Active signposting frees up 80 inappropriate GP appointments a week

Case study summary

Waterside Medical Centre in South Warwickshire has six GPs and almost 13,000 registered patients. To improve how it managed its rapidly increasing patient list, the practice took part in the Learning in Action element of the Time for Care programme by NHS England’s Sustainable Improvement team.  The programme is part of the support available through the General Practice Forward View.


The idea

Along with a group of 13 other practices within South Warwickshire, Waterside Medical Centre took part in the programme, which takes a collaborative approach to learning and improvement focusing on the 10 High Impact Actions. With ‘active signposting’ an action the group identified as a priority, the practice had an opportunity to look at reducing the number of patients seeing a GP with problems that could be dealt with by other practice staff or wider health economy.

Testing small cycles of change

Over six months the practice attended six Learning in Action workshops, where the group was introduced to various tools and techniques from quality improvement. The Plan, Do, Study, Act cycle, which provides a structured approached to improvement, enabled the practice to undertake a number of cycles to test the following.

  • How will patients respond to being directed away from traditional face-to-face GP appointments?
  • The level of support from the Patient Participation Group (PPG) and staff of active signposting at the engagement phase.
  • Will patients object to non-clinical staff asking active signposting questions?
  • Will reception staff accurately elicit details from patients and accurately record them in the reason for appointment?

During the study phase of the cycles the practice found it needed to take the following actions to effectively implement active signposting.

  • Significantly engage with patient groups, staff groups and GPs to develop shared aims and objectives of signposting.
  • Develop a training and support package for practice staff with regular team review meetings.
  • Ensure training is current.

The practice worked through the actions between each workshop and brought back their learning and progress to share with the group to get their feedback, input and collaboration in progressing certain actions.

Sharing and learning with other local practices

Whilst working on the actions the practice encountered a number of challenges e.g. difficulty in engaging a representative group of patients, technical issues with the phone system, and inertia of some staff and clinicians. It brought these to the workshops to share and learn what was currently working well in other practices, and whether there were any ideas and experiences they could adopt. Following this the practice designed and tested the following resources and shared with the rest of the group.

  • A Standard Operating Procedure.
  • Phone script information leaflet for staff to use.
  • Newsletter for patients explaining the changes.

The collaborative element of the programme enabled learning from others, this helped the group work as a community which led to significant progress. Improvement happened at a greater pace than it would have had the practice worked by itself.


  • Active signposting has helped the practice release 11% of inappropriate GP appointments, this is 80 appointments per week equating to 13 hours of GP time.
  • The freed up appointments have given GPs more time to focus on those patients that need their time (e.g. those with more complex care needs), as well as improving access for patients who need to be seen.
  • Feedback from the PPG has been very positive, results for the friends and family test have improved by 5%.
  • Staff feedback has been very positive, with most pleasantly surprised by how positively patients have received the change and their willingness to share clinical detail.

Implementation tips

  • It is important to have clear aims, objectives and measures for any project of change you embark on.
  • Engaging and motivating staff to support and endorse the change is essential.
  • It is important to inform and educate patients about the changes and the rationale. You need to make sure communications are clear and impactful.
  • There is great value in working collaboratively with fellow managers on these problems, sharing learning and resources.  It helps speed up the process of change and improvement.
“We have always run a very tight ship with a robust duty doctor system.  Our unavailable appointment assessment indicated that a maximum of 10% could have been seen elsewhere however, the Learning in Action programme helped us achieve a higher improvement.  The collaboration with other practices without a doubt was significant in making the improvements we have, which are now sustained within the practice.”
Tim Morris, Practice Manager, Waterside Medical Centre