This years survey looked at the difficult subject of appointments and we wanted to gauge your feelings and open ourselves to suggestions to improve the current and frankly unacceptable situation. Never in the history of the practice have we had the situation where we have people queuing at the door before we open and all available appointments having gone befor 9am. In the last year this has become a routine and depressing norm.
Our patient numbers have not increased over the past few years and we have even been forced to seek permission to shut our list to stop a flood of patients from other practices and control demand. However, even with this measure our list size hasn’t really dropped, as we still accept immediate relatives in the same household (new babies, returning university students etc.). We have increased the number of appointments significantly to a point where the doctors are struggling to cope with the workload generated but still demand outweighs supply, rather like widening the M25!
Practice income has dropped severely over the past 4 years with increasing pressure from “on high” and 0% annual uplifts. This years promised 1% uplift to practice income has actually been recalculated for GPs down to a pathetic 0.28% because the government have somehow obtained figures that suggest staff costs will go down by 1.7% this year. I suspect this is based on the fact that well funded flagship PMS practices have suffered big cuts, leading to redundancies. We, as a GMS practice, have never been in the privilaged position of being well funded! Being a practice in leafy and affluent Surrey, we also suffer badly from a formula that says we need less funding than deprived area. Because of this we have an “adjusted” list size, which means we are paid nothing for 11% of our list, probably translating to a financial loss to the practice of £50,000/year. We are unable to challenge this, even though practices in the same area are penalised only 6%. The effect of this as well as other factors means that we are now a practice struggling to keep our heads above water and there is a real possibility that if staff and partners income continues to fall at recent rates, we will not be a viable business.
There has been a vast increase in workload generated by unilateral changes to the GP contract. We have had a huge target based workload put upon us, simply to justify the payments we got in the past for looking after patients. We are now looking after most of the chronic illnesses and have been given most of the work previously done by the hospital out-patient clinics. It has taken a huge number of appointments out of the system and took us to the edge of coping. Last year however, the government abolished Primary Care Trusts and replaced them with Community Commissioning Groups. The idea was that GPs would control the flow of money and commission services for their patients. Nice theory but we infact inherited a debt and have been made responsible for shortages in the system. This has generated a huge workload and a pressure to take on even more work from secondary care. A consultant in the hospital can not even ask for a colleages opinion in the same department without returning the patient to the GP for a further referral. I suspect this was the final straw that has pushed us to the point of having queues at the door.
Thank you for your opinions and input. The fill results can be seen on the link below.
We were quite suprised that there wasn’t more concern about the appointments with over 80% of you finding no difficulty or moderate difficulty getting appointments and over 80% (allowing for N/A results) finding no difficulty getting urgent problems dealt with.
It would appear that the majority of you would expect to be able to get an appointment in 48 hours. This was the target we have always worked to but is becoming more and more optimistic
We looked at ways to use time more efficiently in order to increase throughput and free up routine appointments by having a duty doctor walk in service but this doesn’t appear to be popular although increased use of nurses and health care assistants may be an option.
Finally, we did ask if you were happy to continue a “virtual” participation group or would rather a face to face group. Most would like to continue as we are but if there are any keen volunteers out there to take on some of their work of this group, we would love to hear from you!
The open questions are always interesting! We had a lot of good suggestions and would also thank those of you who gave positive comments. Sadly, due to financial and time constraints, many of your suggestions just aren’t possible. We would all love to have more staff and doctors and provide a service we could be proud of. Not only is the shortage of appointments difficult for patients but it puts enormous pressure on all of us working here. Our receptionists would love to have more appointments available rather than having the unenviable task of acting as gatekeepers!
There was a strong desire to get on-line booking up and running as soon as possible. This was on last years wish list but now we have finally had our system upgrade we can move ahead (as soon as we have learned how to use it!!)
So what is the action plan?
We had to look at what is possible, not what is desirable. We feel the following are possibly obtainable:
- To increase the use of nurses and healthcare assistants for routine issues
- To increase the number of prebookable appointments and extend how far ahead you can book
- Initiate on line booking as soon as possible
- Renew the touchscreen arrival system that became non functional after the computer upgrade (when funds allow)
If we can agree on this course of action, we can try to move forward as soon as possible.
Thank you all again for you valuable input.
For the full report, click on the icon below.
To see the survey itself click on the link below: