Why GP surgeries need crowd control
Getting a same-day appointment with a GP can be a challenge.
In this week's Scrubbing Up, Steve Martin and Dr Rupert Dunbar-Rees of the BDO Alliance, which advises on ways of changing behaviour, looks at how things could be improved.
It's 7.45am and at first glance you could be forgiven for thinking that the steadily growing crowd are waiting in line to get their hands on the latest iPad or smartphone.
But this queue isn't outside a high street store or a shopping centre. It's outside a GP surgery and the goal is simple.
It is to be one of the lucky few who secure a same day appointment with their GP when the doors open at 8.30am.
Others will be calling for an appointment, knowing they'll more likely hear the engaged tone than a cheery receptionist each time they press the redial button.
Demand 'outstrips capacity'
When they eventually get through some will get an appointment.
Others however will be less fortunate, stress levels rising when told, by the equally stressed receptionist, "Sorry but all the appointments are gone for today. I might be able to get the locum to see you tomorrow."
The situation we are describing here is an extreme one and perhaps not the norm in every GP practice.
However for a growing number, the ability to offer patients a same or next day appointment with their GP is becoming increasingly difficult for one simple reason. Primary care is full up.
When demand starts to outstrip capacity something needs to be done.
Some practices place embargoes on appointments allowing only urgent cases to be seen on the same day.
Others will provide telephone consultations first in order to filter those patients who need to be seen from those who don't.
Patients requiring routine appointments or test results are asked to wait a few days or call back at less busy times.
Some practices adopt all of these approaches and more besides, resulting in an appointments system that even the doctors find hard to fathom.
No single answer
On the face of it the answer seems obvious. Employ more GPs and open longer hours to increase capacity - but this would be a mistake.
Sure, it would have a short-term effect, but demand would quickly fill the increased capacity. Within a few months the system would be back where it started.
Introducing embargoes and increasingly complex barriers for patients to jump through is also a mistake.
Human psychology tells us that if something is less available we want it more, often leading people to invest additional effort, ingenuity, even deception, in order to get what they want.
The morning queues and engaged telephone lines are evidence of this, as are patients who will book appointments weeks in advance 'just in case'.
Some may even claim an emergency in order to secure an appointment, when the reality may be somewhat different.
This leads not only to frustration amongst doctors and patients, but also calls into question how much extra and unnecessary demand appointments systems themselves generate, over and above genuine 'need'.
There is no single answer to this complex problem yet everyone has a role to play.
Persuading patients to take a greater responsibility for their health, to use the system appropriately, to attend booked appointments and to realise that a trip to the chemist will often suffice, can all help to free up valuable GP time for those who really do have a genuine need.
Longer term we need to support GPs in managing patient expectations and anxieties.
Reducing dependency, encouraging self-care and having adequate ways of dealing with those that abuse the system will be vital. These things will take time but there are some basic things that need to be done now.
GP practices need to better understand when demand for services is highest and shape capacity around those demands.
They also need to assess whether the appointment system they employ is too complex, inadvertently making the problem worse.
Finally they need to question whether some of the embargoes that have been put in place to fix the problem are actually creating a perception of appointment scarcity.
Unless we address some of these much more straightforward changes which can be put in place right now, efforts to improve appointment availability by dealing with the more complex issues will always struggle to get off the ground.