Patient Participation Action 1
Action 1–Review of Appointments System
Internal review followed by detailed discussion with the Patient Participation Group. To include full review of current appointments system, with focus on have we the right number of appointments at the times of days wanted by patients. Also to focus on supply and demand issues to improve access. Review to include publication of how the appointments system works, what appointments are available and when, published on website and in practice leaflet.
The practice has looked at the appointments system, focussing on availability of appointments and appointment times.
Background – Doctors
Each GP has 15 appointments morning and 15 appointments afternoon. In addition to this they have time to refer patients, complete paperwork and make home visits. Each GP has six weeks holiday per year. Time also comes out of the working week for CPD, for GP Registrar training and for attending Clinical Commissioning, Medicines Management and Child Protection meetings.
When all GPs are in we have 570 appointments per week, plus one GP seeing patients who require a same day appointment. Taking into account GP leave and other commitments the total number of GP appointments offered throughout the year is about 25,000. The practice list size is 10,600.
Some GPs are more popular than others and get booked up quicker. Some GPs work part time and so availability of appointments with them is reduced.
Since the survey of 2012-2013, a number of changes have been made.
Doctors – Appointment Changes
Receptionists have been encouraged to try to direct patients to their ‘usual GP’ or to the GP that ‘they lasted consulted with’. This make consultations more effective for the patient as the history does not need to be re-taken.
We have reviewed GP holiday scheduling and have restricted the number of GP sessions that can be absent through leave in any given week to 16. This figure is a couple higher than we would really like, but almost all GPs have school age children and pressure on school holidays (especially half-terms) can be difficult to manage.
We have shared duty same day appointments across a larger number of clinicians on busy days, ie following a Bank Holiday.
We have opened the White Surgery to four mornings a week. This has not created any more appointments but it has provided better local access.
We have allocated new baby checks to all GPs rather than to just two GPs. This makes access to particular GPs slightly better.
A GP Registrar has come into post, August 2013. This has added an additional 62 appointments per week to the figures above.
We have added two additional appointments a week into the Saturday Extended Hours clinic.
Partnership change has created an additional 30 appointments per week. This is included in the figures above.
We have not looked at moving appointment times significantly. Routine GP appointments are available from 8.30 to 17.50 on a Monday, 8.10 to 17.50 on a Tuesday, 9.00 to 17.30 on a Wednesday, 9.00 to 17.50 on a Thursday and 8.10 to 16.50 on a Friday.
Background – Nurses
The nursing team have 275 10 minutes appointment slots available each week. The actual number of patients that can be seen is somewhat less as clinic lengths vary depending upon the service being provided. Asthma, diabetic, mental health, dementia review appointments are 20 minute. COPD appointments are 30 minute.
In addition some appointment times are reserved to provide nursing assistance to GPs during advance contraceptive consultations (vasectomies and coils, etc).
Nursing staff get five weeks holiday a year. The total number of nurse appointments available (before clinic length variations are taken into account) is over 12,000.
Nurses – Appointment Changes
We have added an extra 4 appointments per week as a result of nurse staff changes in the review period.
A rescheduling of vasectomy appointments has created an additional 6 nurse appointments a week.
Background – Midwives
Midwifery services are provided by Hampshire Hospital FT and hosted by the practice. It is seen to be preferable for patients to be seen at the practice rather than at the Birthing Centre.
Midwives – Appointment Changes
From February 2014 we will have 8 additional midwife appointments every two weeks.
In summary
It is difficult to determine the true impact of any changes because patient demand fluctuates so dramatically. Certainly when there are no clinicians on leave access will be very good. However, it is during periods of leave that pressure points will occur and it is for the practice to manage this as effectively as possible.