GP contract requirement
Since 2015 practices have been required to offer their patients the ability to book and cancel appointments online. Since April 2019, the requirement is for practices to offer a significant proportion of their appointments for direct online booking, as well as actively promoting this option to their patients.
The 2022/23 contract sets out a more targeted requirement that all appointments which do not require triage should be available to book online, as well as in person or via the telephone. These can be made up of GP appointments, nurse appointments, appointments with other practice or attached staff, etc. including those made available online to NHS 111.
During the Covid-19 pandemic, a number of practices turned off their online booking (and, therefore, cancelling) of appointments. Data in early 2023 indicated that around 8% of practices still had this service disabled, despite the contractual requirement and potentially.
Whilst practices differ in how they manage their appointments, there are very few that are not suitable or adaptable for online booking. Bear in mind, however, the reality of more appointment requests being triaged and assessed prior to actual booking. Practices must ensure that the number of appointments available to book online meets the reasonable needs of their registered patients. This needs to be balanced against the nature of the local population to avoid introducing additional inequalities.
Be aware that offering appointment booking based on the basis of ‘first come first served’ may not reflect patient demand or support equitable care.
Setting up online booking of appointments | step by step guide
Practices decide the type of appointments, specific clinics, or individual clinicians, and when those appointments become available for booking. GP system suppliers provide detailed information to help practices tailor set-up to suit their local needs.
Here is a simple guide to setting up online appointment booking:
Step 1 | Ensure that your system is configured
Configure your clinical system to accept online booking and cancellation of appointments and then set up the surgery sessions to suit your practice appointment schedule.
It is important to have your staff set up correctly on your clinical system and to ensure that leavers are updated on the clinical system as soon as possible.
Step 2 | Decide what your online appointment system will offer
Consider offering routine, telephone, and face to face appointments, as well as offering a choice of clinics and clinicians. Consider involving your patient participation group (PPG) in shaping the service and providing ongoing feedback from their continued involvement.
It is important to remember that only patient-facing appointments should be marked as bookable.
The system default is to make all appointments bookable during set up.
When required, appointments can be changed to unbookable during setup. However, this is frequently overlooked.
If appointments such as admin meetings, fridge temperature checks, etc. are not changed to unbookable, they may be included in your practice’s baseline total (showing a greater number of available appointments than is actually true).
Step 3 | Review how clinical rotas and appointment types are set up within your clinical system
The following points are worth considering, to make online booking for patients as easy as possible:
- create individual rotas for clinician type e.g., doctor, nurse practitioner, practice nurse, health care assistant, midwife etc. or for clinic type e.g., smear clinic, diabetic clinic, etc.
- within individual rotas set up dedicated slot types, e.g., face-to-face appointment, telephone appointment, blood test, blood pressure checks, cervical smears, contraception etc. and future plans should include a wider range of appointments such as health checks, holiday vaccinations, etc.
- consider any appointment data you may need to capture and include this information in either the rota or slot type
- decide which rota and slot types to offer patients to book online and set this up within your clinical system
- think carefully about naming conventions remembering the information seen by patients using an online booking system should be obvious to ensure appropriate appointment booking, for example use ‘blood test, instead of ‘phlebotomy’. Practices are advised to make it clear in the clinic description that patients should only book blood tests at the request of a clinician
- provide patients with an overview of the different types of clinicians and what they can deal with, for example a pharmacist may be more appropriate to deal with a medication query
- ask patients to book into appropriate slots, warning that any appointments booked inappropriately may have to be rearranged, also advise that an inappropriate appointment may not be identified prior to the patient’s attendance. In some instances clinicians may screen clinic lists prior to starting the clinic but this is not always possible or an appropriate use of clinician time.
- review rotas and appointments offered to ensure they continue to meet the needs of your patients (PPG involvement in reviews will ensure that the patient voice is heard) and remember that this demand can change.
Where a practice runs triage appointments, patients may be booked directly into a triage column rather than to an allocated clinician. To ensure that clinicians are available, appointment slots may also have been included in their own calendar. If these slots are bookable, this creates a duplicate appointment slot. Should this happen, the appointments in the clinician’s calendars should be set as unbookable as the practice is using them as a placeholder and not an appointment.
Gaining an understanding of the slot types and how they may be reported locally and nationally can be useful.
Step 4 | Decide the number and type of appointments available online
Practices can choose, for example, to make only routine appointments available online to retain control of urgent slot or triage slot booking.
System settings have an option to restrict appointment booking to specific age groups. This is useful for dedicated clinics, when specific age cohorts are eligible to book, for example over/under 65s’ flu vaccination.
Practices have an option to embargo slots and release them for online booking in a predetermined timescale.
Step 5 | Decide on a maximum number of appointments that a patient may hold over a fixed period
Many practices limit the number to two or three to prevent individual patients making appointments ‘in case’ they need them thereby reducing availability to others. Creating a limit of one means that any appointment at all (e.g. for a blood test) will prevent a patient booking anything else.
Online slots can be booked manually by practice staff on behalf of patients who do not use or are unable to use online booking. Once a slot is booked by any means, it becomes unavailable in both the patient view and receptionist view.
Step 6 | Remember to link in your messaging service
Practices may use an automated appointment reminder system, which can help reduce your ‘did not attends’ (DNAs). Ensure that any online clinics align to the automated messaging service you have installed. There are several commercial options for this service.
Step 7 | Promote your online booking service
Think about the ways you engage with your patients. Let them know when appointments are available, particularly if you are promoting a specific service such as flu vaccination. Use practice websites and social media to encourage patients to book online.
Consider offering patients practical support and guidance to learn how to use online services, either in practice or community venues. This can encourage uptake of all online services. Your patient participation group may be able to support you with this.
