Why GP surgeries need crowd control

People queuing GP appointments are in demand

Getting a same-day appointment with a GP can be a challenge.

In this week's Scrubbing Up, Steve Martin and Dr Rupert Dunbar-Rees of the BDO Alliance, which advises on ways of changing behaviour, looks at how things could be improved.

It's 7.45am and at first glance you could be forgiven for thinking that the steadily growing crowd are waiting in line to get their hands on the latest iPad or smartphone.

But this queue isn't outside a high street store or a shopping centre. It's outside a GP surgery and the goal is simple.

It is to be one of the lucky few who secure a same day appointment with their GP when the doors open at 8.30am.

Others will be calling for an appointment, knowing they'll more likely hear the engaged tone than a cheery receptionist each time they press the redial button.

Demand 'outstrips capacity'

When they eventually get through some will get an appointment.

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Primary care is full up”

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Others however will be less fortunate, stress levels rising when told, by the equally stressed receptionist, "Sorry but all the appointments are gone for today. I might be able to get the locum to see you tomorrow."

The situation we are describing here is an extreme one and perhaps not the norm in every GP practice.

However for a growing number, the ability to offer patients a same or next day appointment with their GP is becoming increasingly difficult for one simple reason. Primary care is full up.

When demand starts to outstrip capacity something needs to be done.

Some practices place embargoes on appointments allowing only urgent cases to be seen on the same day.

Others will provide telephone consultations first in order to filter those patients who need to be seen from those who don't.

Patients requiring routine appointments or test results are asked to wait a few days or call back at less busy times.

Some practices adopt all of these approaches and more besides, resulting in an appointments system that even the doctors find hard to fathom.

No single answer

On the face of it the answer seems obvious. Employ more GPs and open longer hours to increase capacity - but this would be a mistake.

Sure, it would have a short-term effect, but demand would quickly fill the increased capacity. Within a few months the system would be back where it started.

Introducing embargoes and increasingly complex barriers for patients to jump through is also a mistake.

Human psychology tells us that if something is less available we want it more, often leading people to invest additional effort, ingenuity, even deception, in order to get what they want.

The morning queues and engaged telephone lines are evidence of this, as are patients who will book appointments weeks in advance 'just in case'.

Some may even claim an emergency in order to secure an appointment, when the reality may be somewhat different.

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On the face of it the answer seems obvious”

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This leads not only to frustration amongst doctors and patients, but also calls into question how much extra and unnecessary demand appointments systems themselves generate, over and above genuine 'need'.

There is no single answer to this complex problem yet everyone has a role to play.

Persuading patients to take a greater responsibility for their health, to use the system appropriately, to attend booked appointments and to realise that a trip to the chemist will often suffice, can all help to free up valuable GP time for those who really do have a genuine need.

Longer term we need to support GPs in managing patient expectations and anxieties.

Reducing dependency, encouraging self-care and having adequate ways of dealing with those that abuse the system will be vital. These things will take time but there are some basic things that need to be done now.

GP practices need to better understand when demand for services is highest and shape capacity around those demands.

They also need to assess whether the appointment system they employ is too complex, inadvertently making the problem worse.

Finally they need to question whether some of the embargoes that have been put in place to fix the problem are actually creating a perception of appointment scarcity.

Unless we address some of these much more straightforward changes which can be put in place right now, efforts to improve appointment availability by dealing with the more complex issues will always struggle to get off the ground.


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  • rate this

    Comment number 22.

    Always use a Walk in Centre for one off or weekend requirements.

    Only use my GP when I can give a few days notice.

  • rate this

    Comment number 21.

    In these areas where there is a delays of 3 or 4 days in getting an appointment I would imagine that no shows are a big problem. By the time some people's appointments come round they are probably feeling better and don't bother cancelling and clogging up the system for others.

  • rate this

    Comment number 20.

    The main problem with the NHS is Andrew Lansley. He should resign.

  • rate this

    Comment number 19.

    On the few occaisions I have been to the doctors surgery I have always made an appointment then waited between one and two hours.

    On the one occaision I was 15 minutes late, I was told I had missed my slot and would have to re-schedule.

    This makes no sense to me

  • rate this

    Comment number 18.

    I had to make an appointment with my GP myself just the other day. I needed to from last friday, but with Easter and such, had to wait for last tuesday. The first free appointment? Monday next week. Six days later, you might not even be ill anymore, nevermind a genuine health scare, you need checked fast.

