‘The October access changes will affect our ability to provide good patient care’

GP partner Liz Woodroffe on how the contract changes to online access will be detrimental to her practice’s ability to provide good and efficient care to their patients

We’re a single-site practice in the centre of Cambridge with a mixed population of around 15,000 patients (slightly student weighted). We are six partners and one (soon to be two) salaried GPs, all with personal lists (with salaried GPs’ list capped in size) and minor illness cover most days via the advanced nurse practitioner and paramedic.

At present, we manage access completely through Accurx triage, which is on from 8am to 11.30am and 13.30pm to 5pm. Our patients can phone us and can be helped to fill in the Accurx form, but all inputs are streamlined through Accurx so there is one source through which we can prioritise. If a patient walks in, they are given a paper form which is triaged in the same way.

We aim for most patients contacting us with a routine problem to see their named GP, their requested GP, or the doctor they’re currently consulting about that problem, within two to four weeks, as appropriate. Each GP will have ‘continuity slots’ within their rota.  Duty doctor shifts last half a day to guard against decision fatigue, hence the need for a pause on Accurx between 11.30 and 13.30 to enable the morning influx to be completed prior to changeover and allow for visits, paperwork, meetings – all the usual things.

Our main concern is that the high continuity, high proportion of face-to-face appointments, and rapid (same-day) response that we already achieve, together with online access for seven hours daily combined with phone and walk-in access, will actually deteriorate if we keep online access open all day.  Our patients know to contact us when the Accurx is ‘on’ and know that, in an ’emergency’, they can still phone when the Accurx form is ‘off’.

This could have a number of consequences. It may further disadvantage patients without online access, risking discrimination. Also, when we have trialled 24/7 access to Accurx previously, it led to increased demand, making it more difficult to prioritise actual clinical need – it is easier to contact your GP than to search nhs.net for information, especially for the 3am self-limiting minor illness. Finally, it takes away from continuity.

We will be forced to decide between processing faster and potentially making poorer decisions, or we safeguard against decision-fatigue/ system overwhelm and reduce the number of appointments available. This is more than a ‘difficult tension’ – it is potentially a patient safety issue and these are decisions none of us want to be forced into with limited funding. Our triage is purposefully ‘doctor heavy’, as GPs are often the most experienced clinicians to be making these decisions at speed. 

Dr Liz Woodroffe is a GP partner in Cambridgeshire

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