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Practice’s ‘King Canute’ GP appointment system stems tide of patient demand

GP partners in Dundee, Scotland, have set up a novel GP appointments system that allows for patients to be seen on the same day by offering a ‘pool’ of appointment slots rather than individual appointment times, which they say was inspired by the tale of King Canute.

The GPs say their system – which does not limit the length of appointments and prioritises patients according to need and whether they want to see their usual GP – has helped them address ‘a major access problem’ and led to improved satisfaction for both patients and staff.

GPs Dr Ron Neville and Dr Simon Austin, from the Westgate Health Centre in Dundee, said in the tongue-in-cheek Christmas edition of the BMJ, that they – like King Canute, who is said to have attempted to stop the waves – should not aim to ‘control the tide’.

Instead, they worked out their ‘high water mark’ of patient demand, allowing for the maximum number of appointment requests on their busiest days.

They set up the daily appointment pool guaranteeing patients would be seen that morning, while still providing pre-booked appointments.

They then invited patients telephoning for an appointment the same day to attend the surgery at 10.30am, 11.00am or 11.30am – allowing for 20 patients per half-hour slot and advising them they may need to wait a little longer than usual. Patients were asked, if they wished, to say what the problem was, or indicate if they had a ‘personal problem’ or wanted to see a preferred GP or a female doctor.

The team made a minimum of four doctors available for the appointment pool, aiming to have six, and said it was ‘rare’ for the pool not to be empty by midday. Children or distressed patients were seen first, followed by patients who wanted to see a specific GP, and the doctors saw as many appointments as needed – with male partners aiming to make up for additional appointments for female GPs by, for example, dealing with any potentially difficult patients.

The system led to patients being more appreciative, the atmosphere in the reception became calmer and nurses were able to plan their work more easily, the GPs reported, while their patient experience survey scores went up from 74% in 2009/10, to 87% in 2011/12 after the pool was introduced.

One ‘pleasant spin-off’ has been the GPs have met ‘whatever access target local or national bureaucrats throw at us’ – despite struggling to fill extended hours appointments.

Dr Neville and Dr Austin summed up: ‘Our local emergency department says it does not have any problems with our patients using its service inappropriately, suggesting we are meeting demand for acute care well. Subjectively, our staff and our patients value and appreciate our team innovation. Objectively, our statistics support this.

‘We did not quite manage an evaluation free radical NHS change, but we did try, and we kept our feet dry.’

They added: ‘King Canute could have kept his feet dry and his reputation intact if he had reflected for a moment, consulted with his courtiers, and moved his throne back up the beach to the high tide mark. From there he could have surveyed the North Sea every day and sat comfortably as the tide ebbed and flowed.

‘We decided to retreat to the “high water mark” of patient demand.’

BMJ 2014; available online 15 December