Managing demand seems like the holy grail for healthcare. Everyone is talking about it but no one has found out how.
Trouble is, “managing” for the provider means “restricting” to the patient. We’re not allowed to say “rationing”, so we say “diverting”. To the patient, “fobbed off” is simple and clear. Perhaps you have been there yourself.
We know that receptionists are daily turning away 12% of patients from the average practice. We’ve seen as high as 23% in some, and we’ve seen plenty of GPs in denial. They aren’t on the front desk doing it.
All is revealed when we chart “bookings by time of day” which looks like Blackpool Tower at 8am.
The attempt to ration forces patients to phone early, all at once. The wait just to get through gets everyone’s blood boiling, abuse is heaped on receptionists who get the blame for system failure. Not everyone falls ill at 8am, but anxiety and just-in-case drive demand into the spike.
“Fobbing off” is a game played by government too, the NHS111 service based on the theory that a computer and a layperson can efficiently deal with an infinity of medical problems for £10 a go. They take 14 minutes each, outcome, huge rework, 10% sent an ambulance (now 32% of all ambulance demand), another 7% told to go to A&E. A GP knows the right thing to do in less than half the time.
What we have found consistently is that instead of the patronising attempt to “manage” demand, what works is to understand and predict demand, then match capacity as closely as possible. It needs perseverance, but as you take out the rework here’s the secret: it’s less work.
PS. We’ve just released this 90 second video for patients on askmyGP:
I showed it to a PPG this week and they loved it, which was pleasing. The other side of the demand/capacity equation is GP workload, and we are excited by this service as it offers up to 40% saving of GP time. Do drop me a line and I’ll explain how.