Step-by-Step Guide: Back to basics

Five key principles of moving from restricted access to responsive access

1. Measure demand

Before you can start, you must understand demand and how your appointment system works. For example, do you know how many patients come through the door each week and when?

• Equip a receptionist with a tick sheet template and record when a patient requests an appointment, even if one isn’t available. A template is enclosed at the end of this section.
• Separate ‘book on the day’ and pre-bookable requests.
• Collect on a weekly basis.

This will enable you to identify variations in demand for same-day and pre-bookable appointments, roughly how many appointments you might need each day and the general split, that is, how many appointments might need to be left for same-day and how many are for pre-bookable. This information will be important when comparing against your current capacity (see section 1.2, Demand versus capacity). A total tally sheet is also provided for you to compare demand to appointment supply.

2. Shape demand

Start looking at ways you can shape demand. Not everyone needs to be seen by a GP in a consulting room. Consider opportunities for:

• telephone consultations
• GP triage
• skill mix
• internet booking
• patient education
• group sessions (for example, smoking cessation)
• wider use of local pharmacies. 

3. Match capacity to demand

There is more on this in the next section, but consider the following:

• Mondays are the busiest day, followed usually by Tuesdays, Fridays, Wednesdays, and Thursdays.
• Two thirds of your day’s workload will come in before midday.
• Generally, most of the unwell people will call before 10.30am.
• Measure your third available appointment to give you an indication of whether you are offering enough appointments.

4. Contingency planning

Always plan ahead for holidays and try to account for sickness, and the flu season.

• Try and calculate demand and capacity weekly to identify when and how many extra appointments are necessary when there are GP shortages.
• Pre-booked appointments could be suspended on Mondays and reintroduced when the pressure is reduced.
• Try increasing the number of telephone consultations. 

5. Communicate

It is crucial that you always communicate change to staff and patients. Their feedback is crucial.

• Discuss at weekly team meetings.
• Use simple patient questionnaires or other methods to gain feedback.
• Test out small changes before implementing on large scale.
• Set up patient groups to help resolve access issues.