GP Appointment System

We have collated below comments collected in the last 2 years relating to GP appointment systems. The same issues come up repeatedly.

Included here are comments directly related to booking and appointment which are the most common comments. Some people find the system works ok for them, but the most common comments are:

  • People find the appointment system difficult to use, particularly getting through on the phone
  • People saying they can’t get an appointment for 2 or 3 weeks
  • Issues with 084 numbers – these came up when they were introduced, but have been mentioned much less lately
  • Some people report going to A&E because the GP is closed

Quality of Care

We very rarely collect comments complaining about the quality of care at GPs in Hackney. We far more often hear that people feel their GP listens to them.

Regular comments relating to GPs (not included here)

  • Happy with the treatment/care from the GP
  • People not able to see the same doctor, and wanting continuity of care
  • Appointment times are too short
  • GP will only look at one symptom in at an appointment
  • Issues with repeat prescriptions
  • Waiting for test results back from hospital
  • Not being referred to services they would like
  • Delays in appointment times
  • Attitude of reception staff (particularly from eg People living with HIV, people with disabled children, people not speaking English well)
  • Some comments about people being discharged from GP for non attendance or because letters return

Questions

  1. What are the results of the Triage trial for GP appointment systems which took place in early 2012 – see response from PCT to first recommendation below, and extract from Enter and View in Appendix 1 at a surgery which was taking part in this trial
  2. Are there other ways that GPs are working to improve their booking system?
  3. Are Hackney GP’s offering enough appointments? (eg if multiply average time someone visits GP by number of patients on the list)
  4. What is the rate of non attendance? And how are GPs looking at reducing this?
  5. Is there evidence that any groups – for example young people, people not speaking English well, are using A&E because of the difficulty of accessing GP?
  6. How do GPs offer appointments to people who cannot speak English well? [ 20% of Hackney residents identified in the 2011 Census that they spoke English “not well” or “ not at all”]
  7. How many GPs offer online appointment booking? And what is the take up?
  8. How do GPs address any issues for people with learning disabilities and making appointments? [We have not had comments from people with learning disabilities about the appointment system directly, but have had comments that they have not had their yearly health check].
  9. Is there any research to show if there are some patients who would prefer drop-in service – however long they had to wait – to booking service?
  10. We received comments about the difficulty of looking after disabled or hyperactive children in the waiting room – do surgeries have ways of prioritising these patients?
  11. How many practices still use and 084 number? Do they offer a landline number as well?

