A hot topic that practice managers often talk about is the management of appointments. A key element to this is the allocation of pre-bookable appointments versus those available on the day. A recent post on the Practice Index Forum once again raised the issue and some really good points have been raised in the discussion, which we’re going to look at here.

Under pressure

As is so often the case with general practice, it’s hard to keep everybody happy. On the one hand, practices are under pressure to offer more pre-bookable appointments. On the other, patients are all too often complaining that they can’t get an appointment within 24 or 48 hours of phoning in. So what different percentage splits are practices utilising when it comes to appointments?

Percentage splits quoted on the forum are:

The upshot of this is that there’s no magic number and what works for one practice might not elsewhere. That means finding the right balance for your needs is of paramount importance. This is a subject we’ve addressed before – click here to read more – and it’s most definitely worth conducting an access survey to measure supply and demand.

Addressing the needs

One practice manager told us that it was an access survey that led to his practice changing their view on pre-bookable appointments.

“I’m happy to admit that we did have access problems,” he said. “We carried out an access survey that clearly showed we had miscalculated when our busiest times were. We assumed it was Monday morning but actually it was Friday, so we shifted the working hours of our part-time GPs accordingly.

“We were also having real problems with DNAs, so we slashed the number of pre-bookable appointments by nearly half as they definitely led to more no-shows – nearly 250 every six months in fact. We now have a 20/80 pre-bookable/on the day split and we’ve banished all accessibility complaints. Now, patients can call at 8.00am for a morning appointment and at 2.00pm for an afternoon appointment, with appointments released twice a day to maximise patient access and choice. Pre-bookable appointments are available in the mornings from 8.00 – 9.00am, late nights from 5.00 – 8.00pm and on Saturday mornings.

“This change has been a revelation and, in my experience, I would warn practice managers about making too many appointments available. It does vary from place to place though – another PM told me that they have a relatively high black and minority ethnic (BME) population, which usually leads to a far greater demand for on the day appointments. It’s therefore all about adapting appointment systems to suit local needs.”

Monitoring online bookings

Plenty of advice has been offered on the Practice Index Forum. One comment said: “We watch who is booking the appointments online and decide whether we feel that they are abusing the system. For example, we have one patient who has repeatedly tied up one appointment per day for the next four weeks so we have revoked their right to book online.”

Other advice included:

• “Generally we have 25% per session per GP embargoed for ‘on the day’ appointments which open up at 8am. We also have 2–3 embargoed appointments which free up at 1pm for the GP on the late shift. However, we do make adjustments to this as necessary, usually increasing the number of embargoed appointments during the few days before or after bank holidays and at Christmas/New Year and first week in January to cope with extra demand.”

• “Patients booking online can only have up to 2 appointments booked this way in any 90 day period. This generally works well for us with reasonably happy patients and staff.”

• “Recently we have started releasing our on the day appointments for online booking at 6.30pm the previous day (barring Monday appointments). This has resulted in a steady stream of approximately five appointments being booked overnight via the online access facility. These patients have commented that it’s brilliant to be able to access appointment booking at a time to suit them.”

• “We don’t have any pre-bookable appointments. Patients can just get in touch online or on the telephone, and get triaged and seen usually within between half an hour and three hours, if they contact us during opening hours. Obviously patients that get in touch online at 2.00am have to wait until we open! There is no rush on the phones, and the patients know they can call any time and get their problem dealt with so a lot less stress for everyone.”

• “Practices that offer responsive access find that most patients want to be seen on the day or soon after. There are sensible things you can do, like preserving more capacity for same day on a Monday (and other busy times).”

Patient access and appointment ratios will no doubt continue to be a headache for practices, especially as the GP recruitment crisis continues. All you can do is work out what’s best for you – and continue to monitor the situation.

How have you addressed this issue? Are there any magic tricks that you can share with your fellow practice managers? Let us know by commenting below or in the forum here.

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