Access to appointments 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

The receptionist will try and direct you to the most appropriate service, this might be a referral to a Community pharmacist, who can deal with a multitude of ailments and refer back to the GP if medication is required. Please ask our receptionist for further information.

We also signpost patients to Southport and Formby Health 7 day service. This can often suit those working, offering extended hours, evenings and weekends. Appointments are available to see GP's, Nurses, Health Care Assistants, Advanced Nurse Practitioners.

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, we may ask you to phone NHS111, which 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.

Resources

Kings Fund Report (2016) Pressures in General Practice

BMA - Pressures in General Practice - August 2021 

GP Patient Survey 2021 - Ainsdale Medical Centre results

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

The number of admin related calls has also risen sharply. We are still receiving queries regarding COVID passes and wanting information for their employers, for example.

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

In May 2022 alone, we received 6,541 calls. Over the last six months this has varied between 6000 - 7000 calls.

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 two new receptionist, who are a great addition to the team, but are in training, so, may take a little longer to deal with your query.

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.