Benefits of online appointment booking
Evidence shows that patients who are informed and involved in their own care have better health outcomes and are less likely to be hospitalised.
Benefits to practices
The benefits of online appointment booking to practices include:
- reduction in unplanned surgery visits in person to make, cancel or reschedule appointments
- reduction in telephone calls to make, cancel or reschedule appointments, reducing pressure on phone lines (which can have an effect of reducing call wait times overall) and practice staff
- potential to save staff time with less direct patient contact, particularly when booking high-capacity clinics such as seasonal vaccination clinics
- fewer missed appointments – NHS figures released in 2021 tell us that it is 21% less likely that a patient will fail to attend an appointment booked online
- where a patient uses the option of including a reason for the appointment, an opportunistic review by a member of the practice team may suggest there is a more appropriate person to deal with the problem, and the patient contacted accordingly (remembering that patients still have the option of seeing a specific/preferred clinician). For staff trained in care navigation it is relatively easy to identify if an appointment is with the wrong clinician however the onus will always be on the patient making the booking
Benefits to patients
The benefits to patients include:
- fewer surgery visits needed to make, cancel, or reschedule appointments
- fewer telephone calls to make, cancel or reschedule appointments, reducing the frustrations of lengthy call waiting times
- ease of use and convenience with 24/7 access
- choice of clinician
- online services can be helpful to people with reduced mobility, sensory difficulties or learning difficulties
- patients can access the service through the NHS App, other commercial providers of apps, and the practice website, using a smartphone, tablet, or computer
- people with proxy access can book appointments on a patient’s behalf which is useful if support is needed for a patient to attend an appointment
- patients may be able to choose whether a face to face or telephone appointment is the most appropriate enabling flexibility to fit around their own schedules
- patients can check their appointment details in the online portal, reducing the potential for missed appointments and the need to reschedule
Barriers to using online appointment booking
NHS England has published guidance on improving access and reducing inequalities in access to GP services.
Barriers to the use of online appointment booking from a patient perspective include:
- being unaware of the service and its benefits – practices need to promote online services widely, particularly if demand is high and capacity limited
- lack of skills or confidence in using IT
- problems with access or activation of an online account – practice staff need to be able to support patients with this, as it will save practice time in the long run
- mistrust – being concerned that the system is not secure, and that information may be accessible to others
- lack of equipment and the infrastructure required for online access
Barriers to the use of online appointment booking from a practice perspective include:
- capacity issues as demand is likely to outweigh the available appointments
- inappropriate booking by patients, creating a need for intervention by practice staff. Clear and concise rota and slot descriptions as well as clinic and clinician overviews can go some way to preventing this.
When promoting services, practices should make sure patients know that online access is accessible from a smartphone or tablet and that a personal computer is not needed.
To reassure patients about the security of their information, the practice privacy notice needs to be freely available, for example, on the practice website. The notice explains how the practice uses patients’ data and information.
Staff briefing and training
Although now well-established as a service, staff may occasionally need refresher training, particularly following changes to your system. Existing and new staff will need to understand how the system works and the policies of the practice that relate to online bookings. Staff need to understand how:
- online appointments are made
- to inform patients about using online services
- to register patients for online services including identity verification, proxy access, and
- to support patients with sensory, intellectual, or other needs such as limited IT literacy
- to address patient concerns
- to encourage and explain to patients who telephone or visit the practice that it can be easier and simpler to book online where this is appropriate
Data collection | online appointment booking
Data about online appointment booking has been routinely collected and published by commissioning group area since 2018. GP systems were, however, originally designed for functionality rather than data collection. It has become apparent that not all activity at practice level can be classed as an appointment. Examples include GP admin, referral writing, and reviewing test results. It has also become obvious that terms to describe slot types vary from practice to practice.
To ensure that GP appointment data (GPAD) is as accurate as possible, NHS England and the British Medical Association (BMA) have jointly published a set of standardised definitions of appointment and activity types.
Why activity data is important
Activity data is important as the foundations of ‘fit for purpose’ services today, and for the future. The NHS needs to be confident that data collected from appointment systems reflects true activity. This helps to:
- plan capacity and the workforce to improve health and care
- understand the impact of service changes, for example the use of triage, video contacts and online encounters which were rolled out during the Covid-19 response
- inform national policy development by giving a true picture of how capacity is used
The appointment mapping process is the start of introducing some uniformity in the baseline data. NHS England is committed to working with general practice to progress this work to ensure continual refinements. This will benefit both individual practices and the wider service planning agenda.
Appointment context types
The GP appointment categories are sub-divided in three context types:
- care related encounter | activity involving contact with a patient, whether a face-to-face appointment, a telephone consultation, a video or online consultation, a home visit, etc.
- care related activities | activity which does not involve the patient but is about or on behalf of the patient, for example writing a referral or reviewing a test result
- administration and practice staff activities | which includes all activities and tasks required for managing general practice and its staff
National guidance sets out more information regarding the importance of accurate data collection.
Ensuring that appointments are available to book online is just one step in a series to deliver the vision of digital first primary care as set out in the NHS Long Term Plan.
Related GPG content
- Identity (ID) verification
- Proxy access
- Safeguarding – to follow
- Promoting online services
- Practice websites
- NHS App
- Digital skills for patients
- Health equalities and inclusion – to follow
Other helpful resources
- NHS Digital, GP appointments data dashboard and guidance
- UK guidance for patients on appointment booking and the NHS App
- UK guidance for patients on appointments and bookings
- NHS England, Network Contract Directed Enhanced Services guidance on appointment categorisations 2021/2022
- NHS England,Support and resource guides aimed largely at GP practices and their staff to provide help and resources to encourage more patients to register for GP online services. Includes useful case studies regarding flu clinic appointments.