Case study summary
Seven Dials Medical Practice in Brighton is made up of 3.75 whole time equivalent GPs serving a patient population of over 8,000. The practice participated in the Productive General Practice (PGP) Quick Start programme delivered by NHS England’s Sustainable Improvement team, to help reduce the number of inappropriate appointments seen by its GPs. The programme is part of the Time for Care support available through the General Practice Forward View.
Improve signposting to help reduce inappropriate GP appointments.
An opportunity to make improvements
The team collected data over one week to identify how many GP appointments were being used, and the percentage that they felt were inappropriate. Out of 366 available appointments, 31 (8%) were considered inappropriate because they could have been seen by a different healthcare professional or signposted elsewhere. The rate of 8% was far lower than the practice had predicted, as it estimated the number would be high as 20%. Despite the reassuringly low rate the team still felt there was more it could do to reduce the 8% further.
The team felt it could make further improvements in signposting. With the majority of appointments booked by reception, the team reviewed how this was being done and found the following.
- All reception staff had their own script for dealing with patient appointment requests by phone, some which were more effective at signposting than others. There was no one script that was being used as standard by the team which meant patients were receiving an inconsistent service.
- When a call came into reception the patient would be issued with an appointment first and then asked why they would like to see the GP. By this point the patient was reluctant to provide any information in fear of having their appointment withdrawn.
- Due to patient confidentiality staff felt uncomfortable openly asking patients in reception for their reason for an appointment, making it difficult to gauge whether the appointment was appropriate or not.
A more proactive approach to signposting
Two members of the reception team attended signposting training provided by the CCG. On returning to the practice they shared their learning and material with the rest of the team. To complement and build on this learning, they used support from the PGP facilitators to test a number of ideas that led to the following changes being made.
- A common script is used to book all appointments which includes suggested language and responses. It is aimed at extracting the relevant information from the patient to help staff make a decision as to whether the appointment is appropriate, or whether it would be better signposted elsewhere.
- Paper slips are issued to patients at reception to write down their reason for wanting to see a GP, helping eliminate the risk of compromising patient confidentiality.
- Posters are displayed around the practice explaining why patients are asked the reason for their appointment. Information about what help the local pharmacist can provide is also placed in the waiting area. This educates patients about how this service can often be more appropriate for them for minor illnesses.
Following the changes made the team collected new data to ascertain what impact the improvements have made.
- 30 inappropriate GP appointments have been released a week, this is equivalent to the practice providing two additional GP sessions a week for patient consultations.
- There is a greater number of GP appointments available to patients that require them, resulting in less waiting time for an appointment.
- Patient awareness about the different local services available to them has increased which means there are fewer inappropriate appointment requests. Patients are also receiving a more consistent service from the reception team.
- Reception staff have enhanced their skills and knowledge around active signposting. They feel more confident in what they are doing and more able to appropriately signpost patients to the right services that will serve their needs better.
Undertaking the programme has made us have a different perspective, a deeper view on appointments and helped us implement improvements.
Valerie Leach – Practice Manager, Seven Dials Medical 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