Appointments
Contents
Appointment Systems
According to Government targets all patients in
England should be able to see a GP within 48 hours. Many GP
practices have implemented an appointment system called
Advanced Access to help achieve this.
It is a method of improving access for patients so that they may
see a GP at a time and date that is convenient to them, while
enabling practices to understand, manage and
control demand.
The system is based on the
principle of the 10 minute appointment, with the majority either
bookable on the day or for the next day. Patients who wish to plan
forward for their consultation should be able to do so, as
pre-bookable appointments are an important part of Advanced Access.
The Government is currently agreeing an advanced booking guarantee
under which patients will always be given the opportunity to book
ahead when it is clinically justified for them to do
so.
Getting the Most Out of GP Appointments
In recognition of the time pressure on GP appointments, the Patient
Association has produced a booklet for patients on getting the most
out of the consultation. It examines the two-way relationship
between the patient and the doctor and clarifies what is expected
of each party in this exchange. It emphasises how patients can
prepare in advance of an appointment, and examines issues such as
obtaining a second opinion and getting a referral.
Patients can help GPs before
and during a consultation by:
- Recognising that they do not always need an appointment with
their GP. For advice on coughs, colds and other minor health
problems, they can see their practice nurse or local pharmacist
instead.
- Keeping their appointment or cancelling in good time. It is
estimated that at present 10 million GP appointments a year are
being missed.
- Not expecting a GP certificate of absence if they are off work
for less than seven days, as they can self-certify for this
period.
- Recognising that GPs are not the only professionals who can
countersign passport and driving licence application forms.
- Not always expecting a prescription.
- Ordering repeat prescriptions in good time.
- Following the doctor’s medication advice.
- Thinking before calling out the doctor for a home visit.
- Being polite, reasonable, honest and open.
You and Your Doctor (Patient
Association)
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Referral and Hospital Appointments
Referral to Hospital
In the UK the most common route
into specialist care is through referral from a GP.
Since GPs hold a unique overview of patients' health and
treatment via personal medical records, they are best placed to
assess, in partnership with the patient, whether a specialist
referral is necessary and to which secondary care service patients
should be referred. GPs are sometimes referred to as "the
gatekeepers of the NHS", as the right to a referral is not an
absolute one and is based on whole person assessment. Certain
hospital services, such as sexual health clinics and accident and
emergency treatment, can be accessed directly and do not
require GP referral.
If a GP decides that a patient
needs referring to a hospital specialist they will write a letter
to that specialist setting out a brief medical history and the
results of any relevant examinations and investigations performed
to date. Once the specialist has seen the patient (s)he
writes back to the GP explaining the diagnosis, and any
prescribed treatment and plans for follow-up. In this way the
family doctor is kept informed about what is happening to the
patient.
Similarly, when a patient is discharged from
hospital a letter is sent to the family doctor with a brief
outline of the reason for admission, result of investigation,
treatment prescribed and plans for follow-up (including advice for
the family doctor as to what is required of him/her). The GP is
therefore the focal point around whom all NHS care is
coordinated.
The Royal College of Radiologists
has set up an excellent online Virtual Hospital
Department intended to address some of the fears
that are associated with a visit to hospital for x-rays or
other scans, and for cancer treatment.
Booking Systems
GP practices must provide details
(in the practice leaflet) of how they refer patients for
specialist or hospital care, including information about any
booking systems used by the practice and any choice of care
available to patients.
Soon all patients in England will
have access to the Electronic Booking Service (
Choose and
Book) which allows GPs to make initial hospital
or clinic outpatient appointments at a convenient time, date and
place for the patient. When a patient needs to be referred to a
consultant or other healthcare practitioner they will be asked by
their GP where they want the treatment to take place; and will
be able to choose from 4-5 choices of provider.
These providers can be NHS trusts, NHS foundation trusts,
treatment centres, private hospitals or practitioners with a
special interest, operating in primary care. Generally there will
be at least one private provider on the list.
The patient will then be
able to book the appointment on the spot. If preferred, patients
can make their appointment later - after consulting with family,
carers or colleagues - either on-line or through a telephone
booking service. Patients can already contact the NHS Choose and
Book Appointments Line (0845 608 8888) for (i) help with
booking outpatient appointments and (ii) information about the
choice of provider offered by their GP.
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Doctor/Patient Relationship including Chaperones
Doctor/Patient Relationship (General)
Aspects of the
doctor-patient relationship - such as confidentiality, consent,
candour, treatment choices and examinations of an intimate nature -
are regulated by professional codes and guidance. Ethical guidance
on a number of such areas can be accessed via the link below.
Intimate Examinations and Chaperones
Although all medical
consultations, examinations and investigations are potentially
distressing, patients can find examinations and investigations
involving the breasts, genitalia or rectum (“intimate
examinations”) particularly intrusive. Also consultations involving
dimmed lights, the need for patients to undress, or intensive
periods of being touched may make a patient feel vulnerable.
For most patients respect,
explanation, consent and privacy take precedence over the need for
a chaperone, but for others the presence of a third party makes the
experience less threatening.
NHS guidance advises that practices
should have a chaperone policy in place.
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