Access to appointments FAQ

It is understandable that patients are frustrated and confused about accessing services at the surgery as the pandemic situation evolves.

The surgery is incredibly busy and  the demand for our services, primarily appointments with our GPs, easily exceeds the capacity we have to safely care for our patients.

We have created a frequently asked questions (FAQ) page to try to provide answers to some of the questions we are being asked when patients contact us or post on social media.

 

 

FAQ


The demand from our patients for appointments each day easily exceeds the capacity that we can safely provide to meet it.

Since long before COVID, Primary Care has been adapting to profound changes in two factors.

1. People are living longer but with more complex health needs.

2. There are fewer GPs relative to the size of the population ( see chart below)

Over recent years GP surgeries have adapted by bringing in new kinds of clinician such as Advanced Nurse Practioners (ANP), Pharmacists, Physiotherapists and Paramedics. These clinicians can see patients whose need lies within their area of expertise leaving more time for the GPs to look after the needs of patients with complex conditions.

Also in the same period of time, more GPs have either retired or dropped their hours ( and some GPs have returned to practice though typically only part-time.)

All of these factors were contributing to a commonly held feeling that it was more diffiucult to see a doctor and uch more difficult to see the same GP consistently.

Since COVID things have got much worse and demand for GP appointments has rocketed.

Its hard to measure demand but it is clear that people have , understandably perhaps,  been holding-off from getting help from a GP during the last year and a half and now they are often wanting help on a number of concerns.

Many people are sufferering with health consequences of the COVID pandemic. This can be directly because they have COVID or through conditions related to long-covid or indirectly as a result of  the impact of isolation and financial worries on a person's mental health.

These factors are not unique to Ainsdale Medical Centre. They are being felt by every GP practice in the country.


The British Medical Association (BMA) have recently launched a UK wide petition calling on the UK Government to provide the funding and commitment needed to urgently increase the number of GPs, practice nurses and other practice staff and to improve the premises in which they work. You can read more about it here

Dr Ben Allen, a GP in Sheffield, has recorded a helpful short video for his patients which explains some of the changes that are being felt by patients across the country. He has kindly made it available on YouTube

Dr Jon Griffiths, a GP in Winsford, Cheshire has written a good article  - What are GPs Actually Doing - published 5th September 2021

 

 

 

 

 

 

 

 

 

 

 

On most days the capacity we have in place to see patients with acute needs is all taken up and  at some point during the morning we have to tell patients that we are full.

The time at which we reach our capacity varies from day-to day dependent on the overall level of demand but when we are full we cannot carry on booking patients in and still offer safe care.

In these circumstances, patients are offered two choices.

  1. If their condition can wait, they can try calling us back the next day when more on-the-day calls with our GPs will be made available from 8:30am

  2. They can call 111. The NHS 111 service is available 24 hours a day and can help if you have an urgent medical problem and you’re not sure what to do.

    We only refer patients to 111 when we have reached our capacity on any given day.

    111 should be seen as an other level of triage that we use when we cannot safely handle any more calls on any given day. They a large-scale operation - available 24 hours a day and they also have access to GPs and other healthcare professionals who can, where appropriate, offer clinical triage.

    The 111 team can refer a patient back to the GP by booking directly into our appointment system if they think that is the most clinically appropriate course of action


    The 111 operators have ready-access to a directory of local services such as walk-in clinics, minor injury clinics and out-of-hours services.

    There is likely to be a long wait to get through to 111 but this is the same of almost all healthcare services at the moment due to spiralling demand.

There are three categories of patients for whom we will allocate an extra appointment after we have reached capacity.

  1. Children under 5 years old with acute healthcare need
  2. Patients who are on the GSF palliative care framework
  3. People who have been referred back to the practice after having been triaged by the 111 service and assessed as needing a same-day appointment.

 

 

The simple answer to this question is 'when all the appointments are booked'

We have a certain number of appointments each day and a proportion are held back ( embargoed) until the day itself to enable us to meet he acute needs of our patients on that day.

The number of appointments each day can vary - there are usually more appointments on a Monday as that is always a busier day.

On any given day our capacity can be adversely impacted by unplanned events such as sickness absence.

It is also getting much harder to source locum doctors to cover for planned absences of our regular clinical team particularly during the school holidays when locum resource is very scarce.

There is no contractual measure that determines how many appointments a GP surgery should provide on average over a longer period of time.

A benchmark of approximately 75 contacts with a GP per 1000 patients per week is generally used by general practice and commissioning organisations.

