General Practice - Appointments, Capacity and Choice

Talk to anyone about the thing that irritates them about General Practice and the first thing they mention is appointments. It’s not just the patients! The staff also feel the pressure on appointments.

How can we increase capacity in General Practice so that there are enough appointments when there are a falling number of GPs?  What is ‘enough’ appointments anyway?

There are those who say we should also increase choice for patients in where they go for primary care – “more surgeries” is the cry.

The digital solution

There are several websites or Apps, such as http://askmygp.uk/ that allow people to enter their symptoms and answering some questions allows the GP to work out the best way to help.  These may advise the patient as to who is best p[laced to help them. This may create some spare capacity so that those who need to see a GP, such as people with complex needs, can do so.

The ‘do it on the phone’ solution

Instead of seeing a GP or other healthcare professional the patients the consultation will take place on the telephone or via Skype or some form of webcam interaction or by email. There are a number of solutions available to manage phone calls such as http://gpaccess.uk/ & http://www.digitallifesciences.co.uk/

Both of the above solutions could also be considered the ‘managing the demand side’ solutions.

The Changing traditional General Practice or more GP surgeries solution

(‘more of the same’)

This solution is about increasing the number of GP surgeries so increasing the number of appointments and increasing choice for patients.

So how do you go about developing a new surgery? You need to raise the cash to buy or rent a suitable building. You need to recruit the relevant staff. That means a full multi-disciplinary team to provide a 21^st century service. The cost of a building for 6000 patients could be around £1.5 million but could be more if an extended team is required.

 This investment has to come from somewhere.  There is the Prime Minister Innovation Fund (now with a smart new name) that was for existing practices if they developed 7 day working. There has not been any funding for new builds from central government for the last 25 years or so. If there is a new housing development and if the local planning authority is up to the mark such a new building could come from ‘planning gain’ and built into the cost of the development. However the developers would only build the bare minimum – based on 1990’s requirements.

However there is still the problem of revenue costs which has to currently come from the NHS. Unless, of course, there is a change in the views of the public on private healthcare or health insurance.

Finally there is the problem of recruiting the staff. GPs and nurses are hard to recruit or retain at the moment.

The nuclear solution

One way of increasing appointments with a GP is to do the reverse.  Patients will only see a GP after they have been seen by another health care professional, (a nurse, a pharmacist or an emergency care professional).  They would refer patients onto a GP as appropriate in the same way as a GP refers to a consultant.  Thus the GPs would see fewer patients.

Other solutions

• Reduce unmanageable & unsafe workload
• Improve perception of General Practice as a career option for junior doctors & nurses.
• Reduce administrative & regulatory burden.
• Return to self-management of minor illness.

There is a final solution 

There could be real and meaningful investment to restore the percentage of the NHS budget spent on General Practice back to the 10% it used to be.

So how will these solutions increase choice and capacity?

Really the only solutions to do that are ‘the more of the same’ solution of increasing traditional general practice by increasing the number of practices.

This is highly unlikely given that there is no investment in new building and real problems in recruiting new GPs.  If the government does not invest will private investors take that role?  Again, in my opinion, I think that is unlikely as there is no profit to be made from general practice at present.

Would a community enterprise or other not for profit organisations invest in general practice?  That is an interesting question.

So sadly I can see no way to increase choice for patients.

Similarly the only way for general practice to survive is to manage demand rather than increase supply.

#GPincrisis

Urgent prescription for general practice

Impact of a shortage of GPs

In many parts of the country GP surgeries are having trouble recruiting Doctors and Practice Nurses. 

What impact is this having on patients and the care they receive?

My guess:

·        There will be a shortage of appointments, so patients will have to wait longer to see a GP.

·        Telephone lines will be even busier so it will be harder to contact the surgery.

·        Patients will be asked (forced) to see someone other than a GP.  This may be a Practice Nurse or a pharmacist.

·        More locum staff may be employed.

·        Practices may close completely.

·        Surgeries will close their lists to new patients.

·        Branch surgeries will be closed.

New patients will have to join another practice which may be some distance away from their home.

This will put pressure on these other practices as they get more patients joining the practice and the cycle continues.

Don't just talk - do something.

Have you ever talked about your GP surgery over dinner, sitting in a café, standing in the checkout at the supermarket….?

Well you are not alone!

A Million people a day use their GP surgery and most of those will have something to say about the experience.

Most of those experiences are good.

However sometimes us patients have ideas about how to make the experience of talking with a GP or practice nurse better.

There can be problems with the phone service, making appointments isn’t always easy, seeing your own GP can mean waiting weeks, no privacy at the reception desk, access can be difficult for those with disabilities and as for car parking…!

So instead of talking about things on your own – join your Practice Patient Participation Group (PPG) and do something about them.

A patient participation group is a bunch of volunteers who want to make a difference.  They work with the practice to gather information from patients and to make suggestions about improvements.

They look at the surgery and ask:

What works well?

What works less well?

Are there services that are not provided but would benefit patients?

They also run an annual patient survey, hopefully the questions are set by the patients not the surgery.

Sadly General Practice is going to have to change. Being part of your PPG is one way you can help to make sure we keep the best bits of General Practice

Your voice on its own is very quiet.

But the voice of the many people in the PPG is much louder and will be listened to.

Please join your Practice Patient Participation Group.

Ask at reception or look on the practice website.  Maybe there is a social media page?