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Theme: Evidence for Policy and Practice
At Ivybridge Health Centre, Beacon Medical Group currently uses a hybrid system for booking GP appointments, including a mixture of a “Doctor First” system (in which patients are telephone triaged by a doctor who decides whether the patient needs an appointment the same day), and a pre-booking system (in which patients pre-book an appointment).
Staff at the Health Centre have raised concerns that the current hybrid model is sub-optimal, and that it would be beneficial to adopt a consistent system across all patients. However, it is unclear which system to adopt, or whether either would be an improvement on the current hybrid system.
To help with this decision, PenCHORD explored the potential impact of three different GP appointment scheduling policies at Ivybridge Health Centre, to find out which way of working is likely to promote reduced waits for GP appointments and more appointments with patients’ own GP.
Specifically, this project sought to answer the following questions:
1. What would be the impact on waiting time for a GP appointment, probability of a patient seeing their own doctor and GP utilisation rates if Ivybridge Health Centre adopted:
2. How would each of the above compare to the current hybrid model?
3. What could be the potential impact if a percentage of those patients who could be seen by the community pharmacist were seen by the pharmacist instead of a GP?
The project team developed a simulation model of the current hybrid appointment system at Ivybridge Health Centre. They then amended the model to test the different scenarios outlined above and investigate what impact these potential scenarios would have.
The prediction from the model, and the team’s recommendations for the optimal appointment system to use based on the modelling evidence, were presented to Beacon Medical Group at the end of the project.
The model predicted that converting to a system where either all patients are triaged by a doctor over the phone first, or all patients pre-book appointments without a doctor triage, are both more optimal than the current hybrid system.
If a doctor telephone triage system was used, the model showed that telephone calls should be kept to 4 minutes or less to achieve optimal performance. Moreover, it would be essential that telephone calls did not exceed 9 minutes, as the model predicts that this would cause the system to collapse and average waiting times to increase.
Assuming that call lengths were kept to 4 minutes or less, all patients who need an appointment should be able to see their own GP within 3 days. 54% would see their own GP the same day and the average wait would be 0.3 days.
If a patient pre-booking system was used, all patients should be able to see their own GP within 2 days. 50% would see their own GP the same day and the average wait time would be 0.3 days.
Beacon Medical Group are now using these findings to explore ways to train staff in effective telephone triage, to ensure they are able to quickly identify over the phone whether patients need to be seen or not.
It is hoped that the evidence from this project can be used directly to inform the Centre’s decision about whether to switch to a pre-book only system, a “Doctor First” only system, or to keep the current hybrid model.
Uncertainty around optimum GP appointment allocation policies is a widespread issue for the health service both locally and nationally. There is therefore potential for the findings from this project to generate insights into optimising appointment policies in primary care that could be of use more widely.
The project team also hope to publish a paper on the model’s findings that could inform future research.
The results have been used as the central evidence for a business case by the Care Group Manager for Medicine, presented to the Executive Board
A £1 million business case has been approved to : a) Extend opening times of ACU and open 7 days per week b) Cover additional staffing for extended opening times
Beacon Medical Group
Dr David Gwynne
Ms Claire Oatway