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Why I find that offering good access cuts patient demand

Despite their opposing conclusions, I agreed with the majority of what Dr John Oldham and Dr Andrew Wordworth said on 48-hour access (October 28).

We were a first-wave collaborative practice, not a 'flagship' practice but a rather noisy 'junk'.

I have believed that access is the key to good-quality general practice and have provided routine appointments within one working day for nearly 15 years.

Starting out as a singlehanded GP with a list size of 1,200 meant I could offer this and still have the ability to shop during surgery time!

As the list size grew, I could afford to employ a little extra doctor and nursing time to maintain this access.

The list size peaked at 2,400 and then to a much more manageable 2,900 for the current one-and-a-half partners. Access has been maintained throughout by shaping the demands using telephone consultations, good use of the nurse, and educating the patients themselves on how to use the system well.

One of the problems of the system currently developed in order to 'improve access' is to embargo appointments so that patients are restricted in their ability to book in advance.

These patients will always end up being seen at sometime, therefore we allow them to book days, weeks or months in advance if they wish to do so. Restricting access does not cut demand ­ on the contrary offering good access cuts demand.

Although we are quite 'leafy' we have a high ratio of mental health and elderly patients. We can offer good access because happy patients are easier to deal with. We try to engender a sense of teamwork, which extends to the patients, and I doubt that any of our patients would question the quality of the care they receive from us.

I start a surgery at 8.30am and am away by 6pm I virtually never see more than 30 patients in a full day, including visits. I have a half-day off and do a weekly endoscopy session. I am the official doctor to the Teletubbies and have a life outside the practice too!

Dr Nigel C Wood

Stratford-upon-Avon

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