Access: New ways of working can help GPs meet patient demand

A demand-led approach to managing appointments, that includes phone consultations and online access, can help create a sustainable general practice, argues Harry Longman.

Every day over 100,000 patients are turned away from UK general practices. Inside, pressure rises relentlessly, from demographics, more treatments, rising expectations and the burdens of bureaucracy and inspection.  GP recruitment difficulties in much of the UK are a sign that pressure is bound to rise further.

Yet the solutions on offer so far have proven little more than sticking plasters. Remember the Darzi centres that were going to cut use of secondary care? The 8-8 centres in every PCT? The urgent care centres, which would take pressure off A&E but didn’t? NHS111 was going to do the same.

Now it’s the turn of 7/7 GP hubs, and the evidence shows they are costing around three-times core general practice per consultation.

Demand-led thinking

The failures are predictable from the supply-led thinking behind them. Build it and the people will come. Patients are pushed from core GP services and pulled by fee-for-service tariff or pre-paid capacity, all stoking supply-induced demand.

However, demand-led thinking can enable GPs to provide better service and increase their capacity.

One of the earliest pioneers of this, 16 years ago, was Dr Chris Barlow a GP in Quorn in Leicestershire. He emailed me a couple of weeks ago, at 2pm one Monday afternoon, saying how he had 22 spare slots this afternoon, all calls dealt with and just two more patients booked in. 

He was one of the first to realise, and prove, that two-thirds of patients don’t need a face-to-face consultation. By dealing with them over the phone, he could quickly work out who did need to be seen, and offer them an appointment the same day (unless they want a later day). 

Using this method, DNAs all but disappeared, patients got used to the idea that if they need help, the doctor is there, so they don’t need to book ahead ‘just in case’.

Shift to phone consultations

The channel shift to phone enabled the practice to become demand-led, able to predict the numbers of calls each day and respond to them usually within minutes. GPs are in control of who they see and when, while patients love the service.

Finding this practice in 2010 made me excited about the possibility of transferring the idea to others. I unearthed some 40 or so already operating a similar system, and set to work understanding how it worked, creating new measures and research evidence in the process.

It isn’t always easy to make the change to this way of working and not all practices have succeeded. It takes leadership and perseverance. But the vast majority of practices that try this have proven what Chris and others found, that the whole system works. 

The fear of remote consulting is giving way to understanding that the system overall is safer, as patients are not turned away. They are seeing that demand doesn’t carry on upwards, but is finite and predictable.

Online access

The next wave is already on the way, as patients want to seek help online. There’s no sense in online appointment booking – it doesn’t save the GP any time. But putting GPs in control of who they see, when and how patients are helped means another step up in efficiency.

The future for UK GP can and should be better and brighter. Size of practice and structure matter little, efficiency comes from understanding demand and getting the workflow right. Good clinical practice means having time for the right patients, and there’s no other method on the horizon to achieve that.

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