There is an increasing demand on primary care for same day appointments, and GP practices are finding their appointment system under inordinate amounts of pressure. The rising populations along with the transfer of many hospital based services into the community has seen the GP workloads increase dramatically without the necessary resources to successfully deliver these services. As a result of this increasing workload, patients are waiting increasing lengths of time to be seen by a GP. 

According to the National GP survey in England, one in six patients need to wait a week until the next available appointment, and one in four will resort to attending A&E if they deem their appointment not soon enough. According to a Health watch survey, one in five patients also admits to misusing A&E for non-emergency treatment as a result of poor access to their GP.

 The growing emphasis on enhancing patient access to their practice has encouraged us to look into re-evaluating the way we book our appointments. At The Elms we are very fortunate to have a highly skilled nursing team with various specialities. Together with the GPs and the nursing team we have created a hybrid system where our patients will be signposted appropriately to the right clinician for their problems. This has led to developing the role of the Duty Clinician which comprises of a team consisting of Duty Doctor, Nurse Practitioner and Nurse Prescribers who will call back our patients who feel that they need to speak with a clinician urgently on the day.

 The system can be explained with the following process; 

  1. Patients will call the practice and speak with the reception as usual to book an appointment. (Please remember that we can pre-book appointments 2 weeks in advance for GPs and 4 weeks in advance for nurses; for non-urgent health issues).
  2. The receptionist will ask the patient their name, date of birth and a brief description of their health problem.
  3. Using the signposting criteria developed by the clinicians the receptionist will offer the most appropriate appointment available.
  4. If you are booked with the Duty Clinician, they will call you back as soon as they can, depending on their current workload. Unfortunately due to the unpredictability of the Duty Clinician’s day we are unable to give you a specific time for the call back. It is imperative that you give the receptionist your current contact details.
  5. When the Duty Clinician calls you back the patients are able to talk to them about their health problem in the same way they would if they were in the practice attending an appointment in person.
  6. If the Duty Clinician thinks that the patient needs to come into the surgery to be seen (either the same day or in the next few days) they will book you in a suitable time with the clinician themselves.

 Key points to remember

  • If the patient wants to speak to a clinician urgently (i.e. if it is an emergency situation) then they must let the receptionist know who will inform the Duty Clinician.
  • If either the Duty Clinician or the patient feels they need to be seen, then a face to face appointment can be booked. We are not trying to stop patients seeing their GPs.
  • If the patients want the Duty Clinician to call them back at a specific time due to work commitments etc. then please let the receptionist know of this.
  • Patients are still able to book face to face appointments and telephone appointments with the GPs in advance.
  • Patients do not necessarily need to ring first thing in the morning as the appointments are available throughout the day and the Duty Clinician will prioritise the calls.

 We are hoping that with these changes, we can;

  • Manage the clinical case load more effectively and efficiently
  • Improve utilisation of our nursing team and other health care professionals in primary care
  • Reduce DNA’s
  • Free up GP’s time to enable them to proactively provide preventative primary care, improve long term management of chronic disease and promote self- care and empower patients; rather than firefighting on the day!



Don’t have to be first through on the phones to book an appointment

Have contact with a Clinician sooner

See their GP sooner when appropriate

Get more time with their GP when they need due to reduced pressure on appointments

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