Introduction
When Dr Eleanor Barnard gets to work in the morning, she knows she won’t be turning away any patients who need help. I get to see everyone I need – it’s great,” she says.
Nobody waits too long for an appointment, even for routine things like a blood pressure check, and I can regularly review my patients. There are no queues in the surgery - Wallington Medical Centre in Surrey - and only two DNAs a month, on average.Some days I don’t even fill all my appointment slots. I leave every day on time, on the dot. For most GP surgeries in the UK, this is stuff of fantasy.
GPs are buckling under a deadly combination of unmanageable workloads and declining budgets. On average, GPs turn away one in eight patients who ask for help each day. GPs are rarely able to prioritise patients according to need or give them the time they deserve. As a result, GPs are blighted by a feeling of lack of control – over their time, over which patients they see, over their professional lives.
What you are about to read is a manifesto for change. It is meant to bring hope to those who believe that there is nothing we can do to return control to our GPs; that there are no solutions that work, and that the system is too big, too established, too difficult to turn around. It is meant to inspire those who find the idea of change overwhelming.The reality is that Dr Barnard is not alone. She is part of a small but significant group of over 80 practices across the country that have broken with the traditional system of booking patients and found a new lease of life.
Serving deprived and wealthy areas, with partnerships and salaried GPs, ranging in size from 3,000 to 23,000 patients, they are delivering outstanding and sustainable outcomes. These include:
• Patients consistently accessing a GP on the phone within an hour
• A drop of 50% – 80% in patients missing appointments (DNAs)
• Improved continuity of care (typically 10 – 15%1)
• A reduction in A&E attendances. We’ve measured 20%, now being independently researched in the tele-First programme by RAND/Cambridge University.
• GPs able to spend anything from 1 to 30 minutes with a patient – not all boxed into 10-minute slots, though the average face to face duration is the same
• An enormous increase in productivity, as GPs see or speak to more patients each day
• Work spread more evenly throughout the day.
The demand led redesign costs £1-£2 per patient per year – no more than 0.05% of the £116.4 billion NHS budget – to save far more in costs.
To find out more about the service redesign research www.gpaccess.uk/research
or to read further GP Practice case studies www.gpaccess.uk/case-studies/practices