Recommendations/Questions to PCT related to this, and responses

Recommendation/Question from Hackney LINk / Response from Commissioner for Primary Care NHS North East London and the City
Triage System
As a result of the feedback about appointment systems a new triage system is being trialed in some Hackney practices, including the Allerton practice, where LINk carried out and Enter and View visit. What is the feedback on new triage system? / The triage system at Allerton is part of a national pilot. Information is being collected on demand and capacity, and will be analysed in September in comparison to previous systems, and an action plan developed. Practices receive £5000 to implement the system, which we encourage them to spend on aids like touch screen registration and real time surveys.
Recommendation/Question from Hackney LINk / Response from Commissioner for Primary Care NHS North East London and the City
Use of 0844 Numbers
Several people expressed concern about their GP surgery having an 0844 number. It costs between 3p and 5p per minute to call an 0844 number, the rate is the same whatever time of day. This compares with calling a local number from a landline of 3.4p peak rate, 1.7p evening & 0.6p on weekends. Mobile packages vary. For GP surgeries an 0844 number is attractive as it is an additional source of income.
Issues
  1. People may be paying a lot more to call surgeries, especially from mobiles
  2. There is not good knowledge about 0844 numbers and their costs
Recommendations
  1. That PCT looks into use of O844 numbers by GP surgeries
Questions
  1. How many GP practices use 0844 numbers?
  2. Has the PCT advised GPs on use of 0844 numbers?
  3. Are call charges publicised by GP practices?
/ As you will be aware the Department of Health announced a ban on premium rate telephone numbers in February 2005. This did not include the use of 084 numbers however the Department followed this announcement with amendments to the GP contract (GMS, PMS and APMS) [General Medical Services, Personal Medical Services, Alternative Provider Medical Services) Regulations and Directions.
In April 2010 a contract variation was issued to all providers placing a contractual obligation to ensure that contractors must not enter into, renew or extend a contract for telephone services unless satisfied that people will not pay more to make calls to the practice than they would to make equivalent calls to a geographical number.
On 28th February 2012 the Department published further guidance on the use of 084 numbers in the NHS. This further guidance has been issued to clarify what types of calls are included in the Directions and Regulations, the role evidence should play when considering the use of 084 numbers and the roles of the GP practices and other primary medical services contractors or Primary Care Trusts, other NHS bodies, and the Department in resolving disputes.
NHS NELC [North East London and the City] has received a number of communications from patients, local MP’s and other parties raising concerns about the use of 084 numbers in surgeries. While practices are not prohibited from using specific number ranges (i.e. 084 numbers) NHS NELC does not support practices using these numbers. We therefore advise practices to avoid using these numbers. If any practice is considering using such numbers we would recommend that they consider the impact that this may have and to fully ensure that patients are not charged more than the equivalent cost of calling a geographical number from a mobile, landline or a payphone.
The PCT [Primary Care Trust] has conducted some initial research into the cost of calling 084 numbers from a variety of providers, and initial findings have concluded that calls to 084 numbers from various mobile networks cost between 20p to £5 per minute, which is more than it would cost to call a 01, 02 or 03 number.
There are a small number of practices in Hackney that already utilise 084 numbers and the Primary Care Commissioning Team has contacted them directly in order to implement a detailed review of any contractual arrangements with telecoms companies for 084 numbers.
Recommendation from Hackney LINk / Response from Commissioner for Primary Care NHS North East London and the City
Access to GP services for Asylum Seekers
Ensure that every GP practice in Hackney understands and complies with the eligibility criteria for:
  • Regstration with a GP services
  • Access to primary care services
  • Access to advocacy/interpreter services.
and do not require patients to produce a passport for registration with the GP practice.
To do this we believe there is a need to:
Write to GPs and Practice Managers:
  • Setting out the eligibility criteria for registration and access to services for asylum seekers.
  • Asking them to confirm their systems for registration of new patients and access to services (including interpreting/advocacy) do not create barriers to asylum seekers receiving care and treatment.
  • Seeking agreement that they will provide services to asylum seekers on the basis of need.
Discuss communications with GP practices with and Hackney LMC (Local Medical Committee)
/ Following the outcome of the consultation on the closure of the walk-in centres, the PCT intends to undertake a wide marketing exercise in conjunction with the CCG [Clinical Commissioning Group] to promote the importance of being registered with a GP. To facilitate this, the PCT will launch the pan-East-London registration policy and will work with practices to ensure compliance.
The PCT has recently completed a round of contract review visits to practices in City and Hackney where their responsibilities around access and their perceived barriers to registration were discussed.
Following this we will be writing to all GP Practices to clarify the eligibility criteria as part of the registration campaign
Practices will be invited to participate in a local incentive scheme to assess their demand and capacity and their ability to balance both urgent and routine access. They will record demand and provision of appointments over a period of two-weeks in September and will submit bids to fund an action plan of system improvements. Improvements to their processes for registering patients will be a key part of this scheme.

Comments relating to GP appointments 2012/13

  1. Making an appointment to see a doctor is very difficult, You have to ring 8am in the morning but the telephone is always engaged, you can not get any appointment even if you success to talk the staff after 10 minutes pass 8AM.

  1. The receptionists have an attitude problem at my GP practice is so much trouble getting appointments

  1. They are good at the […] Practice when you get to see them

  1. […] Practice it is hard to get an appointment sometimes, even if you say its urgent

  1. Some GP practices advise their patients to go to A&E if they have no appointments.

  1. London is a 24 hour city so the distinction, with regards to GPs, between in hours and out of hours could be considered arbitrary

  1. GPs are not offering common standards in terms of access

  1. They could have a system where you have a fixed time for your appointment, but as soon as that time arrives, if you have a child with special needs, you go to the front of the queue - like they do in theme parks

  1. Fast-tracking parent's with autistic children to be seen immediately rather than waiting around and worring toys being availabe to distract them

  1. GP's need to change the way they way the see disabled children in the practice. My son won't sit still around waiting I sometimes have to chase him around in the practice waiting room and I can see people looking at me annoyed by my son's behaviour.

  1. I don't really see my GP much, but I know people who have called when its an emergency and staff have not treated it as an emergency

  1. Turkish speaking lady who was attending with daughter about 4 years old. Not happy with service and planning to change GP. She said, via teenage daughter interpreting, that it’s difficult to get an appointment and that she saw a different doctor every time. No interpreter was available so appointments had to be booked when an English speaking family member was available. Appointments were never kept to time and she always had to wait. The teenage daughter was aware of the touch-in screen and that Turkish instructions were available.

