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Research and Projects

PenCHORD - Doctor First

Who is involved?

Theme: PenCHORD
Status: Complete

Background

Doctor First is a GP appointment system where all patients speak to a GP on the phone on the day they call the surgery. The GP may then ask the patient to come in that day if necessary. Doctor First aims to reduce patient waiting time while liberating time for the GP. We used data from a pilot of Doctor First and built a simulation to examine the potential impact of the appointment system and compared these results with those as described by the originator of Doctor First.

We found that the Doctor First system requires more time than a conventional appointment system for those under 20 years old, moderate time savings are made for 20-80 year olds, and significant time savings are made for 80+ year olds. This is due to the phone > Face-to-Face conversion ratio being >50% for the under 20 year olds (and so the majority require both phone and face-to-face appointments), ~40% for 20-80 year olds and <40% for 80+ year olds.

Both phone > Face-to-Face conversion rates and the time spent on the telephone were higher than advertised for Doctor First. The modelling suggested a moderately improved ability to meet patient demand, and a slightly lower utilisation of GP time. If the model was run according to how Doctor First is described by the originator (18 patients per hour on the phone, with 2/3 of patients not requiring a subsequent face-to-face appointment) much more significant gains are expected.

Context

Doctor First was introduced into a surgery already running a phone-triage system. In order to compare Doctor First with a full face-to-face appointment system a simulation was built to mimic performance if all appointments were face-to-face.

Method

Patients call for appointments with weekly patterns in accordance to historic data. The model allows for various types of appointments to be allocated (e.g. on-the-day appointments, same week appointment, long-term advance booking) and allows phone appointments to be used or not (durations for both phone and face-to-face appointments may be set in the model). Patients failing to obtain an appointment may return the next day or may go elsewhere. A certain proportion of patients may be classified as high priority and the GP will use over-time to see them. The model monitors the proportion of patients obtaining an appointment, the utilisation of available GP time, and the requirement for GP overtime.

Discussion

The benefits of the Doctor First system depend on the phone > face-to-face conversion ratio and the time required for the phone contact. The different population characteristics in Devon may mean the benefits of the Doctor First system are smaller than obtained elsewhere.

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