The practice formerly had an appointment system in place, combined with open access to see the ‘duty doctor’. GPs worked a rota to be the duty doctor for a day, and this limited their available appointments that week to four days.

There we more patients calling in without appointments than patients booking via the telephone. In June 2004, the practice had an average wait for a routine appointment to see a GP of 14 days.

The practice worked hard at understanding their demand and reshaped their appointments system accordingly.

Open surgeries have been incorporated into their system, and patients no longer need to request an urgent appointment to see their GP or nurse on the day they wish to be seen.

They shaped demand by discouraging follow-up appointments on their busiest day – Monday – and moved Monday clinics to less busy days in the week. They also looked at pathology results, and whether the patients required face-to-face consultation for results. The used a vacant room for two further sessions per week for the practice nurses, and changed a GP-led diabetic clinic to a nurse-led clinic.

They worked down the backlog by calculating how many extra appointments were needed to clear the excess, and then adding extra appointments to each day of the week for two weeks. They also capped pre-booking appointments to one week on a short-term basis, but now they have more control they offer pre-bookable appointments up to four weeks ahead.

They took into account teaching sessions, practice meetings, study sessions and their half-day closure. They agreed to avoid holidays in the busiest months, and not to attend courses or take leave on Mondays without consultation with other staff. It was agreed that the practice manager and senior receptionists were responsible for deciding to implement contingency plans when necessary.

Facts and figures:

Baseline waiting time: GP – 14 days, Nurse – 9 days
Current waiting times: GP – 0 days, Nurse – 0 days.

They have sustained the improvement by constantly keeping track of demand, and hold a very detailed analysis of this in a spreadsheet which is regularly reviewed.