried Slaves coming forward to work for them so as to make some profit for their business.

    Had there been payment per face-to-face consultation, the same surgery would never admit there being a recruitment crisis. Here in Australia, there is no payment for GPs when they do telephone consultations and the same rule should be introduced in the UK.

    Unsuitable or offensive? Report this comment

  • Yup this system has a high risk element and sold and used in Dorset .
    Nothing special.
    Best to aim for £200 per patient as some practices ,earn £160k pa and attract partners

    Unsuitable or offensive? Report this comment

  • Bob Hodges

    "|Anonymous | Salaried GP|06 Jun 2016 2:00pm!

    I detect a chip on the shoulder there. Life's changed. People don't advertise partnerships because applicants don't want them anymore. Most jobs are advertised as partner/salaried

    Unsuitable or offensive? Report this comment


    Unsuitable or offensive? Report this comment

  • Advertising costs. Our ads for Phlebotomist in the local paper cost more than £400 with no result. Adverts in magazines for GPs can cost you thousands before you get someone wishing to risk a partnership. For a 4000 patient practice with 24000 per month including rent and aspiration, it is almost 6 pounds per patient from which you also have to pay salaries, overheads and mortgages not forgetting the Indemnity subscription of 1500. So how much are we really being paid to provide services. Are we placed to advertise for partners or staff? No we aren't. But if you aren't in a position to advertise, you will also not be eligible for funding available for Practices able to document that they have been searching for partners. Catch 22.

    Unsuitable or offensive? Report this comment

  • Hang on --Why do telephone advice or triage - if no appoitments then no appoitments - full stop.

    Telephone calls- advice could have severe legal issues - lead to court proceedings and charges as we have seen recently.

    So tell patients NHS 111/a.e/wic/pharmacy but no GP appts-final!

    Unsuitable or offensive? Report this comment

  • As a patient I have to report total satisfaction with the way in which telephone triage has worked for me. Mostly an entirely satisfactory telephone conversation, once an urgent appointment, once an appointment at a convenient time. I hope it is working as well for the practice.

    Unsuitable or offensive? Report this comment

  • I worked at a practice in north London that had this "doctorFirst" system, again due to the lack of available book in advance appointments from the unmanageable demand.

    The patients much preferred doctorFirst as they were guaranteed contact with a dr on the day they wanted it. the company providing doctorFirst gave us pages of reports on how great their system is and how happy the patient are. so how was it that the same number of drs doing the same number of sessions could provide so much more patient contact? The answer: we all had to take 45 calls from 0800-1000 to triage, then from those, book in for ourselves to see in person any we could not safely deal with over the phone, usually 40-50% of the 45. So basically, where we were having 35-40 patient contacts per full day, doctorFirst increased this to 65+ per day. there is nothing clever or resourceful about this system, it simply dramatically increases the work load, unsurprisingly.

    Unsuitable or offensive? Report this comment

Have your say