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Balancing Appointments - Top Tips for PMs


A discussion thread on the Practice Index Forum has once again brought to the fore the hot topic of how GP practices balance pre-bookable and on-the-day appointments.

The discussion – click here to access it – makes for interesting reading, with different practices utilising different appointment splits, many of which are adjusted across the week. While some practices opt for a 50/50 split, others have slashed the number of pre-bookable appointments dramatically, highlighting how there’s no ‘one-size-fits-all’ answer for practices.

With that in mind, here are some top tips to help you manage patient access to appointments gathered from the forum thread and conversations we’ve had with practice managers and primary care focused organisations.

Measure demand

Underpinning any management of appointments has to be a deep and thorough understanding of patient demand. When is demand for same-day appointments highest? What day of the week is busiest overall? What times of the day are most demanded? Armed with information you can make informed decisions.

Move resources

If you have spikes in demand you can utilise resources effectively, especially when it comes to part-time staff. One PM told us: “We carried out an access survey that clearly showed we had miscalculated when our busiest times were. We assumed it was Monday morning but actually it was Friday, so we shifted the working hours of our part-time GPs accordingly.”

Consider DNAs

No-shows are a huge problem when it comes to maximising GP access. How many of your DNAs are for pre-booked appointments? How far in advance were those appointments booked? These figures may impact your thinking on the volume of pre-bookable appointments you make available.

Think about timings

One PM suggests filling early slots in advance. “I’ve heard of so many practices who save the first four or five slots for same-day bookings, but I think this is plain wrong. Common sense dictates that if reception opens phone lines at 8am, it’s not possible for many patients to make it to the surgery for an 8.30am appointment. Instead, offer these to people booking in advance – early (or late) appointments are great for people who need to fit appointments around work.

Sell the less popular slots first

When taking advance ‘bookings’, try to fill quiet times first. Wednesday is a relatively calm day in many practices, whereas Mondays can be manic, so why not try to offer midweek appointments first while keeping more appointments free for same day appointments on Mondays?

Mix it up

Mixing up the types of appointment offered to patients can ease the pressure and improve access – something the CQC does look for when inspecting practices. Could some working people who can’t make daytime appointments be spoken to over the phone or on Skype? Practices should consider local patient context when identifying the optimal mix of appointment types.

Is it really urgent?

The skill and tact of receptionists really come into play when managing appointments. Could it be worth having a prepared set of questions to ask patients when assessing their need to be seen that day? If the need is urgent a solution can then be found, including utilising the services of pharmacists or nurses, which will need to be communicated to the patient.

Follow-up appointments

A number of practices have told us that the single biggest boost to patient satisfaction comes from allowing them to book follow-up appointments, however far in advance they are, when they are in the practice.

Sit and wait

Providing the option for patients to sit and wait can ease pressure and clear backlogs. One PM, commenting on the forum, said: “We have sit and wait on a Wednesday morning which all GP’s do. We find this mops up well. We also have sit and wait on the morning after a bank holiday and between Christmas and New Year.”

Limit online bookings
While online bookings can be helpful, the system is open to a degree of abuse. The answer could be to do what one practice has done and have a policy that dictates patients booking online can only book two appointments this way in any 90-day period.

Release online appointments the evening before

Talking of online appointments, practices are reporting success in releasing on the day appointments for online booking at 6.30pm the previous day (barring Monday appointments). This has resulted in a steady stream of appointments being booked overnight via the online access facility. Patients have commented that it’s brilliant to be able to access appointment booking at a time to suit them.

Morning triage

A common technique being adopted to ease pressure on appointments is to hold morning triage. A forum comment said: “We start the day with a GP doing triage for one and a half hours on Mondays, then one hour on Tuesday, Thursday and Friday. The same day slots are initially reserved for this GP to put any patients into that they have spoken with on triage. If not used they are open for Receptionists to use for calls as they come in during the day.”

Another PM commented: “We don’t have any pre-bookable appointments. Patients can just get in touch online or on the telephone, and get triaged and seen usually within between half an hour and three hours, if they contact us during opening hours.”

An interesting concept worth reading about is the Stour Access System – for more information click here.

Start with a clean slate

Another option is to start afresh each morning with a clean sheet – along the lines of the Dr First concept. GPs all have a telephone list and a surgery list. The receptionists do not make any appointments but take the patients details and a brief summary of what is wrong then puts the info on the GP’s telephone list. The GP’s then phone the patient, if they can deal with the problem on the phone it is done, patients may be “signposted” to another appropriate person or if they need to be seen the GP will give them an appointment that day to come in. Patients can choose which GP they would like to speak to providing that GP is working on that day, if they do not have a preference then the receptionists will try to keep the telephone lists as even as possible.

And finally…

Whatever ideas or policies you adopt to ease any appointment pressures and improve your situation, ensure all staff stick to them. This is the only way you’ll ensure they’re working (or not). There’s plenty of discussion out there – especially on the Practice Index blog – on this topic, and numerous research studies to ponder.

Above all else though, it’s worth remembering that, as mentioned earlier, there’s no one-size-fits-all answer and what works for one practice might not work for you. Don’t be afraid to admit failure when you need to – and celebrate when something works!

What tips and tricks have you used to ease your appointment pressures? Let us know by commenting below or head to the Practice Index Forum.