  1. Patient waiting with her partner was waiting 25 minutes past her appointment time. When she came out from her appointment as she had earlier stated that the service at this surgery we appalling. A letter reception should have called her in to collect from the surgery she had to book an appointment to get this from a doctor. Which meant taking time out of work unnecessarily and demonstrated a poor communication between reception staff and doctors and being delayed?
  2. Patient felt that the staff where fantastic but restricted by the facilities and could not go above and beyond to give patient’s a good service. She felt that there was not appropriate signage. There is no understanding appointment system which changed around summer 2011, it not indicated on notice boards.
  3. I was late for an appointment once coming from work it needs to be highlighted that due to the Olympics the traffic is very heavy now which caused her delay. Despite ringing the practice to inform them about being late when she arrived roughly 5-10 minutes they cancelled her appointment. There was little done by staff to rectify the situation and she had to book an appointment that was two weeks away or go to the hospital if she needs an emergency appointment.

  1. Patient said every time she has appointment she has never been seen on time on our visit she had been waiting 15-20 minutes past her appointment time. Work only gives employees an hour for an appointment any additional time taken means that she has work additional time which not fair. Her main concern was being seen on time.

  1. Patient complained that you have to ring at 8:00am to see a doctor on the same day and they are not flexible if you’re 10 minutes late for your appointment. Today her appointment delayed by 13 minutes and no reason has been given.

  1. Patient concerned about getting appointment as she had great difficulty in getting an appointment as she had tried all of last week phoning in to get an appointment for today.

  1. When I first told my doctor I was depressed they said "The whole world is depressed". It took me 10 years to go back to my GP, this time she tutted and rolled her eyes and said "I haven't got time to talk about this now". But later she tried to make another appointment for me, but I have lost my trust in her, and didn't take the appointment.

  1. We need some kind of fast-tracking for children who are disabled

  1. Maybe there could be some kind of poster to alert reception staff – some kind of system of colour cards. Nothing complicated, but staff need to know that we are not just parents winging.

  1. Patient has used practice for more than 18 years. Over the years has seen a series of GPs, however more recently has had a Dr […] who is a male. He cares for you and looks after you. You are not just a number. One thing that is wrong, is getting used to doctors and then they leave. I dread the day when Dr […] says he is leaving. I attended an appointment on Monday 12th which was ok, I saw a different doctor, however that same evening, Dr […] contacted me directly by phone, and booked an appointment for me to attend at 11am. Years ago it was hard to get an appointment, but now it is better.

  1. Patient been with practice 10 – 15 years as a patient. Doesn’t see doctor with an advocate. Getting an appointment to see the doctor is OK. Sometimes you don’t get to see the same doctor, or the one of your choice. Felt the doctor listens.

  1. Had been with practice for 1 plus years. Doesn’t use advocate and is OK if people speak slowly in English. Sometimes difficult to get an appointment, you have to come at 8am in person to the surgery to get an appointment on the same day. So for my appointment this afternoon I had come at 8am this morning. If you try to ring the phone lines are very busy. The doctors are very helpful, but I get to see different doctors. Dr [….] is very good, he listens and understands and knows my problems and speaks slowly. The previous doctor I had before that was very good, but she moved or left the practice.

  1. Patient at this practice for 15 years. Sometimes it varies, most of the time it is OK. At times it is disappointing that you keep seeing different doctors. But when you are sick and need to see a doctor, you need to see a doctor - you can’t choose and you can’t wait. Getting through to get an appointment before 9am on the same day is very difficult on the phone, as it is always engaged. Sometimes my daughter who goes to college, if she is ill and I try to call, to get an appointment for after college, I can’t get through to make the appointment, and I have to go to the surgery in person. The receptionists repeat the same thing to you all the time ‘All appointments gone’. As a patient my reasons should be listened to, and they need to be more helpful to your problem. They don’t listen to you, but tell you ‘No appointment available’ always putting their side across. Doctors are alright, but there have been problems with the GP. I was given a medication of steroids and was told a side effect could be getting diabetes, but I had no option but to start this medication. My children queried this medication that could give me this life threatening disease, and said that I should go back to talk to the GP. When I was seen by another GP, the information was false that I had to take that particular medication. I was a bit disappointed with that.