Wednesday 19th Feb 2014 - Kate Hodkinson
There is a huge amount of pressure upon practice appointments and availability which has been growing over recent years. In 2003 patients visited their practice about 4 times a year on average. Now the average in a year is about 5.3 visits. This figure is increasing year on year due to several important factors:
Practices have tried many different ways to ensure that patients can be seen appropriately and to meet national and local targets set for access. The perception of the patient, in many cases, has changed over recent years and there is a very common view about what constitutes good access in the mind of the patient – some of this, the NHS has directly contributed to and is now creating a lot of problems.
The NHS standards and targets over recent years have created the impression that patients need to be seen today. Six or seven years ago, patients had very little expectation of being seen on the day unless they had a very urgent need. Patients were generally quite accepting of being given an appointment 3 or 4 days ahead. But this has all changed.
The make up of the clinical team in general practice has changed over the last ten years.
Yet, despite these increases there is still a feeling of increasing pressure on appointments and this remains a cause of dissatisfaction for many patients.
One of the first things that a practice needs to understand is whether this is a real problem to them in practice – i.e. are we offering enough of the type of appointments to meet the needs of our patient population?
Is this a problem of patient perception and use of the systems?
Both of these are real problems to the practice but they need to be resolved in different ways.
As the general practices range of services are offered by a combination of doctors, nurses, health care assistants and phlebotomists, it is worthwhile considering a review of who delivers what and to measure the capacity and range of each service.
Recent research in Denmark considered the issue of substituting a nurse for a GP in consultations. This was considered appropriate in 14.8% of consultations according to GPs and when patients were consulted, the considered that this was appropriate in 11.7% of consultations – although there was little common ground over which consultations! This tells us that patients are definitely amenable to being seen by a different provider of the service in some circumstances. The challenge to practices lies in knowing where patients will find this acceptable and the ways of communicating any changes to them.
I have heard this being barked by some poorly trained receptionists when instructed to ask patients the main reason for their consultation with a GP. I can understand why patients respond negatively to this and the subsequent problems this creates.
When trying to match a patient and an appointment – this is the single most important issue – why they need to be seen – as this will begin to indicate:
For these reasons many practices are now moving to a system whereby patients are routinely asked for the main reason for their consultation when booking by phone or in person. The vast majority of practices have used this approach for nurse appointments for many years and it has made a positive impact on the use and planning of appointments. So, why is there so much reluctance to implement the same thing for GP appointments?
If a practice thinks that this type of approach would help in the planning of their appointment system there are a number of things for them to think about in terms of planning:
The benefits for a practice and their patients in being able to match need and supply are tremendous. Happy patients are easy to deliver services too and have a knock on effect in helping to create a happy team. Saving one unnecessary appointment for each clinician in your team each day mounts up over a month, a quarter and a year and also reduces the amount of frustration felt by both parties. You can ensure that patients are aware of all the services and options available to them and that they are used appropriately.
Taking control of the thorny issue of supply and demand for appointments begins with an audit of the current situation. First Practice Management subscribers can take advantage of a ready made assessment tool to assess this. Thornfields can also provide bespoke training for your team in communication skills and customer service to help the transition.
Remember, demand for GP consultations will only be increasing in the future, now is the time to start taking control in preparation for those increases.