At the start, patients were waiting up to two weeks to see a particular doctor. Friday was fully booked by Monday. Surgeries were overbooked with the added stress of five-minute emergency appointments at the end of surgery, plus advice calls.

The practice knew it had to make better use of the nursing team. A needs analysis had shown that 20% of doctor consultations could have been with a nurse and 20% of nurse consultations could have been with a health care assistant (HCA) or phlebotomist. The practice had recently appointed two HCAs and one of the practice nurses was to become a trainee nurse practitioner.

The lead GP did a presentation on the improving access model to the partners and practice manager and, along with the reception co-ordinator, attended the programme’s learning workshops.

Analysing capacity and demand and matching them was the key to success. The practice measured demand over two weeks by counting the number of requests for appointments made that day. It confirmed that Monday was the busiest day. Capacity was measured as the number of doctors' appointments available. The practice just about met demand across the sites, but often the appointments were not available in the right place at the right time and there was no extra capacity in the system to cover absence/holidays.

The practice used Plan-Do-Study-Act (PDSA) cycles to implement small changes, keeping staff and patients informed as they progressed.

They began moving the workload from doctors to nurses to HCAs. They made all doctors' appointments 10 minutes and introduced two 5-minute telephone consultations into morning surgery times for doctors. Doctors were also able to book their own follow-up appointments on screen. Monday became ‘book on day’ only. They also altered the balance of appointments across two main sites to mirror demand. They moved to paperless consultations, providing greater flexibility of where patients were seen.

They made no advance bookings at all for a couple of weeks as they dealt with the backlog – also using locums. They set a start date when the trainee nurse practitioner was able to do her own surgeries and no one was on holiday. On the start day they introduced three pre-bookable slots at the beginning of each surgery.

The new system worked well and the practice now monitors the appointments system on a daily basis making changes as necessary. All members of the team remain committed to making it work – and are happy to work harder on busy days to avoid developing a backlog. Doctors are prepared to move site to meet demand if necessary.

Patients are generally happy and reception staff are less stressed. Doctors are freeing up much needed time to do other parts of the job.

Facts and figures:

Baseline waiting time: GP – 7 days, nurse – 5 days
Current waiting times: GP – 0 days, nurse – 1.8 days.