Case study summary
GPs at Forum Family Practice in Cramlington were overwhelmed by a heavy workload and struggling to meet patient demand for face to face appointments. By participating in the Productive General Practice (PGP) Quick Start programme the practice found ways to reduce the GPs’ workload. The programme is part of the Time for Care support available through the General Practice Forward View.
Release inappropriate GP appointments to help reduce GP workload and make it more manageable.
Using data to demonstrate the problem
The practice undertook an analysis of all GP face to face appointments over 2 weeks. They identified when the patient should have been seen by another clinician or service, and when it would have been more efficient to deal with as a telephone appointment.
- 28% of face to face appointments would have been better dealt with by another service/practitioner such as a practice nurse.
- 11% were for cough/cold symptoms that should have been referred to the local pharmacy.
- 20% of appointments could have been undertaken by phone e.g. medication reviews or sick notes.
Collectively this demonstrated that over half of all GP face to face appointments could be managed differently.
Understanding the reasons why
The team discussed the reasons behind why so many face to face GP appointments were not being utilised efficiently.
- Reception were not asking patients the reason why they needed to see a GP, as they felt the matter would be personal/confidential and the patient would not want to discuss it with them.
- A number of patients were frequent attenders who were suffering from loneliness rather than any medical related issues.
- There was a lack of understanding from patients as to what other services were accessible and could be more appropriate for them.
This highlighted to the practice key areas where changes needed to be made.
Making changes that would lead to significant benefits
Navigating patients to the correct clinician/service
Working together the GPs and admin team made a number of changes that help navigate patients to the most appropriate clinician/service.
- The lead GP recorded a greeting message for the phoneline explaining to patients that reception will now ask the reason why they need to see a GP, to ensure they are directed to the right person to help them.
- Reception now ask all patients the reason why they need to see a GP and find that unless it is personal (which often it is not), patients are happy to tell them.
An acute telephone line has been set up to give patients advice around seasonal illnesses. For example, during seasonal norovirus patients are put through to an answer machine message for advice. If they are experiencing sickness and diarrhoea they are advised to keep themselves hydrated, but if the symptoms are more than four days old they must select an option that will take them to a member of staff to action appropriately. As seasons change more options are added to the telephone line e.g. coughs and colds, hay fever.
Providing the right mix of face to face and telephone appointments
Timed telephone slots for two GPs are now available. Patients are advised a GP will call between 1.00pm and 2.00pm, but if they do not answer the GP will not ring again. They will have to contact the surgery to arrange a new appointment.
For every 2 face to face appointments this has released, GPs can now undertake 4 telephone appointments. To date all telephone slots have been utilised and none required a face to face appointment.
Supporting and educating patients
The team discussed ways to deal better with vulnerable and lonely patients and came up with a rolling educational programme with themed coffee mornings for patients. This is aimed at encouraging lonely patients to come out of their homes and socialise with others, while showcasing a seasonal theme that educates all patients. The practice started with a Christmas tree decorated with over the counter medicine boxes to help patients identify they can buy some medications cheaper than the NHS can prescribe/dispense.
Not only has this helped reduce the number of frequent attenders but supports the social prescribing agenda by promoting self-care.
A seasonal education of common conditions such as colds, coughs, sunburn/sunstroke and allergies/hay fever, has been agreed by the team. Actions are in place to support this including dedicated messages on the acute telephone line, website, posters including QR codes to make it easier for patients to download information and be directed to
appropriate websites, TV screen messages and social media.
- The changes made have released 23 x 10 minute face to face GP appointments per week, equating to over 19 GP hours a week. The released time has reduced demand on the GPs’ working day significantly, helping to reduce their heavy workload and make it more manageable. 10 of the 23 appointments have been transferred to an additional 20 telephone consultations within the working week. On a daily basis all face to face appointments are used however, it has reduced the number of “urgent extra” appointments GPs used to see every day.
Staff across the practice feel more confident in contributing their ideas and change. The admin team now raise issues directly with the GPs whereas before they did not have the confidence to do so.
- Patients are seeing the right clinician the first time, saving them time and inconvenience in having to book a new appointment if navigated inappropriately. Where a GP face to face appointment is required, this is now easier to book.
- There is greater belief in and willingness to engage with others, within and outside the practice. The team has already shared policies, procedures and documentation with other local practices, putting them in a good position for greater closer working as part of a Primary Care Network.
“Super proud of the team, with the foresight and ideas they came up with. Everybody’s engaged and part of making changes” Gail Yule, Practice Manager, Family Forum Practice
“The work that has been carried out has been really useful in identifying where we could make efficiencies. The practice team have worked really well together in looking for novel approaches and I think have enjoyed the process. It has been important that both the GPs and staff have had supported each other in making these changes” Paula Batsford, GP, Family Forum Practice
If you would like to find out more about how you can access the Productive General Practice Quick Start programme, visit our ‘Releasing time for care’ web page.