the Clash between speedy access and seeing a doctor you know

1
the Clash between speedy access and seeing a
doctor you know

• two linked studies in west London- seeking
  patients views and
• observing receptionists

• Navjot Gill medical studentsRachel Timms BSc
  in Social Medicine
• George Freeman project supervisor
• Department of Primary Care Social Medicine

2
my co-workers cannot be present today!

• receptionist study
• Rachel Timms BSc

• patient study
• Nav Gill BSc

3
background -1

• originally all general practice was without
  appointments and todays work was done today!
• long waits for appointments became prevalent
  often two weeks or more
• British government responded by setting access
  targets
• all patients should be able to see a
  professional within 24 hours and a doctor within
  48 hours

4
background - 2

• concept of Advanced Access imported from
  California to help practices achieve new targets
• variable implementation but many practices
  severely restrict forward booking to keep
  capacity free to meet access targets
• patients cannot choose who they see and personal
  continuity is suffering?
• what was happening in our locality?

5
method

• two linked studies each in three practices
• patient study
• pre-consultation questionnaire in waiting room -
  200 patients in each practice
• choice of doctor
• problem type
• waiting time
• trust

6
method

• two linked studies each in three practices
• receptionist study
• observed booking process during one week
• telephone and face to face bookings
• record on proforma sheet
• brief receptionist interviews at end of week

7
practices

• practice GPs receptionists patients
• patient study
• A 6 8,000
• B 7 11,000
• C 8 12,400
• receptionist study
• D 5 3 9,500
• E 5 7 11,000
• F 2 3 3,000

8
results 1 - practices and access systems

• patient study
• A B traditional with choice of doctor doctor
  triage for urgent requestssimilar results so
  presented together
• C same day booking (very limited advance
  booking)
• receptionist study
• D same day booking - emergency slots
• E nurse triage for urgent requests
• F same day booking only telephone
  consultations

9
results 2 - patients

• 651/763 completed questionnaires (85)
• AB C
• seeing chosen doctor 64 41
• seen on day of request 26 81
• wait to see a chosen doctor 34 18
• dont mind who I see 34 42
• write in comments 2 10

10
patients comments

• practices A B
• I have seen all of the doctors in this practice
  and I consult with different doctors for
  different matters. Therefore, I have many usual
  doctors. (f 44)
• My only criticism of what I think is an
  excellent NHS practice, is that you often have to
  wait 10 days or thereabouts to see your
  doctor. (m 71)
• practice C
• I would usually ask for a female doctor and
  would prefer to see the same doctor but, I would
  rather see any doctor than not get an appointment
  at all. (f 25)
• With the current appointment booking system
  here, one has to see the GP on duty. The concept
  of a usual doctor has disappeared. (f 61)
• The present arrangement is certainly not
  working! I find great difficulty in seeing the
  doctor I want to see. Can we please go back to
  the old system or update the present system. (m
  69)

11
results receptionist observation -1 appointment
requests for a specific doctor
12
results receptionist observation - 2appointment
requests for a specific doctor
13
seven receptionist interviews

• most thought that being seen quickly was more
  important that seeing a specific doctor
• if a patient wishes to see a particular doctor
  they must be prepared to wait
• inappropriate for receptionists to decide what is
  urgent
• experience and personal knowledge does help

14
summary of results

• GP care is indeed becoming much less personal in
  west London
• patients are accepting change, often reluctantly
• receptionists are responding to the priority for
  quick access
• demand for personal care reflects its availability

15
does it matter?

• these studies cannot measure costs and benefits
  of change away from more personal care
• this needs more studies
• but it is simple to monitor what is going on