One question we’re often asked by practice managers is ‘how many appointments do I need to offer?’ It’s a critical issue for practices – yet it’s one that’s hard to answer.

As we discussed in an article on Practice Index back in April 2015, various figures are available based around the ratio of appointment numbers per 1,000 patients. These figures vary widely but do provide some base evidence to work to. That article is well worth a read.

A complicated issue

The reason why there seems to be variation in appointment ratios is that the number of required appointments 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 size and makeup of wider clinical team including nurses, healthcare assistants, counsellors and pharmacy staff and even the number of consultation rooms all impact on availability of appointments. Deprivation levels and age can also impact on demand.

Due to this complexity, the CQC does not have a formula or ratio for the number of GPs sessions that should be provided per 1,000 patients. This, it says, is because care is provided using different models with a variety of skill mix: using GPs, advanced nurse practitioners, practice nurses, physician associates and healthcare assistants. Practices take differing approaches dependent on their circumstances.

In one of its mythbuster articles, the CQC says that the Royal College of General Practitioners in Scotland suggests practices should check how their activity compares with others. A 2012/13 Scottish government study found the total annual contact rate for (including all face-to-face contacts with either a GP or a practice-employed nurse) varied from 3,000 to over 7,000 contacts per 1,000 registered patients. GPs undertook an average of two thirds of the consultations in their sample. The average standardised practice had a total of 85 face to face contacts per 1,000 patients per week, 56 of these by a GP.

A practice’s responsibility

In its advice to practices, the CQC explains that a GP practice is responsible for determining how many appointments it should offer each week to meet the needs of their patients. Yet, it’s an important part of inspections that’s looked at under the question of how responsive a provider is. In particular, under key lines of enquiry (KLOE):

• R1: are services planned and delivered to meet people’s needs? This includes whether the services provided reflect the needs of the population served and ensure flexibility, choice and continuity of care.
• R3: can people access care and treatment in a timely way? If people do not have timely access to appointments at a time that suits them, we will pick it up here.

Fewer but longer

Appointment numbers came to the fore last year – and were complicated somewhat – by the BMA releasing a report suggesting that fewer, longer appointments should be made available.

It argues that GP appointments should be extended to 15 minutes because an ageing and increasingly overweight population means that many patients need extra time at the doctors’ surgery. The GPC committee believes that increasing the length of appointments by 50% would allow for improved decision-making and service, as well as reducing the administrative burden for doctors outside clinic hours.

Dr Brian Balmer, who is on the GPC’s executive team, said: “In a climate of staff shortages and limited budgets, GP practices are struggling to cope with rising patient demand, especially from an ageing population with complicated, multiple health needs that cannot be properly treated within the current 10-minute recommended consultation. Many GPs are being forced to truncate care into an inadequate timeframe and deliver an unsafe number of consultations, seeing in some cases 40-60 patients a day.”

He said this was well above the 25 consultations a day recommended in many other EU countries. “We need a new approach that shakes up the way patients get their care from their local GP practice,” he said.

Based on a widely accepted formula of 72 appointments per 1,000 patients each week and an average list size of 1,600 patients (per GP), the report, Safe Working in General Practice, proposes that GPs should be offering 115 appointments a week – an average of 23 a day over five days.

Whether that would work or not is most likely a decision that has to be made by practices on an individual basis. It does however, as the points made earlier also do, highlight how complex this topic is.

A helping hand

This complexity has prompted Practice Index to develop a Rota Generation Tool, which is designed to take the headache out of building and populating an appointment/staff availability rota.

Staff lists are automatically populated from core staff data and work out if you’ve got enough appointments available, or if you need to call on support from locums or bank staff, allowing flexibility to adjust according to sick leave, maternity/paternity leave and holidays. And, before you ask, this tool is based on a ratio of 108 appointments per 1000 patients, including nurse appointments.

To find out more about the tool and how it works, click here.

How do you manage patient demand at your practice and is it working? Please comment below or in the forum.

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