Medico-legal: Five tips for dealing with demand for appointments

MDU medico-legal adviser Dr Beverley Ward discusses how to run your appointments system.

A well-managed appointments system is essential in challenging times (ISTOCK)
A well-managed appointments system is essential in challenging times (ISTOCK)

With demand for GP appointments now reaching record levels, a well-managed appointments system can help to ensure that complaints are kept to a minimum.

The average GP practice dealt with 4,384 more consultations per year in 2011/12 compared with 2004/5, according to a recent estimate by the RCGP.

During the year to March 2013, there were nearly 5,000 written complaints about practice management systems in England, including the appointments system, according to national statistics.1

GP practices face a considerable challenge in finding innovative ways to meet patient demand for appointments without compromising patient safety or overloading the system.

The following five tips are designed to help GP practices safely manage the increasing demand for appointments.2

1. Polish up practice staff telephone skills

Poor communication and perceived rudeness during telephone calls are a common cause for complaint.

It is worth considering regular training sessions for reception staff in telephone skills, including checking the caller's identity, actively listening without interruption, being courteous and staying calm when dealing with an aggressive caller.

It is also important to ensure there are enough staff to deal with calls at peak times.

Your telephone policy could include your commitment to answer calls within a certain timeframe, how calls are documented and emergency contact numbers.

2. Train staff to carry out telephone triage

Telephone triage is a useful way of determining urgent and not so urgent cases, so appointments can be allocated according to patient need. However, the process must be thought through, to ensure confidentiality and patients being seen in person when necessary.

If non-clinical staff are involved in triaging cases for a GP to call back, they must have appropriate training and there should be a full written protocol, which includes red flag symptoms. To protect confidentiality, calls should be taken where they cannot be overheard, rather than at a reception desk.

3. Document telephone consultation advice

Many practices provide a call back service, so patients can talk to a health professional or be allocated an emergency appointment.

The practice nurse or GP should have access to the patient's records and make the same detailed clinical notes that would be expected in a face-to-face consultation.

In the event of a problem, the practice should be able to document the reason for the call and the advice offered. If calls are recorded, this should be made clear to patients.

4. Set up systems to help minimise your DNAs

Text reminders can help to minimise missed appointments, although we advise GP practices to seek patients' specific consent to opt-in before texting them.

Make sure you explain what information will be texted and the security arrangements in place.

If the information is serious or important, such as requests for urgent follow-up, consider alternative or additional methods of communication. Details of text messages sent to, or received from, patients should be noted in the medical records.

Ensure your practice has a protocol for prioritising and responding to missed appointments and that a record is kept of any steps taken to follow up urgent appointments.

For example, if a patient is acutely unwell and fails to attend an emergency appointment, it is important the practice can demonstrate that all reasonable steps were taken to investigate the circumstances and need for care.

5. Regularly review your appointments policy

It is important to provide patients with information about your services and how best to access healthcare practitioners. Your practice appointments policy should be available on your website and in the waiting area.The MDU also recommends that new patients should be made aware of it. The policy could include the following:

  • Surgery times - extended hours sessions and how to obtain medical help outside these hours
  • Types of appointment available - urgent, advance, practice nurse, travel clinic
  • Appointment booking methods - telephone, online
  • Home visits - how to request one and the circumstances in which they are provided
  • GP access - whether patients can request a particular GP, a longer appointment
  • DNAs - how to cancel an appointment and the practice statement on patients who miss their appointment

Dr Ward is a medico-legal adviser at the Medical Defence Union


1. Health & Social Care Information Centre. Data on written complaints in the NHS 2012-13. August 29 2013.

2. Ward B. By appointment. MDU In Practice 2014; 10(1): 4-7.

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