By Robert Campbell

Have you ever attended an NHS out-patient department and wondered why there are so many people waiting? Have you ever been seen on time? Well, to be fair, sometimes I have. As you know, it’s all very well telling GPs to keep to ten-minute appointments but no one plays by such ‘rules’, do they?

Ten minutes – Is that all?

Some doctors are naturally slow at consulting but that doesn’t mean they’re bad doctors. Some patients need more time than others and come with lists and printouts from the Internet. Keeping to ten minutes needs precise and positive action as no one plays to the rules!

Ten minutes slips by?

The ten minutes slips by almost unnoticed. But is any of the ten minutes wasted waiting for the patient to walk from the waiting room? Is there a seat nearer to the consulting room? Is the doctor still completing the action from the previous patient on the computer? Are there other distractions, such as interruptions from phone calls? Does the doctor simply need a break? There are so many curious factors that will eat away at the seconds. Then there are home visits pressing. No one plays to the rules!

I’ll see my patients only!

Each doctor and nurse will have their own way of working. They might stand up to greet the patient or just say hello sitting down. They might read the patient’s notes before speaking. Time continues to tick away. They might like to see their own regular patients and may get slightly irritated if other patients pop their heads around the door. No one plays to the rules!

Ink run out!

There are frequent interruptions to a smooth-flowing day. For example, the prescription paper runs out, or the ink, or the sample bottles… A pre-surgery check can help prevent most of these problems.

Managing the impossible

As a practice manager or reception manager, you might think you’re just dealing with appointment slots, perhaps 15 per session, five urgent and the rest booked days or weeks in advance.  There is a difference between a patient with a new problem and one who has a pre-existing condition. In my view, a patient with a new undiagnosed problem should probably be seen before one who has a long-term problem. However, what if the patient with a long-term problem has a sudden worsening of their illness? Who then is seen first? And who decides?

Tweaking the numbers

Ideally, a full-time GP should see around 135 patients a week over nine sessions (four and a half days per week). Doctors who work part-time, in my view, are more likely to set more precise limits on the time they will give and the numbers they will see. The same applies to locum GPs. A list size of 1,800 patients used to be viewed as workable. These days it’s very difficult to find published average GP list sizes as practice lists are now pooled and the average practice size is around 7,450 in England. This suggests a need for around 560 appointments per week minimum, run by at least four full-time GPs.

‘Did Not Attend’ factor

The DNA rate varies from place to place, but I wonder whether patients who book weeks ahead tend to be the ones who ‘DNA’. A quick look at the Internet research suggests that between 1% and 3% of appointments are DNAs on a given day, but where patients book a week or more ahead the DNA rate might be 4% plus. So does advance booking of appointments create its own problems? A full-time GP, therefore, might theoretically experience five cancelled appointments a week; 230 per annum. Text-messaging reminders to patients apparently produces a 20% reduction in DNAs. Now that’s worth a thought!

Triage and signposting

So, all in all, there are numerous factors that affect the operation of a successfully run appointments system as the face-to-face consultation stands the risk of being overtaken by Skype and telephone consultations. And don’t forget a request for an appointment might be triaged and the patient signposted to another perhaps lesser service or not so qualified individual.  All in all, no one plays to the rules.