Routine telephone GP appointments

Nightingale Valley Practice – Bristol

The problem

Prior to April 2016, we offered routine appointments, same day appointments and an on-call GP in the morning and afternoon. The receptionists were under increasing pressure to manage patient expectations when they all wanted a same day appointment and patients got frustrated having to phone up on more than one day. The on-call GP list was ever expanding with "urgent" requirements of same day contacts and the team were all feeling the pressure with having to make 100+ telephone calls and seeing any patients who needed to be seen.

Continuity in patient care was difficult as the patient had to speak to whoever was on call or whoever had a same day appointment available, rather than the GP who had been dealing with their query. The on-call GP was also finding it difficult to phone patients as the phone lines coming into the practice were too busy to allow any outgoing calls. GPs carrying out a normal surgery, had to squeeze in time to speak to their own patients where necessary, thus, making their working day longer.

The Bright Idea

We implemented a new system where we had an on-call team consisting of two doctors and an Advanced Nurse Practitioner. We added routine telephone slots to GPs carrying out normal surgeries that could be used to add their own patients in to improve continuity and to reduce the on-call list. Reception staff attended telephone triage training which was supported by the clinicians to help with signposting, minor ailments and drilling down to what the urgency of the patient's illness was. Same day appointments were no longer available to be booked by patients and were instead protected for the on-call team to add patients who need to be seen that day. We updated the welcome message on our telephone system to inform patients of the changes and what to expect so that they had been informed prior to speaking to a receptionist, this included giving our average appointment waiting time.

Posters were put up in the practice prior to the change date to inform patients and on our Facebook page and website. Three contract mobile phones were purchased for the on-call team to use so that they didn't lose time waiting for available lines, they also use Bluetooth headsets to allow them to work efficiently whilst on the phone.

The impact

Patients

Continuity of care has improved and patient expectations are managed better. There are reduced waiting times for appointments and urgent and prompt medical advice is available when required. Patients are also signposted to more appropriate services.

Workforce

The team have worked much better together and staff morale across the practice is better – the team have managed to have a team lunch most weeks. Staff also have more manageable workloads.

Practice

There has been a large reduction in complaints, both formal and informal, around the appointment process. Positive reviews have been left on NHS Choices and the practice's Facebook page.

There is also lower staff turnover due to increased morale among the team.

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