Dr Bradshaw Appointments Podcast (Episode21)

Dr. Bradshaw explains that patients may not always be able to get an appointment with their named GP because the GPs have other responsibilities such as writing reports, attending meetings, and developing the practice. They also have limited appointment availability due to these tasks. The on-call doctor handles queries from reception and tries to accommodate urgent cases. Different types of appointments include on-the-day appointments, pre-bookable appointments for routine or urgent matters, e-consultations, and online bookings. Patients may not always see the same GP due to high demand, holidays, or the need for fresh ideas. The practice is considering adding GP workdays to their website. Positive feedback and tracking of A&E attendances are also mentioned. Today, I'm here with Dr. Bradshaw, who's going to talk to us about appointments. Thanks for sparing the time to do this. My first question is, can you tell me why I can't always get an appointment with my named GP? Every patient has a named GP and that will either be myself or Dr. Rao, however you can see any GP in the surgery and one brilliant thing about Mount Road practice is that because we are a smallish practice, generally the GPs do know our patients irrespective of whether you're a named GP or not. The reason you can't always see the named GP is that as partners we have quite a lot of other roles as well as seeing patients, even though Dr. Rao and myself generally say that we would rather be seeing the patients, however some of the things that we're doing in the background include writing reports, attending meetings, trying to develop the practice to make it as good as it can be, preparing for CQC inspections, updating and reviewing policies, dealing with the online consultations that come in and also supervising and debriefing the trainee doctors in the practice and obviously all of this takes time which means we don't always have as many appointments as some of the other doctors which means you can't always get in with your named GP, however as I say every trainee's appointments are discussed at debrief and if there's anything different that we think would be better to be done we ask the trainee to contact you back to amend that so they do all have our stamp on it if you like but that's why you can't always get an appointment with your named GP but it's not to worry, it's not that you're getting less of a service because you can't. Can you tell me why it is that sometimes I might call a surgery and there's no appointments available and yet later I may receive a call to say that there is an appointment available after all? The reason we do this is every day we have an on-call doctor and the role of that doctor is to supervise the medical students and any trainees for that day and they're also the ones that are taking all the queries from reception so that might be is it alright if I take this tablet with my tablets that I'm already taking or have my scan come back or I've got tonsillitis and there's no appointments today, what should I do? And the way that we manage this is the on-call doctor does not have routine appointments booked on that day which allows us maximum flexibility to try and squeeze people in as and when we can because we don't obviously want patients phoning and then having to go 111 or A&E just because we can't sit them in here. So consequently on that day the on-call doctor won't have any appointments booked but we'll be able to see any urgent things that we haven't got anywhere else that we can see them for example all the other GPs are booked and all the nurse practitioners are booked. We did used to have it where we did have some booked appointments on that day and then we'd sit the on-call around that but we found that over Covid and more recently we just simply don't have the time to see patients and deal with the tasks coming from reception and have found that on days when say someone's phoned in sick and we have had some booked appointments it's led to a delay with things being actioned for example if I've seen patients between nine and ten and someone's rung with a urine infection at nine o'clock I might not be able to deal with that until half past ten and if I need a sample the patient then only has an hour to get back to the surgery rather than three hours which they would have done if I'd seen it when they first called. So that's why sometimes we call if we deem it necessary for today we'll then squeeze you in on the on-call list. Okay so the next question is can you explain what different types of appointments there are? Yes the most common appointment is the on-the-day appointment so this is the one where you phone and have an appointment for the same day. We also have pre-bookable appointments and there are a few variations of these appointments. Some of these appointments are reserved for if something needs discussing with a patient for example if some blood results come back that need discussing or if there's a hospital letter that needs discussing. Some of these pre-bookable appointments are available for patients to book just as a routine appointment you know in two or three weeks time usually and we've now created a new slot of appointments which is a pre-bookable appointment that's available just two or three days before the actual appointment which is for those sort of things that don't necessarily need to be seen today but do need to be seen sooner than two weeks time when the next routine appointment might be available. We also have the e-consult system which is on our website and Dr Ran and myself deal with these on a daily basis and aim to get back to you within two working days and linking back to the previous question about why you can't always see Dr Ran and myself is again we have some flexibility so that if patients contact us via the e-consult system we try and squeeze them in in any space that we have rather than booking more appointments so it doesn't take any more of the on-the-day appointments out and the final slot that we've reactivated now after Covid is the online booking system which can be booked online in advance. It is a delicate balance between the pre-book appointments and on-the-day appointments because obviously the more pre-bookable appointments we have the less on-the-day appointments we have and generally things that can be pre-booked can usually wait an extra day or two whereas things that need to be seen today often can't wait for another three or four days such as chest infection or tonsillitis or ear pain or pain in general. The other problem we have with pre-bookable appointments is they have a far higher rate of people not actually attending the appointments because they've forgotten or the problem's gone now which means that effectively the appointment's actually wasted and we are tracking this and we have noticed that as we've increased the number of pre-bookable appointments this has been creeping up. The other problem that we've noticed with some of the online appointments is that actually patients are cancelling them right at the last minute which is unfortunate