Someone very close to me whom I have known all his life (we shall call him S) has had recurring headaches for three weeks. He has seen the GP, who diagnosed viral sinusitis, nothing to be done except OTC pain relief. See again in a month if no change.
Someone else even closer to me whom I have known many decades (we shall call her W) takes pity and suggests, “Why not book another appointment for next week. You can always cancel it if you don’t need to go.”
Aaargh! There, in a nutshell, is the problem. The patient perceives it’s difficult to get an appointment, therefore books just in case, making work for the receptionist at some effort to himself. The slot is taken and unavailable to another with greater need. The patient may take the slot, perhaps unnecessarily if things improved, or may give it up. The patient may get around to cancelling it, but that involves further effort so may not bother and simply DNA. (we know that time between booking and appointment is the main driver of DNAs).
Rework all round, lots of effort resulting in waste. The NHS can’t afford waste. I don’t know how often this series of events is played out every day in the UK but here’s an indication: we ask patients when they want to see the GP. In a traditional practice where booking ahead is encouraged, 62% of patients want to see the GP on the same day. In the same practices, when they launch a demand led system where there’s always capacity on the day, that number changes to 91%.
It turns out the desire to book ahead is driven not by convenience, but anxiety. One GP told me they had all available slots booked up at 6 weeks ahead. Come the day, very often it wasn’t the booked patient who turned up but another family member, such was the perceived hurdle to see the GP. What a waste.
So what’s the solution? Changing patients’ perception so there is no anxiety. When there’s no need for patients to book ahead, they stop doing it. “Ah but”, I hear, “if we make ourselves more available, we’ll be buried in demand”. The evidence shows that it doesn’t happen. If you have currently unmet need, there may be a step increase, not always, but there is no further rise. Anxiety demand disappears.
There will always be some patients who abuse any service, but we’ve found that those whom GPs assess as “should have been self care” are constant at 3% both before and after launch. There’s no change in volume, but they are quicker to deal with over the phone or online, so time is saved.
We are firmly of the view that it’s better to trust patients. A few will abuse that trust, but it’s a much better way than that where practices often start , which is suspicious, protective and defensive against patients.
On the same theme, I was struck this week by new data from askmyGP: offered a free choice online of a named GP, 77% of patients were happy with anyone. Of the 23% who named one, out of 6 available the most popular was only 28%. The “Dr Popular” myth says one GP will get buried, but trusting the patients showed that only 6.4% of all demand was for one individual. Aha. Do drop me a line if you’d like the full report.
Meanwhile, I was talking to S and W…
Founder, Chief Executive
GP Access Ltd
PS I wanted a break from you know what, but to compare the manifestos on access to GPs, the King’s Fund has done an excellent chart. Something to laugh and something to cry about from every party, but they are all more difficult, controversial and expensive than they need to be, because they haven’t looked at the evidence.
Our own manifesto for primary care is in three words, Responsive, Relational and Professional.
But the best advice I’ve seen is from @jtweeterson, dealing with Election Fever.