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Appointments and Requests

Appointments

Most surgeries will spend time on trying to manage their practice appointments efficiently. This is an important challenge for practices to meet. We explain below how support for better use of our appointment system can help all patients who attend our practice have better access. The actions we suggest individually are small but when added up across all our patients can make a real difference. There is a large variation of individual patient attendances across our patient population. We also consider, in particular for those attending more frequently, how we can improve the quality of care and make the experience more efficient.

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Missed Appointments
Missing an appointment is not extra time for a clinician but a lost appointment for another patient. When appointments are at a premium in General Practice and other areas of the NHS any lost appointments cannot be made up for and this impacts on all patients. The capacity of the NHS is finite (approximately over 1 million appointments per day) but the appointments available can be significantly increased by reducing missed appointments.

Simple strategies to avoid missing appointments
Many patients successfully use alarms on their phone or diary entries to ensure they never miss an appointment. For those that regularly miss appointments please consider other patients who might include your family and friends and patients with serious mental and physical illness including cancer.  If we see a pattern of regular missed appointments, we will need to discuss this with you because of the impact on other patients who attend the surgery.

Remember if you do not need an appointment then you can easily cancel it. Cancelling an appointment can be done in many ways as explained under “Cancel an appointment” in Book or change an appointment. Please remember that if you leave this very late then that appointment cannot be filled with another patient, so effectively it is a lost appointment.

Lateness for appointments
Being late for an appointment if the clinician agrees to see you means that the clinician will run late for all the following patients. Some of these patients do not mind but others who have deadlines like picking up their children or getting to work struggle with this. Again, many patients have found alarms on their phones very helpful to ensure they are always on time.

The 10-minute appointment
A GP appointment is nominally 10 minutes. GPs would prefer to have much longer appointments particularly for more complex issues and this is on occasions organised by the clinician when booking ahead. The reason for these short appointments is to maintain the present capacity. If all appointments were longer then this would mean less patients could be seen and that is just not possible with the present demand.

GPs will try to flex their appointments during a typical clinic, but this can mean they run late for other patients.  Other patients can accept a doctor running late for another patient with significant mental or physical illness (including arranging a hospital admission) all of which may need more time than just 10 minutes. However, be mindful of the 10-minute appointment and how running over impacts on other patients. It is better and safer to covers topics thoroughly rather than rush through them and this may mean you booking another appointment.

Getting the most out of your appointment
Before attending your consultation, understanding what your options are can be helpful for many common conditions and a review of Bucks Health Hub may help you with this understanding. An understanding of Shared Decision Making can help you plan what you want from your consultation and allow you to ask the questions important to you. Both approaches can improve the quality of your consultation but also make it more efficient.

An appointment is just for one person
Remember that an appointment is for just one person. It is not safe for a clinician or the patient to squeeze in a second person for another consultation.

Longer appointments
Some annual reviews for long-term conditions particularly when a patient has multiple conditions are much longer and a GP will on occasions ask you to book a longer appointment.

Continuity of care is good
There is good evidence that there are real benefits from continuity of care (seeing the same clinician or clinical team) particularly if you are attending the practice with the same problem. This is considered by the Royal College of General Practitioners in their support for GP practices Continuity of Care . Continuity will not always be possible all the time but is a general principle worth adhering to for improved care. Sticking to the same clinician can also mean in the long run you can attend the practice less and do not have to repeat your history each time you attend.

As the Kings Funds suggests
“There are more than 300 million GP appointments available a year”. Key facts and figures about the NHS | The King’s Fund.

Such a figure suggests the average patient sees their GP more than four times a year. This is just an average figure and disguises the fact that some patients attend the practice far less and some far more. For those patients not attending the practice we need to consider are they accessing the health care they need. For those patients attending the surgery more often we need to consider are the extra attendances adding value for the patient.

Low attendances

For those patients where their figure is close to zero attendances this may be because you are young without any health concerns or just that you would prefer to avoid the GP practice environment. The healthy living information on the health hub under Overview Wellbeing and Disease Prevention can be helpful if you would prefer not to attend the practice and the services can in many cases be accessed without you needing to attend a GP practice. If you are over 40 years of age the NHS Health Check available in our surgery may be helpful. Vaccinations and Screening are always worth considering if relevant to you.

