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At the heart of general practice since 1960

Why having no appointment system works well for me

It is possible to provide a service to patients that meets all the criteria of advanced access without having an appointment system at all, says Dr Cornel Fleming

I have a very simple system for seeing patients. I am open 9.30am-11.30am and from 4.30pm-6pm. No appointment is necessary; patients just come in and are seen.

There is no dragon at the gate, no arguments on the phone, no 'fitting in' of patients and no DNAs.

When I introduced my system it worked well from the start. And there were unexpected benefits. House calls, day and night, just about vanished. Patients told us: 'Why should we call you out when we can see you any time we want?'

My practice has more than 3,000 patients. When the Government's 'access plan' was introduced my PCG tried to get me to have an appointment system 'to improve access'.

I told them I already had instant access. They refused to believe me and asked for a

patient survey. I produced one and 99 per cent of my patients said they liked my system. A PCG official then visited the surgery and admitted

I had instant access – but said I didn't have advanced access.

This, to her, meant a patient could be seen at a specific time that they wanted, such as 'next Thursday morning'. I was advised to set up an appointment system especially for those people.

When I pointed out that I already catered for these patients in that they just had to come into the surgery and they would be seen that morning, the PCG reluctantly agreed that I fulfilled all the criteria for instant access, advance access and any other kind of access!

I can fully understand that for a five- or six-doctor practice there are some advantages to an appointment system. For example, you might have a scenario where one partner is overloaded and the others' workload varies a lot. However, during my locum days I did see one large practice that operated with no appointments.

It had five doctors and new patients were registered to each in rotation so that their lists were fairly even. When patients came in they were seen by 'their own doctor', except in emergencies and when that GP was on leave or ill. This system seemed to work very well.

With all the practice nurses and other ancillary staff that practices can call on today I do not believe that anybody cannot achieve 48-hour access, whether it is a large practice or a small one.

But how you do it is up to you, and my system works very well.

Cornel Fleming is a GP in north London

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