Following on from previous Practice Index blogs that have focused on staffing levels and ratios of staff to numbers of patients, this week we’re concentrating on the number of GP appointments per 1,000 patients and what practices can do to ensure they’re offering the best possible access to their patients.
Plenty of figures are available on the subject. For example, a total figure of 108 appointments per 1,000 patients was being used by CCGs 18 months ago when conducting experiments regarding A&E admissions. This figure included nurse appointments, as well as face-to-face GP meetings and telephone appointments. Meanwhile, the national average – when you take out nurse appointments – is often said to be around the 72 consultations per 1,000 patients mark, while the RCGP suggests that there’s a mean total of 5.3 patient contacts per patient per annum.
Supply and demand
Most practices we speak to achieve somewhere close to the 72 figure quoted above. However, many practice managers believe that simply looking at the number of appointments offered doesn’t delve deeply enough into the issue – instead practices should be looking more closely at the supply and demand for appointments – and ultimately appointment availability.
Appointment availability is influenced by a multitude of factors, some within our control and others beyond it. List size, opening hours, number of GPs employed by the practice, the wider clinical team including nurses, healthcare assistants, counsellors and pharmacy staff and even the number of consultation rooms all impact on availability of appointments.
Then there’s patient demand, which can vary from 5% to 10% of list per week, just for GPs. It seems to be driven by deprivation levels and age, but this means that any average figure doesn’t really help. Practice popularity, growth in list size, growth in the number of patients per whole time equivalent (WTE) doctor and a high prevalence of patients with specific long-term conditions.
When it comes to appointment numbers and therefore availability, reviews of overall appointment availability often show high levels of variability, as evidenced during a review of 21 practices in Barking and Dagenham conducted by the NHS. It was noted that practices offering a supply of fewer than 70 appointments per 1,000 registered patients per week experienced difficulty with access during core hours (as measured through patient interviews, staff feedback and the GP patient survey). Staff at many of those practices believed that demand was essentially unlimited and hence there was no value in offering more appointments. However, analysis showed that practices routinely offering more than 70 appointments per 1,000 registered patients per week were able to meet patient demand and therefore offer greater patient satisfaction.
The mix of appointment types offered to patients also plays a role in determining patient satisfaction levels, as a close investigation of Suffolk’s GP practices showed in the same report mentioned above. The types of appointments most commonly offered are face-to-face appointments, telephone appointments and home visits. Practices should consider local patient context when identifying the optimal mix of appointment types.
It is also useful to analyse at what times appointments are actually available over the course of a day. From a patient perspective, the times that appointments are available can be the key driver of patient satisfaction with access. As a patient interviewed in Suffolk explained, “My partner and I are both working. For a working person, getting an appointment is impossible”.
So how can practices alter appointment supply relative to patient demand? When reviewing supply relative to patient demand, look for evidence of too few (or too many) appointments per 1,000 registered patients per week as well as over- or under-supply on certain days, or over- or under-supply at specific times. All are indications of problems in the availability of appointments.
For example, a comparative analysis of patient demand and supply in Suffolk showed that some GP practices offered too many appointments on Wednesdays, a relatively calm day in many practices, but undersupplied appointments on Mondays, when patient demand peaks after the weekend.
Appointment availability will no doubt continue to be a big problem for practices everywhere, especially as GP recruitment and funding continues to be a major issue. On the other hand, technology such as Skype, which some practices are utilising for appointments, alongside more and more telephone/online contact can help ease the pressure. Otherwise, it’s a case of juggling time to ensure your appointment to GP ratio is meaning you offer the best service possible to those on your list.
How do you manage patient demand at your practice and is it working? Please comment below or in the forum.