because it means that we haven't got time to fill that appointment and that appointment then goes to waste. So obviously it's a balancing act between allowing patients to pre-book appointments wherever possible but also maintaining as many appointments as possible for the urgent things that must be seen on that day. The next question is why can't I always see the same GP? So although we do try and get it to the point where you do see the same GP for the same problem it's not always possible simply because that GP might be in high demand and they're booked up. It might be that they're on holiday and in actual fact they're physically not in the building which is why there isn't any appointments with them. Conversely it might be that one of the other doctors is on holiday and therefore they're covering. So for example if I was on holiday and Dr Rao was covering for me on the days when Dr Rao would normally have appointments and I'd be the on-call doctor, Dr Rao would then be the on-call doctor and wouldn't have appointments so that week he'd have less appointments because he was covering for me. However I would emphasise that we do do thorough notes and for example if I've seen a patient who say got swollen ankles I'll say we're going to try doing this but if this doesn't work we'll try this as a plan B so that when the next GP sees them if it's not the same GP they can clearly see what I was thinking and therefore carry on with the plan that I started. And the final reason why you might not see the same GP is that sometimes it's actually good for us to share a patient and therefore we get new ideas about your condition. So it might be that I've been seeing you for a number of weeks about a problem and I'm just getting to the point where I'm really not sure exactly what's going on and I've tried quite a few things and they don't seem to be improving. So in actual fact seeing another doctor might be actually beneficial to you because they might look at it with a fresh set of eyes and think oh you know we haven't thought about this or we haven't tried this and so in actual fact it provides better care for you even though sometimes it feels like you're having to repeat yourself and you're losing that lack of continuity. Okay thank you. Is there any way we can see on the website what days the GPs are working? So we're looking at putting this on our website and getting this so patients can see when we're working. The only thing that I would mention about this though is that for example on a Friday I am on call, I am most definitely in this practice and I'm working hard but I don't have appointments on that day bookable. So as long as patients are aware that although I'm in the surgery on a Friday so yes it is a surgery day I might not have a pre-bookable appointment on that Friday but we are looking to try and get this on the website to make it a little bit clearer for patients. And are there any other points that you'd like to make to the listeners? Yes so as part of what I was saying before about the partners doing lots of other things involving you know meetings and things there are quite a bit of things that we track in the background just to check how the surgery is doing. So one of those things is friends and family feedback and generally that's when patients fill in a form when you've been in surgery we're finding that over the last few months we're getting some very positive feedback which is lovely to hear. We also track our emergency A&E attendances and this is compared to other practices in the area and other practices in Stoke and we're pleased to say that since November last year our A&E attendances are actually significantly low for this area which is good because that means that patients are generally getting seen more in general practice rather than having to resort to an A&E attendance. We also track the numbers of appointments that we have and again we are generally above average for the area although this is quite a tricky thing to track as well because some surgeries are still doing telephone triage so technically everyone gets a telephone appointment and then if you need a face-to-face appointment you then have a second appointment so that constitutes two appointments whereas we just do one appointment either telephone or face-to-face so sometimes it is a little bit tricky to work out exactly where we are but even with that in mind we're above average for that. I would also mention that there are some other appointments available if the times don't suit you for the surgery which are called extended access and these can be booked via the reception. These aren't always at the surgery so they are Monday to Friday in the evening and they tend to be at the Bathford Clinic but there are other sites available around Staffordshire and also we have some Saturday morning appointments available either at our surgery or at Chesterton or at Audley and again these can be booked via reception and the final thing I think just right at this point is that as you mentioned before about why is it that I ring and then there's no appointment and all of a sudden there's an appointment. Some of that is because we're trying to remove any decision making from reception so that you don't feel the reception staff are making decisions about your health so often if the reception staff aren't able to solve the problem they will then send a message to the on-call GP asking for what we recommend medically would be the best thing to do and that's why sometimes you get a phone call back saying actually no the doctor will see you today or we need to book an appointment or can you send some pictures or something and that's because the decisions are being made by the doctors not by reception but I appreciate this sometimes builds in some delay till you get into the answer that you want. Finally if I've got more than one condition or more than one problem can I book a double appointment? We've had long chats about this and we don't operate a one problem one appointment policy we will try and do multiple things in an appointment however we have to make sure that what we are doing is doing the problem justice so if it is say three or four quick things yes by all means we'll try and deal with them in one appointment whereas the most I've done in an appointment is eight by which point we decided after eight problems that we'd perhaps rebook another appointment but I have had patients who were concerned that they couldn't book a double appointment and then in actual fact the things that they came in with were quite easily dealt with in 10 minutes so it would have wasted another appointment which is why we don't operate a double appointment policy. What we would say is that we will endeavour to do as much as we can do in that one appointment hoping to prioritise the more important things however sometimes you may be asked to book a second appointment if we just cannot cover everything in that one appointment but that's why we don't routinely book double appointments. Thank you very much for taking the time to explain those points both on behalf of the patients and the PPG.