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.

Start Quote

Primary care is full up”

End Quote

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.

Start Quote

On the face of it the answer seems obvious”

End Quote

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 42.

    Some here seem to be blaming patients for this problem. Eh? No-one wants to sit in a germ-filled waiting room for a hour over their appointment time if they can help it. People go to the GP because they have to - for sick notes, treatment or because the GP wants to review them. 'No-shows' are often a function of the appointments system or the illness (too ill, memory probs, in hospital, etc.)

  • rate this

    Comment number 41.

    What a non-answer - all generalities & no specifics. Bottom line - some will always look to beat the system no matter what - & anyway if the number of docs will never be "enough", one can argue to reduce numbers if we, the public, always inflate our need for them.

    Perhaps if we stopped paying docs £100k+ to work a 4 day week, there would be more funds to employ more docs - just a thought..

  • rate this

    Comment number 40.

    I spent some of my early twenties working as a receptionist in a GPs surgery. They are not all dragons and actually have a very difficult job. If they didn't try to screen patients to assess who is most in need of appointments (which they do under doctors' guidance rather than out of their own curiosity) then we'd be reading even more articles about how GPs appointments are filled up by colds etc.

  • rate this

    Comment number 39.

    Many of my visits to my GP over the years have been for a sick note for work, not because I needed treatment or advice. I felt uncomfortable taking an appointment away from someone with a genuine need to see the GP.

    Now I am sick and disabled I am offered a telephone consultation as if it is a good thing, saving me the effort of getting to the surgery. This is no way to run primary care.

  • rate this

    Comment number 38.

    31. Ady

    "Many Doctors are overpaid and underworked."

    I wouldn't say 60 hours a week is underworked. I also wouldn't say that spending the majority of that time dealing with people, in sometimes very distressing circumstances, is underworked.

    Good doctors do a great job. I certainly couldn't do it.

  • rate this

    Comment number 37.

    The fact is that there are not enough doctors in the NHS. We could increase, but that would pull down the income for existing doctors. Some Associations would not be happy. This is the essential problem. The rest is blah-di-blah-di-blaaahh.

  • rate this

    Comment number 36.

    Here's a simple table on doctors per 10,000 population
    Bankrupt Greece has 60
    The UK has 27


    1 Cuba 64
    2 Greece 60
    3 Belarus 49
    5 Georgia 45
    6 Russian Federation 43
    13 Kazakhstan 39
    14 Azerbaijan 38
    15 Portugal 38
    19 Armenia 37
    20 Lithuania 37
    21 Bulgaria 36
    22 Czech Republic 36
    41 United Kingdom 27
    42 Moldova 27

  • rate this

    Comment number 35.

    Even though I can't really afford it I would be willing to pay a small fee to get to see my GP when I need to. The last time I needed an appointment I waited 6 days. I know that our surgery is often blocked up with people wanting a sick note. The NHS isn't perfect but its just not fair how some people abuse the system.

  • rate this

    Comment number 34.

    We need to start producing doctors in large numbers and stop pandering to the vested interests in the BMA and the government

    Even the peoples Eutopia of Cuba has no doctor shortages

  • rate this

    Comment number 33.


    "there are a lot of comments about gp's not working nights and weekends, do you really want to see a gp the morning after shes been up all night"

    In the good old days , GP`s used to be able to sort out a rota amongst themselves , taking it in turns to go on out of hours call out duty.

  • rate this

    Comment number 32.

    Doctors need to stop working only from 9 - 5; people don't only get sick within office hours. It shouldn't be too difficult to arrange for GPs to work in shifts; hospital Doctors manage it. Oh, and receptionists need to stop seeing it as their job to keep patients away from GPs - do they have to be such dragons?

  • rate this

    Comment number 31.

    The article is entirely accurate, we have tried everything to accommodate demands

    There are no doctor shortages in the peoples eutopia of Cuba

    Many Doctors are overpaid and underworked.

    The system deliberately produces too few doctors and some are receiving $300,000 a year when we should be giving ten doctors $30,000 a year

    The system is rigged and broken, but the tories like it that way

  • rate this

    Comment number 30.

    People will have to get used it as the health and welfare budget, if left unchecked or unreformed, will eventually consume all of this country's wealth.

    The Conservatives know this, the Liberal Democrats know this and even Labour know this but it is convenient for them to be in denial for purely party political reasons.

    Just need to enlighten the usual BBC HYS posters who are still in denial.

  • rate this

    Comment number 29.

    "Sure, it would have a short-term effect, but demand would quickly fill the increased capacity."
    Sorry, but this is simply wrong. Your argument - a generic queuing theoretical statement - does not hold true in all finite-capacity systems. Nobody likes to see a doctor unless it is necessary. I don't know how you got away with making such an incorrect assessment.

  • rate this

    Comment number 28.

    there are a lot of comments about gp's not working nights and weekends, do you really want to see a gp the morning after shes been up all night covering thousands of patients. Really , are we not trying to improve working conditions for all, why do you think theres such a big recruitment problem in general practice?
    The article is entirely accurate, we have tried everything to accommodate demands

  • rate this

    Comment number 27.

    No-one can get a doctors appointment so now Kim Jong Cameron can say that no one ever gets ill in the Democratic People's Republic of Britain

    Forwards to victory brothers and sisters of the tory revolution !

    Down with the marxist leninist proletariat !

  • rate this

    Comment number 26.

    Ah, I see the answer is in the BBC sports section "Chinese GP practice"

  • rate this

    Comment number 25.

    The biggest problem with our NHS is the fact that a bunch of old Etonians have sold it off to their corporate pals.

  • rate this

    Comment number 24.

    Several commenters have talked about not being able to get an appointment soon enough so that when they finally get to see their GP they are already better. If you're going to get better in a few days without seeing your GP, why are you trying to see them at all? It's people with "a couple of days in bed" type illnesses that are blocking access to the system for people with genuine need.

  • rate this

    Comment number 23.

    No To NHS Privatisation
    "This is what happens under Tory governments."

    No, this is what happens after a Labour left GPs laughing all the way to the bank


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