A full-time (9 sessions per week) GP might offer 135 appointments per week  based on a 10-minute consultation.

This is a personal view of why there are never enough appointments.

Have you ever thought about how many appointments have been lost in your practice over the years? It’s quite complicated and for both new and existing practice managers, it can be a nightmare.

A survey by GP Magazine earlier this year found that the average number of appointments per GP per day was 41. However, the average patient sees a GP six times a year. I make that a need for 46 appointments per day for 1,800 patients. Now that’s two very busy sessions per day. So let’s look at the factors that might affect the loss of appointments.

Failed to attend

Yes, it starts with those patients who fail to attend for pre-booked appointments and you can add that up each day, week or month. You can argue too about how much that has cost the practice. But it’s deeper than that. Appointments can be booked many weeks in advance, or is that pre-booked appointments are only available weeks ahead?

Researchers have found that for each doctor, between one appointment per session and one appointment per day ends up being wasted!

Despite posters in waiting rooms and warning letters to constant offenders, non-attendance stills occurs. However, evidence suggests that reminder texts for appointments booked well in advance can reduce non-attendance by over 30% (NCBI).

Protected training time

In the last decade there has been a rise in practices closing for a training afternoon once a month and a rise in required attendance at CCG meetings. This protected training time is vitally important for doctors and practice staff if used wisely and consistently. So that’s one session for the GPs, say 15 appointments lost once a month, but remember that’s per doctor. In the practice I worked in, with 16,000 patients, that might have added up to over 1,400 appointments per annum.

Annual leave

GPs tend to work only 46 weeks per annum as holidays are an essential and necessary part of the work/life commitment. You might add in a week’s study leave too. The problem zones are school and public holidays, although demand for appointments tends to fall at these times, or does it? The Tuesday after a bank holiday can also be a nightmare; we tended to have no pre-booked appointments on those days, simply reverting to an ‘open’ appointments system. Problems can occur when more than one doctor insists on taking leave at the same time as others. Would it be different if practice staff doubled up on leave requests? In a large practice – say with eight doctors – that could be 48 weeks when someone is absent. The same applies with part-time GPs; there are always days when not all of the doctors are present. Factor into this scenario maternity or sick leave and the juggling act becomes all the more difficult. Practices have their own policies on when they should employ a locum and who pays!

Meetings and outside commitments

Then there are meetings and outside commitments, all taking sessions out of the practice. Meetings are often unannounced and unplanned and you can literally feel the ripple of disapproval as doctors contemplate yet another pile of ‘extras’. CCGs have also taken out of practices some very good doctors. Outside commitments tend to happen on a regular basis. It just means that the doctor who is ‘out’ is not on call and may well have blocked out a session or may work a shorter week.

Half days and Saturdays

I haven’t mentioned one factor that I suspect still poses problems: the half day. GP practices stopped providing Saturday morning surgeries around 15 years ago, but have you noticed that full-time GPs still like taking a half day? In fact, another trend has been for GPs to take a full day off each week. A large number of practices now offer ‘extended hours’, either in the morning before 8:00 or in the evenings after 18:30. Perhaps these appointments have replaced the lost Saturdays?

Supply and demand

Wouldn’t it be ideal if you could run a practice knowing what the demand for appointments would be and then simply set up sessions and offer appointments accordingly. How nice it would be to have enough doctors available to pick and choose when services are offered. Dr John Oldham, over 18 years ago, promoted a system of balancing the type of appointments offered according to demand. Hence we have embargoed appointments, appointments for today, etc. A new report from the University of Exeter argues that seeing the same GP again and again results in lower death rates. When the Personal Medical Services contract was introduced, my practice emphasised in its objectives that it would try to provide consistency and patients were encouraged to see the same doctor. These days this aim seems very difficult to achieve. Perhaps open surgeries is the solution. Remember 46 patients per day! I make that 25 patients per session, based on 9 sessions.

Lost appointments (per full-time GP)

Failed to attend: 468 per annum
Annual leave: 810 per annum
Protected training time: 150 per annum
Meetings: 150 per annum
Outside commitments: 780 per annum
Half days: 780 per annum
Saturdays: 780 per annum

These are only estimates and relate to a GP who works 9 sessions per week. I make that roughly 4 sessions lost per week. Your own calculations may be quite different and will vary according to the number of sessions and the days on which doctors work. There are of course other factors that affect the efficiency of an appointments system, such as the length of consultations. The system might be set for 10-minute appointments but there will always be patients who take longer and doctors who like to chat!