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GPs buried under trusts' workload dump

Think you've sorted your appointment system? Think again

Dr Samir Dawlatly 

One the biggest headaches for GPs and practice managers is the appointment system. This is essentially the way that GPs try to match the supply of appointments with doctors, nurses, phlebotomists and assorted other health professionals with the demands of their registered patients. No single appointment system can ultimately be fair to everyone.

Most surgeries would be able to tell you what sort of supply is needed to comfortably meet the demand and needs of their patients on any given day. And if the GPs can’t tell you, then the receptionists certainly can tell you when the pressure is on and there are no appointments to offer.

One way to give the illusion that the balance between ‘book on the day’ and pre-bookable appointments is right is to change your system regularly, to keep your patients guessing. As soon as you appear to be getting too many emergency patients, or complaints about access, it’s time to consult the PPG and tweak the system, so no-one is really sure what’s going on and a temporary illusion of sufficient healthcare supply is created. This leaves everyone feeling better, apart from the frustrated patients.

If a practice has honed their appointment system using some form of triage, that's all going to be wrecked

There are three main ways to control who gets appointments at a GP surgery. Firstly, you can educate your patients to know what an emergency is and simply rely on a ’system’ of first come, first served. Those who turn up at the surgery or who can time their phone calls as the lines open do particularly well with this system. It’s not exactly fair and can lead to a number of unnecessary appointments.

The second method is to triage the appointments using non-clinical staff, training them to differentiate the needs of patients calling in or calling the surgery and allocating them the most appropriate type of appointment. This requires training and can weed out some unnecessary appointments.

Lastly, and the current trend, is to use clinicians to triage appointments, either by telephone or digitally. Using clinicians to decide whether a request can just be dealt with requires a phone call or a face-to-face appointment and is time-consuming, but can manage demand. It may give patients the illusion that they are dealing with a call centre.

If a practice has finely honed their appointment system using some form of triage, that is now all going to be wrecked. This is because at least 25% of appointments need to be available online for patients to book directly, bypassing any triage. The only way around this is to make the available appointments triage slots. For practices who use non-clinician triage, patients will essentially be booking a call back from a receptionist to book them an appointment.

Makes me wonder if NHS Employers and GPC negotiators actually understand how GP surgeries operate.

Dr Samir Dawlatly is a GP partner in Birmingham

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Readers' comments (6)

  • Samir, rather than playing constant mind games with patients (i.e. treating them like children), would you rather not the market set the demand priority for appointments???

    Since when did you get the impression NHSE/the state gets us, or gets just about any 'public sector'?

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  • In the rest of society, outside of Venezuela, North Korea, and Cuba, resources are allocated by the dynamic interface of ‘supply’ and ‘demand’. In the absence of a price mechanism for the customer and supplier, time (waiting times or lack of appointments) are used, ensuring no extra resources can be brought in unless the wise daddy government extends its benign gifts of fresh minted money from its central command bunkers.

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  • If you use a triage system, you can meet this target by offering 25% of your triage appointments for direct booking online, can't you? No need to abandon the system...

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  • Another option is not to assume that you can't have an impact on demand. Complete a search for your high intensity users (frequent attenders) and have a look at the top 20-100 and how many consultations they have per year. This group need a different service and you need to look at each person individually. Their problems are unlikely to be medical. Social Prescribers may well be able to have an impact on the frequency of their attendance. A similar approach in Blackpool reduced ED attendance by 93%, with about 70% of the highest frequency attenders able to change their behaviour with the support of other services. Many people are lonely, in debt, living in poverty. GPs are not best placed to fix them, otherwise they would've done that by now. https://www.england.nhs.uk/rightcare/workstreams/high-intensity-user-programme/

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  • If patients had to pay for each contact they would soon start learn to use services appropriately and if doctors only got paid when they did something they would be happier to see patients
    Of course those that are financially disadvantaged will have problems
    But society can’t have it all ways

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  • Samir what is your point?

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