Getting appointments and the government’s primary care recovery plan – 15/05/23
You might have heard about the Government’s new plans to improves access to primary care appointments.
One of the aims of the plan is that when you ring the practice your request will be dealt with in an appropriate way at that first contact, and that you will not be asked to ring back another day because there are no appointments left that day. You might have the idea from the recent media coverage that this is going to be possible immediately, starting in May 2023.
We think there are some important things to know about the announced plan:
- In order to avoid asking a patient to ring back another day there need to be many services in place already. A number of proposals are mentioned in the plan, many of which are not currently in place.
- We are already doing many of the things mentioned in the plan …
- we already have care navigators (we call them patient advisors) – you already speak to these people every time you ring the practice. They have been trained to assess what service is most appropriate – that might be an appointment at the practice, but it might be something else.
- we are already using some of the IT and telephony measures suggested in the plan, and we are gradually implementing and investigating those that we aren’t currently using.
- referrals to ophthalmologists from opticians – as far as we are aware this is already possible and we already encourage local opticians to do this rather than asking us to arrange the referral.
- Some of the initiatives have already been tried and they have been discontinued for various reasons. In particular, there used to be a local scheme for referring patients to the local pharmacist for minor illnesses (Pharmacy First) – it was stopped after a few months and we were very disappointed about that.
- Although they sound very good, some of the proposed schemes will take some considerable time to be put in place …
- Pharmacy First – you will know that many local pharmacies are already struggling to cope with their current workload. If this scheme is to be resurrected in this area, the local pharmacists will need time and a lot of resources to be able to provide a good service of the kind that the government is talking about.
- Self-referral schemes for the falls services, audiology, musculoskeletal services etc. are not in place and we are waiting to hear about the plans for those.
- We are very pleased to hear about the suggestion of reducing bureaucracy for GPs – we will be delighted if this is successful – but there is no detail and as far as we know there is no specific plan in place for this yet.
In addition to all this, for a long time before the government’s plan was announced, we have been trying many things that are not specifically mentioned in the plan. In particular, we have been:
- expanding our staff
- employing different kinds of healthcare professionals who can help out
- trying different ways of working – there are often things we can do to help with some problems without the need for an appointment; the patient advisors can help with this.
Recruiting more staff and different kinds of healthcare professionals
When we talk about primary are we don’t just mean GPs. We include a wide range of different professionals who have skills that are valuable in a primary care setting, and who can support GPs with the workload. These include advanced nurse practitioners, practice nurses, physician associates, clinical pharmacists, mental health practitioners, physiotherapists and advanced clinical practitioners.
Many problems can be dealt with well by a healthcare professional who is not a GP. Some people, of course, definitely do need to see a GP.
When you ring the practice, the patient advisors try to get enough information from you to work out who will be able to help with your problem, and what kind of timescale is needed.
We have been trying for several years to recruit more healthcare professionals (listed above). We have done this as a practice on our own, and by working with our Primary Care Network. We have had some success but we have not been able to recruit as many as we would like. And unfortunately some of the staff we have recruited and trained have left for other roles elsewhere. We are not alone in this – GP surgeries across the UK face exactly the same challenges.
We try very hard not to need locum GPs. We do not think it is the best solution for patients. For us it is always a last resort. In recent years we have had to use locum GPs. But we have been very lucky to have a small number of locum doctors who come regularly to the practice. This means they get to know the practice and the patients, and it is much better for continuity of care.
Appointment system
There is no perfect appointment system. We have tried all sorts of approaches over the years. We continue to make changes so the experience is better for patients.
We have to get a balance between advance booking and having some appointment availability every day. A significant portion of our appointments are already booked in advance. In our experience booking too many advance appointments causes major problems e.g. if a staff member is off sick or has to change their availability at short notice. We know from past experience that increasing advance booked appointments leads to more missed (and therefore wasted) appointments. We know the level of demand for advance appointments would be very high and would lead very quickly to long waiting times. We feel this is likely to be just as bad for patients as being asked to ring back another day, and overall would probably result in more delay in being seen. We estimate that if we switched now to limitless advance booking within a couple of weeks we would have a waiting time of at least 6-8 weeks, and that would continue to grow.
The reality is that:
- We really do understand why patients feel frustrated and angry when they are told there are no appointments left and when they are asked to ring back the next day.
- We would love to be able to provide what the government is asking straight away i.e. to be able to book you in for an appointment at the first contact you have with the practice. We hate having to ask you to call back.
- We are working at full capacity.
- We are doing everything we can to make it possible that one day we won’t have to ask you to ring back another day, but we cannot do this at the moment. Many of the things we need to be able to achieve this are not in our control. We simply cannot, immediately, create and offer appointments with professionals that don’t exist.
- But if we assess that a problem is urgent and really needs dealing with that day we absolutely will see you that day. We will only ask you to ring back another day if our routine appointment slots are full and if the problem is not clinically urgent. We have always done this and we will continue to do this. There may of course be times when you and the practice can’t agree that something is urgent for that day.
We are trying to provide the best quality service that we can within the resources available. We are really sorry that sometimes the service does not, and cannot, match your hopes. We really are doing our best and we will continue to do our best to provide a high quality service.