Exclusive Almost half of GPs who have already implemented ‘modern’ access measures prescribed by the general practice recovery plan say that it has not helped improve access.
The GP recovery plan released early this year set out targets for practices to improve access, with the main support being the introduction of digital telephony systems.
However, a Pulse survey of 362 GP partners in England found that 43% of those who implemented digital telephony systems, online access or care navigators have said the measures have not helped to improve access for patients.
The Government announced £240m of funding for practices in England to ‘embrace the latest technology’ as part of its GP recovery plan in May, including modern telephony systems and a major expansion of the role of receptionists to become expert ‘care navigators’.
Changes announced in the new GP Contract earlier this year now require general practices to buy and install cloud-based telephony (CBT) when their contracts expire. To receive the funding support, practices must sign up by 1 July and can expect an average of £60,000 to support the move to digital telephony, digital tools, and transition support over the next two years, according to the recovery plan.
While industry bodies have welcomed the initiative, they also stressed that this won’t help GPs fulfil their contractual obligations.
The Pulse survey revealed:
- 79% had already installed digital telephony systems, 67% had implemented online access resulting in same-day triage, and nearly 65% had care navigators;
- 94% of respondents having implemented at least one of these three.
- Around 148 (41%) of respondents that had implemented all three systems;
- Of those who implemented all three measures, 46% said they had improved access, while 39% said they had not;
- Of those that had implemented digital telephony systems, 41% indicated that it had improved access while 43% said it had not;
- Of those that had online access, 45% said this had improved access while 40% said it had not.
- Opinions on the benefits of care navigators were split down the middle with 43% indicating on both sides that they had improved access or had not.
One GP partner, who wished to remain anonymous, said that triage by a GP had helped allocate appointments appropriately.
‘Our same day triage system only works because it is a clinician performing it; patients can be asked for clarification and then booked in on the day, dealt with remotely at the time, sent a booking link for an appropriate timescale or signposted elsewhere,’ they said.
‘While patient demand is unchanged, our pressure on appointments seems to have decreased notwithstanding losing appointments because of the triaging doctor. The data shows a gradual reduction in the 8am rush. Patient feedback has been positive. We have several local practices coming to view our model.’
Some GPs said that it was too early to know while several commented that capacity was the problem, not access, and that increasing access had increased demand.
‘They do improve quality of care in the broadest sense, but access to GP (and nursing) appointments is limited by staffing alone and only improving staffing will change that,’ said Dr Charles McEvoy, a GP partner in Ripon, North Yorkshire.
‘We operate total triage as this allows the duty GP to allocate appointments according to need, urgency and direct the patient to the right healthcare professional. This avoids unnecessary appointments. It is not always what patients want, but we do try to accommodate requests,’ said Dr Nicola Bignell, a GP partner in Teddington.
‘Many quick queries are dealt with by replying digitally almost immediately. The downside is that access is uncapped during surgery hours and hence we have more contacts, but we hope this means we are not leaving those with urgent medical needs waiting. It also means we can control the patient flow, that that nobody is waiting for long periods in the waiting room.
‘The administrative workload is unmanageable and approximately 20-30% of what we are being asked to do is work for other clinicians – we are not community house officers and we aren’t funded to investigate on others’ behalf e.g. outpatient and private blood tests.’
Norfolk-based GP partner Dr Nick Morton added: ‘The use of digital telephony as well as online access has ensured we cover a wider demographic of the population.
‘The old queue at the front door at 0800hrs has gone and so access to appointments is guided by need rather than the ability to queue. The downside is that our workload has increased but it feels more equitable for patients.’
One GP partner said the measures had improved access to same day appointments ‘but have seemingly made no difference to the amount of calls we receive and the time callers are waiting for their calls to be answered’; while another said it meant they were ‘seeing the same digitally literate patients frequently’.
Another respondent said that availability was ‘just driving extra demand as opposed to easing pressure’, with online consultation availability increasing the number of requests by approximately 83%.
The survey was open between 9 and 15 June 2023, collating responses using the SurveyMonkey tool. A total of 362 GPs from across the UK responded to these particular questions. The survey was advertised to our readers via our website and email newsletter, with a prize draw for an £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.
Who is surprised. They are just putting more doors on a bus with no more seats.
Oh I see now it makes sense, this is why every practice I’ve done a locum in over the last year has mysteriously installed a complicated and confusing new digital telephone system. Someone in government must have shares in digital telephony
I’ve been saying for 5 years now that probably the key action to improving access is having some sort of ‘triage’ or rapid assessment of ALL requests to see a GP by a relatively experienced GP, who understands the local options available. Receptionists can’t do this and most nurses struggle as do GPs in training. Ensuring people see the appropriate clinician (or don’t see when the issue can be dealt with on phone, online or by an external service) is key to this. BUT if there is insufficient capacity in the practice this won’t make a noticeable difference to access.