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How your practice can save 700 ‘inappropriate’ appointments a year

12 April 2018

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Aylsham and Reepham Surgeries staff was aware of a number of frequent attenders to their practices, but they never analysed the problem until they came across the Productive General Practice (PGP) Quick Start programme.
With support from the NHS England’s Sustainable Improvement team, the practices pinpointed almost 700 ‘inappropriate appointments’ over a period of 12 months.
These appointments were considered ‘inappropriate’ as they could have been dealt with by another method.
By better managing these appointments, the practices could free up around 147 hours of clinical time.
Management in Practice’s reporter Valeria Fiore spoke with the practice manager, Wendy Dicks, to find out how they have done it.
The problem
We knew we had a number of our frequent attenders, but we had never actually looked into this problem.
Thanks to the quick start programme, we discovered that one patient had attended 130 times in a year for blood pressure checks.
The solution
The solution was provided for us to work with the PGP programme. We had already worked on our Did Not Attend (DNA) appointments, not only to improve efficiency and support our appointment availability, but also to support our patients that did not attend but really need to see a doctor.
When the quick start programme came along, we were offered an opportunity to look at our frequent attenders. Having had a lot of success with our DNA, we felt it would be beneficial for us to also focus on those who were often coming to the practice.
We were given guidance on how to select patients. We decided to look at 65 patients who had attended between 30-40 times in a year.
They advised us that that was a good cohort to look at. We grouped patients according to the reasons that stood out to explain why they were attending.
Once able to identify the reasons for their attendance, we could focus on devising a strategy on how best to help them. There is some work we are doing at the moment to educate patients on health conditions and make sure they are supported.
Our receptionists have been doing signposting so they can direct patients to pharmacies or other clinicians and take the pressure off our GPs.
By grouping patients according to their reason for attending, we were able to look at the right pathway for them to take.
Our findings showed that, of the 65 patients:

  • 27 patients were receiving INR (International Normalised Ratio) tests/treatment
  • 9 patients for mainly dressings
  • 14 patients had other conditions such as mental health/Chronic Obstructive Pulmonary Disease (COPD)/pregnancy/Ear Wash Outs
  • 15 had no identifiable single reason.

There were a few patients that were coming two to three times a week for dressing, and those appointments can take 30-40 minutes a time. So that is a lot of work for our staff. Also, if patients with lower leg wound dressing were coming in for a number of weeks, and they were not improving, we started referring them back according to the local lower leg wound clinic under NICE guidance. That helped us release a lot of nurse appointments and also made sure the patients were following the right pathway to receive the right treatment.
Originally we applied this solution to frequent attenders and later to the rest of the patient population.
We released 700 inappropriate appointments in a year just from those patients that we had looked at, but we obviously released others and prevented patients from becoming frequent attenders.
The programme helped us reduce clinical time and made appointments availability a bit better, as we knocked down the number of frequent attenders by finding alternative solutions.   
It took a bit of administration work collating and reviewing the data and to identify the main reason for attendance for each patient. For some patients, we could not find any specific reason for their frequent attendance, which made them the most difficult to deal with. This is because they probably needed more support, as they might be constantly worried about their health, so we would rather focus on their health education.
‘We are very committed to maximising our appointment capacity. We will continue supporting our DNA patients by ringing them to make sure they do not forget to attend their appointment. We have reviewed our frequent attenders in our partner meeting and are continuing to look at how best to support them.’
Wendy Dicks is a practice manager at Aylsham and Reepham Surgeries in Norwich

Picture credit: Aylsham and Reepham Surgeries