GP appointment

Why the appointment-first model is broken – and how to fix it

When the NHS was founded in 1948, the default mode of care delivery was a 10-minute face-to-face appointment with a GP.

Fast-forward 75 years to an NHS with robotic surgery and rapid genome sequencing, and still this 'appointment-first' model is used widely across general practice. When a patient calls their GP practice during the 8am phone rush, they are encouraged to book an appointment on a first-come, first-served basis – often with a minimal assessment of their clinical need.

But if the challenges to patient access today show us anything, it's that this model now comes at too high a cost in time, funds and productivity. In short – it's not sustainable.

We all know the reasons why. The ratio of GPs to patients is declining and the elective backlog is putting huge pressures on general practice. An ageing population now presents with more co-morbidities and complex conditions, fuelling patient demand and making care coordination more time-consuming for staff. Many of these staff are already burnt out. All this makes it incredibly hard to deliver a timely service and continuity of care, which is a huge contributor to the historically low patient satisfaction and staff morale we see today.

Meanwhile, an appointment has become the defining metric by which patient care is judged in public discourse, from media coverage to political debate – a view supported by the NHS' monthly publication of appointment delivery.

More and more practices are starting to flip the appointment model on its head

At the Best Practice Show conference in Birmingham recently, I enjoyed speaking to primary care teams about how they are adapting and innovating to meet patient demand, and how they are using Accurx to do this. What struck me is that even in the face of these extreme pressures, the people in these services are doing more with less and show a remarkable readiness to drive new ways of working. It’s this culture of innovation in primary care that can help address the challenges above. And with newfound changes in the primary care landscape, there’s never been a better time than now.

More and more practices are doing just that. Take St Andrews Health Centre in London, where 99% of patient requests are resolved within 48 hours, with an average response time of 30 minutes. Or Peel Hall Medical Centre in Manchester, who’ve seen 24% less calls and 96% of requests resolved within 48 hours. 

Let’s think about that for a moment. 99% of patient needs are being met within just 48 hours. It’s a remarkable achievement and one that holds huge implications for general practice in the future. 

Taking inspiration from practices like these, and tracking our product data closely, we believe that most practices can resolve 25%-50% of patient requests via messaging without the need for an appointment. 

It’s important to note that these practices still do deliver appointments face-to-face, as well as on the phone and via video consultation, but they also meet patient needs that don’t require an appointment through messaging. For example, if a patient has lower back pain or a UTI, they may be sent a questionnaire to collect more information about the issue. This is so the triaging doctor can understand if they need to bring them in to be seen, or, if they can advise this patient through a two-way SMS conversation, e.g. sending NHS guidance or a prescription to a pharmacy, without the need for an appointment. 

These practices are shifting the care they deliver away from the default appointment-first model, and are building more sustainable routes for patient access. Instead of parcelling all demand into 10-minute appointment slots, they are triaging the majority of requests in 1-2 minutes - even complex ones - to decide the best course of action for the patient. Whether that’s requesting more information via a questionnaire, giving advice over SMS message to manage their own care, or inviting the patient to book an appointment. NHS England calls this a Modern General Practice Access (MGPA) model, and it’s also known as total triage. 

This isn’t a model that exclusively works well for practice staff - patients love it too. Most of us don’t have the ability to take time off work or childcare in the middle of the day to attend a doctor’s appointment. We simply want the security that when we get in touch with our GP surgery, they’ll respond quickly and action our request in the most appropriate way.

The numbers speak for themselves

To demonstrate the benefits that GP practices who run this model experience, we commissioned a survey of 373 GP practice staff. We found that:

  • 81% of primary care staff who already run a MGPA model say that since its implementation, their practice is better equipped to keep up with inbound patient demand
  • Three quarters (75%) say that they are able to provide a more equitable service, where patient requests are prioritised based on clinical need
  • 65% say that since implementing it, patients are more satisfied with their service
  • Half (50%) say that they are happier in their day-to-day role, and 58% say their workload is more manageable

The data speaks for itself, but it’s only when you visit these practices that you can feel the effect. Phones aren’t ringing off the hook, there isn’t a queue of patients in reception and practice staff are more relaxed. They even have time to make a cup of tea. Staff time is freed up to deliver more care for patients who do need to be seen face-to-face, whilst ensuring continuity of care for those who don’t. 

It’s impossible not to see how this will improve staff retention at a time where there are huge workforce shortages and low morale. 

How is Accurx helping?

We strongly believe that the only way healthcare delivery can be sustainable is to move away from an appointment first approach. That’s why we’re going all out to help ICBs and practices implement it. This week, we launched a 5-point support plan to help primary care improve access, underpinned by a commitment to help 1,000 GP practices move to a Modern General Practice Access model by early 2024. Our 5-point plan lets practices enrol in a 12-week onboarding programme, start a free trial of our Patient Triage product and use training packs and materials to manage change internally and with patients. They can also join our online community of 600 (and counting) healthcare professionals to gain learnings and access supportive content on Modern General Practice Access and total triage.

The impact and benefits of this model aren’t constrained to primary care - we can do this across the whole system to tackle challenges like waiting lists and patient flow.

Today, Accurx is privileged to support practices at the forefront of influencing change in primary care, collaborate with the GP community and help teams optimise their workflows for better patient access. We're passionate about helping practices move from the one-size-fits-all model of appointments to a more sustainable system that works for patients, staff and the NHS as a whole. 

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NHE May/June 2024

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