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How separate surgeries for acute and routine care help manage demand

Dr Bodo Brockmann describes how his practice developed an innovative way to cope with both on-the-day and routine appointments

The problem

We and a neighbouring practice were struggling to recruit new GPs. Together, we have almost 24,000 patients at three sites. Most are in a deprived area, with lower-than-average life expectancy, high levels of chronic disease, unemployment, mental health problems and chronic pain. Demand for on-the-day appointments was increasing and we were not able to provide the best service for patients with long-term health needs. We decided to merge with another practice but realised this was unlikely to yield any benefits unless we changed the way we worked.

What we did

Two of our modern, purpose-built sites are less than a 10-minute walk apart. From July 2016 we decided to use one exclusively for routine care and the other as our acute care hub, dealing with urgent and on-the-day problems. At this site we have a team of at least one GP supported by paramedics, nurse practitioners, a practice nurse, a healthcare assistant and a senior community nurse. Our GPs work on average one day a week in the acute hub. Patients are triaged throughout the day and seen according to medical need or advised to book a routine appointment. The acute hub also deals with most home visits unless they are routine reviews.

Calls are taken by our patient advisers, who either make an appointment for the patient at the main practice or add them to the triage list at the acute hub. In response to a specific need to improve access for children we offer a children’s walk-in clinic twice a day at the acute hub. This has proved to be very reassuring for young families.

We have now started to introduce some 15-minute routine appointments as the second stage of the changes and are monitoring how this will affect patient care and workload. If it works, we may increase them to 20 minutes.


Patients were concerned about these changes. We extensively explained and discussed our plans with our patient participation group, held open days and let patients see the benefits the new system would have. We were fortunate to complete the merger without having to make redundancies, but technical changes were required in order to work effectively across all sites. This involved improved computer links, a single telephone system and new dictation software. As a result we have been able to concentrate secretarial, administrative and call-handling staff at a single location, making best use of staff time and available space.


This change has ensured improved access for patients for both routine and urgent scenarios. Before splitting acute and routine care we were constantly catching up with on-the-day demand and felt we were not able to give routine care the attention it required. We have since had many positive comments from patients about being able to speak to someone when in urgent need.

In addition the system benefits us as clinicians by increasing our flexibility. When we are not in the acute hub we have the freedom to work in a way that suits us. We can be more flexible about when we do paperwork or routine visits. This has taken away a lot of stress. While the day in the acute hub is busy, we are well supported by a great team and we enjoy a more settled day when delivering routine care. We are currently dealing with up to 200 patient contacts per day and have about 1,000 contacts a week in the acute hub.

If other practices are considering a similar move I recommend researching local requirements instead of making assumptions. Though it is still early days, our approach has shown very positive effects already.

Dr Bodo Brockmann is a GP partner at Ocean Health in Plymouth

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Readers' comments (3)

  • I've been saying this for years: seperating acute from chronic case, met with resistance but it makes sense. You wouldn't expect any other professionals to work as we do in such a disjointed way

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  • Brilliant. this is something I keep mentioning and as part of the acute hub there should be an acute visiting team and the acute hub should link in with the community service and their crisis response team so that input for housebound/care home patients can be properly co-ordinated.

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  • As the list size increases and people with different skills are employed within surgeries, different ways of working needs tobe explored and encouraged to publish their findings.Practice Management has been left to solitary practice managers.Some times they have assistant.The job of managing practices has become very complex and you need socialist knowledge in HR,Finance,Pension,IT, Regulations including CQC.All this require different type of organisation, a flat structure with leads in various functions probably lead by a partner who has real interest in that area. To work smart both clinicians and admin staff have to work together to develop new organisation.

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