Practice Business Manager Tracy Dell explains that patient demand is predictable and understanding it can help your surgery improve its appointment availability. More importantly, it puts you in control. Here’s how.
Access to general practice has never had such a big focus on it as it does now.
It was one of the main areas of the vision set out in the Fuller Stocktake report, which emphasised the need to provide streamlined and flexible access for people who require same-day urgent care access. It made clear that to facilitate improved access, primary care will receive support and advice from an expanded multi-disciplinary team. And, crucially, it has been given the flexibility to adapt services to local needs.
All of this means that general practice can take a different approach. Practices have been given the green light to reconfigure services to improve outcomes.
The big issue is working out how to do it.
The answer to that is by balancing demand against capacity. To be very clear on definitions, demand means requests for a service from all sources – not just patient appointments; so, all the work involved. And the capacity is all the work that a practice can do with the resources available.
Once demand and capacity are balanced, it allows practices to adapt their service to meet the needs of patients within the constraints of their resources and enable them to manage their time better.
Assessing demand
Each practice must determine how many appointments are needed each week to meet the needs of their patients. And it needs to think about the most suitable person to see each patient.
To do that, the first step is to assess demand, which gives the practice a sense of what is happening right now. An assessment is important for a number of reasons:
- It helps you understand the demand and highlights any pressures.
- You can identify areas that do not have enough clinical resources.
- It enables you to plan and implement new services and/or different models of care.
- You can plan for the optimum take up of Primary Care Network additional roles.
- It aids business continuity. You can calculate the likely ramifications on workload should the practice be forced to close temporarily for any reason, such as flood, fire, utility failure, sickness etc.
To work out demand, the practice needs accurate appointment data – and that means using its own figures.
It may feel unnecessary when there is so much data available. After all, NHS England has been collecting and publishing data from general practice appointment systems since 2018. And General Practice Appointment Data (GPAD) was introduced to enable practices to map the multiple types of sessions against standard appointment categories. So why not use that?
Variation in how practices configure appointments means the data published may be giving an incomplete picture. Our Local Medical Committee (LMC) is supporting practices with the huge task of refining their systems to avoid underreporting of activity. Your LMC may be doing something similar.
Even taking a rough estimate will not work. The CQC states thatit does not apply a formula or ratio for the number of appointments that practices should provide. It points out that practices will take a range of approaches depending on their circumstances, staff, and population needs.
So, each GP practice needs to do the work for themselves rather than using a generic formula. That will then show how the practice spends its time each week and where the demand is coming from.
Detailing demand
A surgery needs to work out how many appointments are actually offered and in what form i.e. whether they are face-to-face, over the phone or online. It also needs to consider whether it includes appointments that are delivered by PCN staff. If so, how is this evidenced?
To get a truly accurate picture, the practice also needs to think about other demands on access aside from appointments. These might include:
- Walk-ins
- Squeeze-ins
- Urgents
- Dip tests
- Internal referrals – e.g. a practice nurse to a GP
- Converted slots – e.g. admin to a consultation
Other areas to consider include bottlenecks, patients being asked to ring back, backlogs and did not attends (DNAs). It is only by understanding all the patient demands on your practice that you can start to map out how many appointments are actually needed and think about a more streamlined approach (see also box below).
Appointment slots need to be configured correctly in line with GPAD guidance. Then an audit should be carried out via the clinical system to establish a baseline of the number of appointments offered on a daily and weekly basis. It should also note which clinicians are providing appointments. The demand can be captured via an F12 protocol in EMIS, a template in SystmOne or a manual tick sheet. Either of these systems can also record other relevant information such as noting any patients that the practice was unable to accommodate.
Auditing and assessing capacity
Doing the above will give you an overview of demand and activity levels at the practice across the week. The data will identify the times and days that are busiest, which can help with planning.
However, a practice can then spot potential capacity by drilling down further into the appointment slots themselves. It does this by auditing the time spent in appointments. Checking to see when a patient arrived, when they were seen and when they left will determine whether the right amount of time has been allocated for each clinical issue. Time can then be added or reduced to ensure appointments run smoothly and capacity is freed up.
DNAs, admin slots and other uses of practice time should be included in the audit and assessed too. Waiting times also need to be analysed so the practice can ensure it is meeting the contractual requirement to see patients for routine appointments within two weeks. Some audits, like this, may need to be conducted manually by logging the date the appointment was requested and then noting when the appointment is booked.
At the end of the audit and assessment process, a practice will be able to see the level of demand and whether there is additional capacity. By tweaking appointments and services accordingly, the benefits can be enormous for patients and staff alike.
A practice that makes the most of its capacity means greater levels of access for patients. And for staff, it can result in less pressure – and therefore reduced stress levels and higher morale – and increased job satisfaction. In turn, that can lead to less sickness absence and enhanced retention of staff.
In challenging times, making the most of capacity is a wise move for every practice.
How assessing demand and capacity can help
The time allocated for cervical cytology might be 20 minutes per patient. If a practice completes 90 per month, that is 30 hours’ worth of appointments.
As an example, let’s say an audit showed each smear actually took 12 minutes. If the time allocated was adjusted to 15 minutes per patient and the same 90 smears were carried out per month, the practice could save 7.5 nursing hours each month.
For practices concerned that reducing the length of appointments may lead to over-running, this can be factored into the plan. For example, an audit could show that phlebotomy appointments take an average of five minutes. However, some may take longer because there are patients who are hard to take bloods from. To accommodate this, set all appointments at five minutes and then add a few ‘catch up’ blocks into the session. That is a better use of time than allocating 10 minutes for all appointments.
Tracy Dell is Practice Business Manager at Cleckheaton Group Practice, West Yorkshire