Frequent attendances

Many people will understandably attend the surgery regularly following episodes of significant physical or mental illness and this is to be expected. In addition, some patients will have multiple long-term conditions and will require more attendances. Some patients will find themselves attending the surgery more often due to health anxiety. Understandably there can also be overlap between these groups of patients. There are some simple steps to consider which can make extra attendances of higher quality and more efficient.

Continuity is good
There is good evidence that there are real benefits from continuity of care (seeing the same clinician or clinical team) particularly in the group of patients that are attending the practice more regularly. This is considered by the Royal College of General Practitioners in their support for GP practices Continuity of Care. Continuity will not always be possible all the time but is a general principle worth adhering to for improved care. Also, on occasions if you are visiting regularly then your clinician may suggest a one-off longer appointment for greater efficiency. Sticking to the same clinician can mean in the long run you can attend the practice less.

Taking a broad approach to long term conditions can help
Taking a holistic (broad) approach to long term conditions, as is explained further under our practice section on Long term conditions, can result in better outcomes. Much of the support described in this section can be accessed without needing to go through the practice.

Considering other options
In some cases where health care attendances (including outside general practice such as hospital and A&E) do not appear to be adding value, it may be worth exploring other possibilities beyond just a consideration of physical illness. This can include health anxiety and medically unexplained symptoms which are covered for adults under Other Mental Health Conditions (Adults). These are common and we can all have health anxiety at some point in time particularly after a bad experience. As explained in the link, there is good local support for these conditions from the local NHS psychology service which you can self-refer to if you think it may be helpful.

A wellbeing focus can be helpful
In addition, many patients find an approach which moves away from a pure focus on medical health but focuses on Mental wellbeingSocial wellbeing and Physical wellbeing can be hugely beneficial. Such support can usually be accessed directly without needing to go through the practice.

A wider network of support
The number of people living alone in the UK has increased by 8.3% over the last 10 years Families and households in the UK – Office for National Statistics. We have all become more physically isolated even if we live with someone else due to many factors including living longer, smaller families, our health, housing and jobs, and present technology. The sections on mental, social and physical wellbeing consider in all areas how you can increase your social interactions.

Not covered in the wellbeing section are other areas of support which are very commonly used by patients. For health support many patients now attend their local pharmacist for advice and medical support for many common conditions, see under Pharmacy for the full range of support available.  Having a local pharmacist that you know, and trust can be very beneficial and widens your support network and can help support minor illness. Also consider both cultural organisations/ groups and religious groups which can provide a sense of community and a further network of support if relevant to you. Widening the support network can provide a more powerful and effective solution, so the GP can still provide value but instead is just a smaller cog in a larger wheel.


Requests

Changing appointments, ordering prescriptions, reviewing results and reviewing your medical notes
Some requests can now be dealt with more easily by online access to your notes. This can allow you to order prescriptions, change appointments, review your results and review your medical notes. We cover how you can obtain online access to your medical notes under online access.

Best time to phone for requests
The best time during the day to phone for requests is late morning and late afternoon when the calls coming in tend to be less.

Urgent requests for prescriptions and documents
Below we cover a couple of urgent requests we occasionally get.

We can all forget to request prescriptions but when it happens regularly it disrupts receptionists from work supporting other patients on the day. Some patients have found it helpful moving to online ordering of prescriptions (explained under online access) and/or tying in the reordering of prescriptions to a specific day of the month well before they run out of medication. Potentially even better if appropriate is moving to electronic repeat dispensing which allows you to just pick up your medication directly from your local chemist without need to put in a regular order. There is more information on electronic repeat dispensing including who it is available for and how to start it under prescriptions and medication.

We understand a patient’s desire to have documents and letters completed urgently. However, we cannot favour one patient over another as every patient’s needs are equally important. The majority of patients will understandably want us to act as quickly as possible. We have 100s of documents, letters, prescriptions and results to process each day which we endeavour to process as quickly and efficiently as possible. For this reason, we have guides on timescales we will complete requests in. We try hard to stick to these timescales even when we have illness in our own ranks. Constant requests do not speed up our activity but just detract from other patient support. We will always do our best to meet our set timescales.

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