We last changed our appointment system in 2011. This was following a visit by the Medical Protection Society (MPS) who suggested that the way we try to please our patient population, was to try to meet the patients’ demands. Through questionnaires and asking patients in person what they wanted, we found out that most patients wanted to be seen on the same day.
To meet that demand, it was suggested to us that we needed to hold back at least half of our available appointments to be released on the same day. This was initially well received by most of our patients. However, over the years, we now have around 250 – 300 patients who insist they need to be seen by a GP on the same day. This in comparison with similar sized practices who have around 30 – 40 patients asking to be seen on the same day.
After our appointments were previously all taken, we then offered a Nurse Triage service, whereby the Nurse would call the patient back. Most of the requests were dealt with, without the need to see a GP (this was because they were simple requests that did not always warrant a GP appointment). This system happens in most other Practices but we admit that we were quite late in introducing this.
As a private Business working under contract to the NHS, we must follow their rules and guidance under the General Medical Services (GMS) contract. What you can expect, under Access to your GP Practice, it states “You can expect to be seen by an appropriate Healthcare professional within 24hrs”. This would of course include GPs / Nurses / Chemist / Health Care Assistant etc. For urgent cases, even in hospitals, the receptionist(s) would ask the problem (this gives the Healthcare Professionals a chance to look at their computer system and make an immediate decision as to whom to call in next). As an example, if Pt A who is No 1 on our list has a sore throat, but a member of your family has chest complaints is told they are No 15 on the (sit and wait) list, the only way our GPs / Nurses will know this, is if we allow the Receptionist(s) to ask the reason why you believe you need to be seen TODAY and why your reason is urgent. This will then give the GP / Nurse the opportunity to call Pt No 15 in next because of their signs and symptoms. As it currently stands, 90% of our patients who call each day, believe their condition is urgent and insist on being seen on the same day (in many instances for problems which would get better even without treatment). This, we’re afraid to say, is why in part it is so hard to see a GP.
Our New System:
With effect from Thurs 28 Sep 17, if a patient asks to be seen for an urgent reason, the Receptionist will politely ask the reason why (the same way they would if you turned up at A&E asking to be seen urgently). At this time, please be aware that every single member of staff are bound by a binding Confidentiality Agreement. They also have ongoing training sessions by both the Local Health Board and our own GPs.
All they are simply doing is guiding you in the correct direction. As an example, if you are normally fit and well, and now complaining of a cough / sore throat / new backache etc they will guide you towards the local chemist(s) who are qualified to treat you (FREE OF CHARGE) under the Choose Pharmacy (please ask Reception for details). In many cases, there will be no need to see a GP, whose appointments will be freed up for more urgent cases. We now offer more next day appointments for routine and less urgent problems in addition to the usual appointments offered within 2 weeks.
Patients who want to ask a simple question to a GP are unlikely to need to make an appointment to see a GP. This can be done by asking the receptionist to ask the same question to the GP. How this is done is by the receptionist putting in what we call “an overnight query”. They will “Task” the GP with the question, and they will reply to that question by 2pm the following day. It really is as simple as that. Yet again, it will free up a GP appointment.
We also have a high proportion of Patients making an appointment to ask the GP for a “Support Letter” for one reason or another. What should happen is that (most patients) should be writing to the GP with their request, the reason why and if necessary with your written agreement to release any personal information to a third party. This is not part of the GMS Contract and is seen as private work. This is why we are allowed to charge for such services. These letters can often take up a lot of time as the GP needs to read through medical records for each patient before completing a letter. At this time, I need to point out that around 20% – 25% of all such letters, after completion, are never collected by the requesting Patient and end up being shredded, which once again is a waste of a GP appointment. We have (by Law) 21 days to complete this written request.
Please remember that you still have the right to tell the Receptionist that your request to see a GP is “Private and Confidential”. What will happen in this case is that the Receptionist will pass on your reason (even if it is Private & Confidential) to a GP or Nurse who will call you back at some stage during the day. At the reception desk we realise that you may not wish to tell the receptionist for fear of being overheard. This is not a problem. You can either ask to speak to the receptionist in private or you will be given a slip of paper that will then be handed on to the GP. Once again, if they cannot deal with your problem on the phone, you will be offered an appointment by them whilst you are on the phone.
What are we trying to achieve?
Ultimately, what we are trying to do is free up the GP appointment slots (especially the urgent ones) for people who NEED to see a GP. By running our system this way there should be a marked improvement to our appointment system.
It is fully understood that some patients will not be happy about this and will state that they know when they need to see a GP. Once again, this is not a problem, however (up to) 299 others say the same thing. If this was the case, there would be no need to change the system and everyone would be happy with it as it was. Patients are not happy with this and want things to change. The only way it will change is if we guide people to utilise other Professional Healthcare people and facilities because these current numbers of patients (up to 300) are still going to insist on being seen each and every day.
On some days our GPs are seeing up to 80 + urgent extra patients (on top of their booked surgeries). This is becoming unsafe and we need to utilise all our services and not send everyone in to see a GP.
We will review this system at the end of the year and may if necessary make further changes to it. You are of course welcome to feed back to us (by letter) any ideas you may have but ask you to bear with us at this time of transition.
If you are unhappy, we politely ask that you DO NOT take your frustrations out on our Reception Staff.
Dr DM Edwards & Partners