  • rate this

    Comment number 17.

    The problem is Not Lansleys, its lack of organisation, non weekend working and public turning up with every sniifle, ache and pain. Peoples hypochondria is stopping people with real problems and ailments from being seen quickly and clogging up the system.

  • rate this

    Comment number 16.

    This is what happens under Tory governments.

    The Tories hate the NHS. That is why they started privatising it.

  • rate this

    Comment number 15.

    My GP opens appointments for that day at 8.00am. You ring up and book and I have never failed to get an appointment that day.

    If you need to come back again by appointment, they ask that you ring after 2.00pm to make an appointment for a time to suit you.

    This stops waiting rooms being filled with people who were sick three days ago.

  • rate this

    Comment number 14.

    What is the BDO alliance referred to in this article? The piece doesn't appear to make any actual suggestions, just points out the claimed problems.

    Why are some areas worse than others, less doctors per patient or related to patient behaviour?

    I would like to see some actual comparisons that show why some areas are worse than others, this piece is just hearsay and scaremongering.

  • rate this

    Comment number 13.

    The problem will clearly get worse now that Lansley has given Doctors a whole raft of administrative and managemewnt jobs to do on top of seeing patients - a local GP who now works in the new commissioning group only sees patients one day a week - is this what he was trained for ??? Cameron & Lansley want the system to fail so that they and their friends make a fortune from privatisation

  • rate this

    Comment number 12.

    My surgery is crazy: lines open at 8.30, I set my phone on redial so that it calls every minute. It is approx 8.50 by the time I get through. "No appmnts left today". How about tomorrow? I ask. "You will have to phone back in the morning"! The idea of "seeing your own GP" is also long gone. Give me my annual tax contribution to the NHS back and I could afford private. Surely that is the solution.

  • rate this

    Comment number 11.

    The surgerys need to be open at weekends & evenings "simple"

  • rate this

    Comment number 10.

    Doctors don't work weekends
    Doctors don't work evenings
    Doctors don't work nights
    Doctors refuse to do callouts
    Most would be away for the Easter hols

    Yet apparently, it's a real mystery why people struggle to make contact with a doctor...

    They get more money than they ever did and work fewer hours, just like the teachers, and yet their service, like with the teachers, is going doon the pan

  • rate this

    Comment number 9.

    A four(4) day wait to speak to the doctor on the phone!
    The 'medicare' industry has a vested interest in ill health, not in actually getting you well. They get upset if you treat yourself for any thing; 'You must not self-medicate'! But half the time they don't know what's wrong with you. If you try to tell them what is happening to you it's quite often the case of 'Who's the doctor, you or me?'

  • rate this

    Comment number 8.

    "Getting a same-day appointment with a GP can be a challenge."

    Just watch this one develop into a charge to book an appointment.
    You can just see Andrew Lansley standing up on his hind legs in parliament to announce that the government has decided to introduce a fee to be paid up front as a means of reducing the appointments queue.


  • rate this

    Comment number 7.

    Surprised to read people turn up as appointment chancers. Don’t they phone first? Even our tiny surgery has never seen queues of patients outside. Emergencies are seen and there’s always NHS Direct to peruse one’s ailments or phone. A queue cure would be visiting reception on arrival to say you’re there, given a ticket, without which one will not be seen. ‘No-shows’ spoil it for many.

  • rate this

    Comment number 6.

    Demand will always outstrip supply and the rush to try and find someone to blame is sadly predictable. To try and blame the GPs or their patients is utterly pathetic. We have all got used to having primary healthcare on tap and when we feel mildly unwell we need to start viewing visiting the GP as one of the "last resort" things we do not the first

  • rate this

    Comment number 5.

    Supplementary: I am over 50 and so I, was thinking of asking my G.P about a health MOT! Does anyone know if this concept still exists? It's probably not very likely, if there are not even the resources for basic urgent appointments.

  • rate this

    Comment number 4.

    Interesting article. I have presented at my GP's surgery twice recently for the 1st time in about 20 years. This was because I was very ill. On my 2nd visit I arrived at the due time and waited in the waiting room. An hour later, the staff told me, I should have announced I was waiting! Why, I was there at the `appointed time?

  • rate this

    Comment number 3.

    My experience is that those clogging up the appointment list are pensioners, benefits claimants and teenage mums. All categories that have 2 things in common: don't work for a living and get free prescriptions. They also have more health concerns.


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