Good quality healthcare means that patients get the care they need, at the time they need it, from people who can meet their needs. Waiting too long to access care is a common cause of complaints from patients, and a frequent cause of stress for practices.

The key to ensuring good access for patients is to match demand with capacity on a daily basis.

Many practices have introduced new working systems with the aim of giving patients quicker access to care. However, some of the changes have had the unintended consequence of making patients feel they have less access to care.

For instance, some practices have introduced same day only appointment systems and ask all patients to call after 8.30am. Once their quota of appointments is full, no further appointments can be made that day and patients then have to try the next day.

This is not improving access – such a system, in fact, worsens patients’ access to timely and convenient healthcare. Practices offering good access offer both same day appointments and pre-booked appointments for future dates.

Who is involved

The National Primary Care Collaborative (NPCC) ran two phases which focused on improving access. Both programmes are now completed.

All PCTs took part and 5,442 practices were involved covering a population of 34,137,769.

Each organisation established an Improvement team consisting of up to 15 people, including GPs, practice nurses, practice managers, a project manager, PCT senior managers and secondary care colleagues.

What we are doing

The NPCC used a model for improving access that helped busy practices to:

• Understand the size and nature of the needs of patients
• Successfully predict demand for care
• Develop services to effectively meet patient needs
• Feel more in control of the workload

It is a method of improving access for patients so they can see a GP or other health professional at a time and date convenient to them. However, it is also about enabling clinicians and managers to gain a better understanding of their demand and, in that process, gain greater control of how they manage and deliver care.

Significant improvements are achieved without additional staff or resources.

Key steps:

1. Understand demand
2. Shape the handling of demand through use of alternatives such as telephone consultations and email
3. Match capacity to meet shaped demand through considering skill mix
4. Develop contingency plans to sustain the system through holidays and illness
5. Communicate continuously with the team and patients about the change

Impact on patients:

• Patients are seen when they want to be seen
• More personal service
• Less anxiety for patients who feel they need urgent care
• Equity in waiting times for patients.

Impact on primary care:

• Telephone management of same day appointment requests can reduce face-to-face consultations by up to 50%, with no reduction in patient satisfaction
• Email and websites can be used successfully for repeat prescribing requests, health queries, and self-help materials and programmes
• Less time spent being reactive and managing patient backlogs
• More time to spend on improving service quality and preventative activities

Impact on staff:

• Clinical and administrative staff aligned to provide the best care
• Staff able to plan and control their work, leading to less stress and increased goodwill
• Increase in positive interactions with patients
• Better planning of schedules and reduced duplication
• More timely decision-making
• Reduced patient complaints
• Less complexity in the system makes it possible to achieve consistent standards of care

Key results