Dr Sue Burke Blog - Re appointments running late
Your doctors and nurses very much regret that at times they run late and our patients are kept waiting. There are many reasons for this.
Firstly the days are very busy, the hours long and schedules tight.
A usual day for the GP Partners
- All doctors working as partners complete 25-30 telephone consultations between 8am -10.30am deciding which patient needs to be seen and who can be safely and effectively helped by telephone.
- They then each offer 12 ten minute face to face appointments
until 12.30 pm.
- Between 12.30 and 1.30 pm
- They check and sign all repeat prescription requests ( averaging 120 per day)
- Dictate or check any urgent letters
- Meet with the Practice Manager to address any practice issues.
- Between 1.30 -3pm they undertake home visits - one home visit takes 45-50 mins including travelling time. If they have more than 1 visit they are immediately under pressure to be back for afternoon surgery.
- From 3-4pm they complete a further 12 telephone consultations each and from 4-6.15pm provide another 12 ten minute face to face appointments.
Under our previous appointment system we helped 523 patients per month. Since the introduction of Dr First demand has steadily risen and in the month of October 695 patients were helped by telephone or face to face appointment an increase of 19%.
- Between 6.15pm and around 8.00pm to 8.30pm they check and action all blood test results (average 25 each) read all hospital clinic letters (average 40 each per day) discharge letters and amend medication where necessary in the clinical record, write reports or letters of referral to the hospital and complete their 'tasks' - queries raised during the day by patients or staff members e.g. nurse queries (average 20 each per day). When On Call they may then have an emergency home visit to do.
- Our dilemma - if we offer longer appointments to try to minimise delays there will be fewer appointments available as we cannot safely or effectively work any harder.
Common reasons for surgeries running over:
a) A ten minute appointment is the time estimated to deal with one problem, patients who present with additional problems or 'lists' produce delay.
b) Patients who attend for routine reviews – e.g. diabetic annual review, asthma reviews, heart disease reviews who then also need new problems addressing during the allotted time for this review will result in delays.
c) Emergency situations arise regularly during the day involving one doctor being tied up for longer than the allotted time- arranging an Admission / ambulance etc. puts an additional 5 minutes minimum on an appointment
d) Interruptions e.g. for 'emergency' prescriptions which are not requested on time, people ringing with real or perceived emergency problems wanting to speak to the GP immediately and interrupting consultations, meeting with fellow professionals - hospital colleagues, social workers, physio’s, the coroner etc. needing to speak with district nurses about very sick patients including the dying we are caring for at home.
We need you, our patients, to help us to work smarter by playing your part
a) 30% of GP contact does not require GP input - could your query be addressed by a receptionist (prescription queries) our secretary (hospital follow up or administrative queries) a nurse or your community pharmacist in the local chemist (minor illness advice)
b) Have your symptoms and problems clear in your mind - while you are waiting think about the problem you have- when did it start, how often does it happen, what does it feel like, does anything provoke it or make it better for example
c) Allow us to deal with one thing at once
At times inevitably we will run late because someone has urgent need of our time - please be patient - next time it could be you!