Simple changes maximise use of appointments and increase efficiency – Dunstan Village Group Practice, North West

Dunstan Village Group Practice in Liverpool has two whole time equivalent GPs serving a patient population of approximately 6.7k.  The practice participated in the Productive General Practice (PGP) Quick Start programme to looks at ways in which it could work more efficiently to better meet patient demands.  PGP Quick Start is delivered by NHS England and NHS Improvement and part of the support available through Time for Care.

Breaking down the problems and identifying the issues

There were four areas the practice wanted to focus on; increasing the use of eConsult, better utilisation of nurse appointments, completion of reception tasks and creating a more organised working environment.  Each had issues, which if addressed, would help the practice operate more efficiently and meet patient demands better.

Increasing use of eConsult

  • There was low usage of online appointments via eConsult.
  • Staff were not actively promoting the system as they had little knowledge of it and did not think they had the permission to do so.
  • Patients were reluctant to take up online appointments, instead preferring face to face or telephone.

Utilisation of nurse appointments

Appointments were reviewed over two-weeks to identify times where different clinicians were over/under utilised.  Findings showed that the nursing team was being used incorrectly, with most appointments assigned to the nurse practitioner, including some that were inappropriate e.g. new patient health checks that should go to the practice nurse.  This led to senior receptionists having to reallocate patients which wasted 20 minutes of their time per day.

Completion of reception tasks

  • Not all reception tasks were being competed in a timely manner.
  • Some tasks would remain incomplete.
  • The reception team had no clear priority for the completion of tasks.

Better working environment

  • GPs were wasting 3.5 hours per week making trips to reception for up to date referral forms. The forms would not always be easily accessible and could take reception staff time to find.
  • Some stationery items were stored in the practice manager’s office, on average she was interrupted 12 times per day by staff needing stationery.

Small changes that require a team effort

Working groups for each area focussed on generating ideas and finding ways to tackle the issues.  Before any changes were made and tested, they were shared with the relevant team (admin or clinicians) for their input and support. This was important if any changes made were to be successful and sustainable in the long term.

Increasing use of eConsult

  • Previously 25 telephone appointments were available each day, this has now been reduced to 13 with the remaining 12 now available as eConsult. Increase of the latter gives patients greater flexibility and improved chance of getting a timelier appointment.
  • Staff are encouraged to actively promote eConsult. A user guide created for them has given them greater knowledge of the system and increased their confidence in promoting it to patients.
  • Patients can now learn more about eConsult and its benefits by accessing a user guide the practice produced. It provides step by step instructions on how to use the system and helps address any anxieties patients may have.

Utilisation of nurse appointments

The order in which nurse options are listed on EMIS has changed whereas the nurse practitioner, who was previously at the top of the list and being over-utilised, now appears at the bottom.  As a result, reception staff do not automatically select this option when filling an appointment.  Reviewing the other first two options (practice nurse and nurse prescriber) has made staff stop and consider if they are making the right selection.

Completion of reception tasks

A staff skills matrix for the reception team was created which lists all tasks the team undertakes, when, how often, and in order of priority.  Staff self-evaluated their skill level and colour coded their name against each task e.g. green = could help others, red = no knowledge.

Information from the matrix was used to create a priority task board which is on display in the reception area.  It is reviewed throughout the day to ensure the completion of tasks is on track.  Where tasks are lagging, staff with the appropriate skills will help complete.

Better working environment

  • All forms are now up to date and easily accessible, GPs also have access to electric copies.
  • Stationery items previously in the practice manager’s office have been moved to an easily accessible point in reception.


  • Over six months the number of patients using online appointments has increased from 37 to 85, an increase of 56%. The work done to increase online consultations was hugely beneficial for when COVID-19 hit and more appointments had to be dealt with remotely.
  • Patients have more choice and flexibility when booking appointments, this is good for people who work and those who are carers.
  • 100% of reception tasks are now being completed daily unless the team is extremely short staffed, on these occasions the team are all clear which tasks should be prioritised.
  • There is better utilisation of nurse appointments. The prescriber nurse and practice nurse are now being used to fuller capacity.
  • 4 hours of senior receptionist time has been released per week due to less reallocation of inappropriate nurse appointments.
  • 5 hours of GP time and 3 hours of reception team time have been released per week through the improvements made to the working environment. This has created a better working day for the practice team and helping complete tasks more efficiently.

“PGP Quick Start has been really beneficial for us.  We are now using the right appointments for the right clinicians, which has given patients better availability and flexibility.  It’s brought our team together, encouraged people to have their own input and feel empowered.”

Laura Rose, Deputy Practice Manager, Dunstan Village Group Practice