Introduction

Have you had enough of the changes to how things work at the surgery yet? We have, but we don’t have any other choice than to change yet again.

Some of you may have heard of the changes to the GP contract. For the second year in a row, the government has imposed changes to the contract after negotiations failed. And, unlike in most other contracts, there is a tiny clause included in the GP contract that the government can one-sidedly change the GP contract. Something they have taken advantage of and imposed these changes despite protestations from the profession these changes would create significant problems for GPs and their patients.

We will need to change our appointment system to fulfil our contract and improve the access to appointments for patients who really need a GP appointment, but fear these changes will not improve services as much as we are told they will.

What are the new requirements for GP practices?

Every contact with the practice should lead to an outcome for the patient, and no longer can we ask patients to try again another day.

What is classed as an outcome?

This could be an answer to a query
This could be signposting to another service, and the government insists we increasingly direct patients elsewhere to a more appropriate service
This could be an assessment of need to determine if an appointment is appropriate

What does that mean at Grimethorpe Surgery from 1 April 2023?

When a patient contacts the surgery, the receptionist will ask for a description of the problem
She will signpost to the most appropriate service to help the patient with that problem (First contact physio, pharmacist, dentist, other services, GP)
She will book an appointment with a nurse or healthcare assistant where this is the required action
She no longer can book an appointment with a GP directly (unless directed to do so by a GP, Advanced Nurse Practitioner (ANP), or Physician Associate (PA))
Online bookable appointments will cease to exist as these can’t be triaged
Where signposting to a GP, ANP or PA is appropriate, the receptionist will pass this to a triage clinician for an assessment of need based on the details the patient has provided
A clinician can only assess the need for an appointment if the patient provides details of their problem (our receptionists are bound by the same rules of confidentiality as all others in the practice)
After triage, the practice will contact the patient to give them the outcome of the triage (which could be signposting to another service, advice, a prescription, a fit note, an appointment with a GP, ANP, or PA same-day or within 2 weeks, or any other action)
The contact to pass on the outcome could be by telephone or text. It is therefore very important we have your correct contact details

What do we hope to achieve by these changes?

We hope these changes will improve the access to GP, ANP, and PA appointments for those patients who really need those appointments, and avoid appointments that are not appropriate and better suited to another service.
We know the pressure on the telephones is likely to increase significantly with these changes and it might be more suitable to make use of the online consultations platform for non-urgent medical and admin queries to avoid long waits on the telephone.

Again, this is not what we want to do, this has been imposed by the government and NHS England. We see no other way to improve access to appointments for patients who really need those appointments and to provide an outcome after every patient contact.

Why does the government want these changes to take place?

The government may have had great intentions. The main thing they want is to improve access to the GP practices for patients. Something we fully support. The only problem is that primary care is not given the tools and resources to make this possible.

Everyone is fully aware of the problems with access to practices:

Patients can’t get through on the phone
There are insufficient appointments
There are inappropriate appointments (eg dental abscess, which should go to a dentist instead)

We all want this to improve and to make healthcare more accessible to all and safer too.

So, why is telephone access such a problem at our practice still?

The volume of calls is much larger than the capacity (2 phone lines for 2 sites)
The queuing system has improved access, but some patients wait a long time
Everyone phones at 8 am for an appointment
Only 2 receptionists answer the phone for 2 sites
There is no space to increase the number of staff to allow more people answering the phone
There is no funding to increase the number of staff if the space was available

Why don’t we just increase the available appointments?

Again, we are limited by the space we have, our clinical rooms are at full capacity
We can’t get more space (we asked repeatedly)
Increasing the number of appointments per clinician makes practice unsafe (as tired clinicians make mistakes)
There are not enough GPs to join practices nationally (despite government promises to increase the number of full-time equivalent (FTE) GPs with 6000, we’ve actually seen a reduction by 2000 in 5 years)

And yet, we agree the access to primary care and the phone lines need to improve. It’s just not as easy as it sounds.

The effects of these changes

What are the positives of these changes?

Our available appointments will be given to those patients who most need them
Problems less appropriate for a GP appointment will no longer end up with a GP
Access to appointments for appropriate conditions will increase
No longer will patients need to phone at 8 am to request an appointment
There will no longer be a system of first come-first served as appointments will be given based on the assessment of need by a clinician

What negative outcomes do we expect from these changes?

The phone lines will become busier and the access on the phone will worsen (unless patients use the online consultations platform more)
Patient choice will be reduced. Instead, their problem will be triaged to determine the need for a GP appointment
Patients can no longer book appointments online when the practice is closed but need to contact the surgery within opening hours
We also expect patients will be unhappy with the change, and potentially take it out on our staff. We hope our patients will realise this is an imposed change and continue to treat our staff with respect

We’re pretty certain there will be other positives and negatives that we’ve not yet thought of.

Summary

In summary, there will be changes to our appointment system from 1 April 2023. There will be some benefits to the new system, but there will certainly also be negatives associated with the new system.

No more online bookable appointments
Increased signposting to other services
Booking of appointments based on need rather than want
A clinician can only assess the need for an appointment if the patient provides details of their problem

These changes were forced on primary care by the imposed GP contract changes, the second imposed contract changes in as many years.

We are certain this won’t be the last change. Our practice manager has worked in the NHS since 1995 and has seen many changes during that time. Most only lasted a few years before another ‘improvement’ was thought out by the powers that be. Some brought benefits, most did not. As long as the GP workforce remains low, resources remain lacking, and the buildings we work from are not built for purpose, none of these changes will be likely to have a significant beneficial effect on patient care.

After all, our GPs are under immense work pressures that are increased year by year. Despite promises from the government that 6000 extra (FTE) GPs would be recruited within 5 years, the opposite has happened and we now have 2000 (FTE) GPs less. This leads to overworked and overtired doctors who will either disappear from practice, will reduce their working hours, or will become unsafe practitioners.

At Grimethorpe Surgery, we work hard to do our best for our patients, provide safe care, and to continue to improve our services. It’s just not as easy as it all looks.

We apologise for the problems we already see coming with this new system. It’s not what we wanted, but we have to do as we are told by NHS England and the government. Let’s hope it will all improve rather than worsen the services provided. Only time will tell.

Changes to the appointment system from 1 April 2023