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.

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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
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    Comment number 62.

    Primary care is not simply GP's! I work as a district nurse. Our service is 24/7 and 365 days of the year! We are paid a fraction of a GP salary yet they would struggle without us. We do home visits and clinics. However, we are becoming thin on the ground and it is most frustrating when an 'housebound' patient turns out to be anything but. People must take more responsibility for their own health.

  • rate this
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    Comment number 61.

    This is certainly true in parts Lincolnshire and has been for many years, you might think we live in a third world country seeing the queues for appointments out into the car park. One can ring every day and never get an appointment, that's why so many end up ringing for an ambulance.

  • rate this
    +1

    Comment number 60.

    The 2004 GP contract was intended to give GPs a huge boost in funds so that they could improve their surgeries, procure better diagnostic equipment. and generally provide a much better service to patients. Instead they doubled their salaries, doubled their pensions, worked 7 hours less each week, and withdrew evening and weekend cover.

    Ignore what GPs say. Watch what they do.

  • rate this
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    Comment number 59.

    I have to say we have a marvellous surgery, we have 9 doctors on staff ( 6 are partners) plus they always have a couple of trainee GPs so if you need an appointment on the day you will always be seen, just might not see the doctor you want, but if you are ill that doesn't matter. I have to go regularly as a few of my meds can only be given out monthly not repeat and always fine they fit me in.

  • rate this
    +1

    Comment number 58.

    "Human psychology tells us that if something is less available we want it more"
    Absolutely. And I wish someone would tell this to the health police, neo-Puritans and often state-funded prohibitionists whose demands for plain tobacco packaging, hiding cigarettes / alcohol, minimum pricing, 'fat taxes', demonisation, removal of fat / calories from products etc dominate these pages and wider debate.

  • rate this
    0

    Comment number 57.

    36. Ady

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

    --

    That probably gives you a hint as to why Greece is bankrupt.

  • rate this
    +1

    Comment number 56.

    May be doctors would like a return to pre-NHS days where patients were well mannered, well dressed, and more importantly well off. Away with the riff-raff who clog surgeries with their self-inflicted maladies or hypochondria. The lesson learned when the NHS began was how appalling the general health of most of the population was - no money, no healthcare. Do we want a return to health apartheid?

  • rate this
    0

    Comment number 55.

    Anyone who understands systems and customer service could make things work... but nobody seems inclined to hire such a person. Is it that GPs just cannot be bothered to improve provision? If so, why?

    No incentive, that's why. They are well-paid already, guaranteed. Maybe a voucher scheme, that citizens 'spend' where they get the best service.

  • rate this
    0

    Comment number 54.

    charge patients £5
    watch unnecessary consultations fall

  • rate this
    +1

    Comment number 53.

    You can never win. Ring up, the 'phone is engaged or the person who answers excuses themselves to speak to someone in front of them. Line up, and they excuse themselves to answer the 'phone.

    Then when you actually see the GP and he asks you to come back in a fortnight, the receptionist says they only make bookings a day or two in advance!

  • rate this
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    Comment number 52.

    this is easy -make doctors work the hours their customers need. This means working evenings and weekends - Doctors are service providers!

    In addition provide Internet booking capability to reduce the need for receptionist so saving costs and raising margins for Doctors.

    In essence Doctors surgeries need to get professional and inline with their customers need.

  • rate this
    0

    Comment number 51.

    The system just doesn't work. I had an asthma appt rescheduled 16 times over 10 months as the only dr who could treat asthma went early to play golf and had to cancel appts. I ended up in resus being intubated with pneumonia when my symptoms got bad - before that I was a healthy 26 year old. Another surgery dr sedated a patient over Christmas rather than section her as he needed to go shopping.

  • rate this
    +1

    Comment number 50.

    Surely one of the important issues is trying to minimise the number of folks missing appointments. Is there anything that can be done to minimise this trend?

  • rate this
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    Comment number 49.

    I was called into my GP surgery a couple of weeks ago on their instigation for a 'routine checkup'. It was the first time I had visited a doctor for many years, I am reasonably healthy and prefer the internet/pharmacist for most things. The surgery was quite busy and I was surprised to notice that everyone else who was waiting seemed to know each other on firstname terms - strange.

  • rate this
    +1

    Comment number 48.

    No 34 "We need to start producing doctors in large numbers"
    Good point. But a 6 year University course to study medicine will now cost £54,000 in tuition fees alone. If you are English, that is.
    Expect to see a drop.

  • rate this
    0

    Comment number 47.

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

    What in retrospect? Could no-one see this coming ?

    With mass immigration on top of an already increasing population, this is just one of the consequences I'm afraid, better get used to it

  • rate this
    0

    Comment number 46.

    I wish someone would make their minds up.Last week there was a report that we had an excess of 20,000 doctors who couldn't find work in the UK and were looking at working abroad.Now we don't have enough doctors.Which is it?

  • rate this
    +1

    Comment number 45.

    Fantastic work, Pete no. 26.

    -----------------------------------------------------

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

  • rate this
    +1

    Comment number 44.

    To get an appointment at my practice you have to phone between 8 and 8.10 am, any later and they're all gone. Doesn't give you much chance really.

    Or, you can get an appointment between three and five weeks in advance - by which time you're recovered or dead!

  • rate this
    0

    Comment number 43.

    The last two times I wanted to see my GP I had to wait two weeks.
    I'm lucky enough to be healthy and quite frankly I would really try not to go unless I was bad enough to need A&E (which I would do my best to avoid at the weekends).

 

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