The increasingly varied nature of the general practice  workforce and the growth in alternative forms of consultaton such as video appointment, telephone calls and on-line consultations make it difficult to produce statistics that reliably compare one practcie with another.

For Ainsdale Medical Centre with a list size of 11,600 this equates to 870 contacts per week.

Ainsdale Medical Centre routinely provide more capacity than this. From September 2021 we will begin to share some of our appointment data with patients in order to be more transparent about what we provide.


Resources

Kings Fund Report (2016) Pressures in General Practice

BMA - Pressures in General Practice - August 2021 

GP Patient Survey 2021 - Ainsdale Medical Centre results

There are two basic models for proving access to GPs.

One is to open access so that patients can freely book face-to-face appointments through reception or via on-line booking without having to explain why they need to see the doctor.

In an environment where demand exceeds capacity this is essentially 'first-come first-served' and there is a risk that the patients with the most complex needs may not be able to be seen.

We think this would make it harder for people to get an appointment with the GPs because some appointments will be taken by people who could be helped just as effectively by someone else at the surgery or even outside such as a community pharmacy.

The other way of running the appointments system is to use triage where appointments are pre-assessed by the GPs over the telephone. 

In many cases the GP can resolve the issue to the satisfaction of the patient in that phone call. In other cases they will consider it important to examine the patient and they will organise that with the patient.

The decision on whether to see a patient face-to-face is risk-based ( ie balancing the clinical benefits that an examination will bring against the potential risks of the patient coming to the surgery ). The doctor will take into account the patient's wishes also in making that decision with the patient.

This means that the reception team will always book you in for a phone call first but this doesn't mean that you are being denied a face-to-face consultation.

 

The demand for appointments is extremely high which is making the phones very busy.

The number of admin related calls has also risen sharply. The COVID vaccine programme has created a huge amount of additional queries and continues to do so with people calling for help with their COVID passes and wanting information for their employer for example.

Both the clinical and administrative queries are also more complex than ever before and this means that each call is , on average, longer than before COVID.

This week alone we have had received news of a shortage of blood bottles which has required appointments to be cancelled on a large scale, the announcement of a third vaccine for severely immuno-suppressed people and  further delays to the Autumn Covid booster programme. 

We are regularly receiving over 400 calls a day ( over 500 on a Monday) which is approximately 30% more than we would have received in the few months before COVID started back in March 2020

If we move staff from other work to cover the phones then this creates backlogs in processing clinical letters and medication requests which in turn generates more queries over the telephone from patients who are waiting for the work to be done.

We have brought in relief staff during the summer but this has been to cover for annual leave for our core staff so this hasn't done much to help meet the extra demand.

 

 

 

 

Patients can come into the surgery to wait in the waiting room for their routine appointment. Patients being seen by the GP face-to-face for acute conditions are still required to wait outside until the doctor is ready.

The doors are locked in order to prevent the reception area and waiting rooms  from becoming crowded and potentially unsafe. Our primary concern is the safety of our staff and our patients particularly the ones who might be deterred from coming to the surgery for appointments if we cannot provide a safe environment.

The overriding guidance is the Infection Prevention and Control Guidance ( linked below) which remains very restrictive in an operational sense. It specifies that all people entering the building  should be triaged for COVID-19 symptoms and assessed for exposure to
contacts prior to admission to the waiting area.

We are keeping the situation under constant review and will make further changes when we can to open up access to the surgery building.

We keep in constant contact with other surgeries in the area to make sure we are being broadly consistent with each other as as with infection control guidance. A small number of practices have got their doors open but  in most cases this is possible because of the circumstances of the surgery building ( eg the size of its reception area) or its location as well as robust risk assessments.

Our location in the centre of the village (which before COVID made it so accessible and friendly) is one of our biggest challenges. Our current assessment is that we would need to limit the number of people  in reception at any one time to 2-3 people including people arriving for appointments and this would certainly mean that people would need to queue outside for large parts of the day.

At the moment our view is that this is a slightly worse option than locking the doors amd in any case would require us to have stewards on the door.


Resources

COVID-19: infection prevention and control guidance - Published by Public Health England - Updated June 2021

In the second half of 2018 the practice took actions to reduce the number of patients on our list to enable us to continue to provide safe and effective care.

We asked a large number of patients who lived outside of our current boundary area to register at a practice nearer their home. This was a painful process for us and even more so for the patients who were affected by this action.

We also closed our list to new patients for a number of months.

As a result our overall patient list dropped from approx 12600 to approx 11600 which is where it remains today.

Surgery Image

Contact Us

Ainsdale Medical Centre
66 Station Rd
Southport
Merseyside
PR8 3HW
Tel: 01704 575133