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How does the Appointments System at Downs Way Medical Practice Work?
Firstly, what is it for? There are different methods of booking for different things:
- blood test appointments are available online, via the NHS App or by phoning the surgery (available to book once the initial conversation with the Clinician has been held and the request form has been raised on the pathology system)
- nurse appointments should be booked by phoning the surgery
- medical assistance – see below.
To access medical assistance, patients can either:
If you use eConsult, you will be asked to provide details of your medical condition to allow the clinical team to assess your need. Some of the forms are quite lengthy, but the detail is important.
If you telephone the surgery, the team will ask you for brief details of your issue. You do not need to be concerned about telling the staff about the matter you need help with. All staff are covered by strict confidentiality protocols. Furthermore, no decisions are made by staff on who sees who or when or how. That is all completed by clinical staff. (They don’t need War and Peace or specifics about a particularly personal matter – just a general indication of the affected area is fine.)
Once the request has been made (both eConsults and telephone requests are treated in the same manner) they are placed in a triage list.
Triage is a system which allows the clinical team (in the case of our triage it is a pair of GP Partners) to assess from the information provided;
- Whether it is appropriate to be seen in general practice (general practice is NOT an urgent or emergency service – if something is more urgent than 48 hours – it probably shouldn’t be coming to us in the first place – but to 111 or A & E) Where the matter should clearly be redirected, the admin team will be instructed to make contact with the patient and provide advice on where they should contact/attend instead. (Patients with chest pains will be automatically diverted to A & E by the telephonist at the outset.)
- Which Clinician should deal with the matter. The practice clinical team has expanded significantly in recent years. Previously, the choice was a GP or a GP. Now, there is a range of clinicians who can deal with various matters, GP’s, GP Registrars, Advanced First Contact Nurse Practitioners, Physicians Associates, Prescribing Pharmacists, First Contact Physiotherapists, to name just a few of the relevant roles. During triage, the GP will determine which Clinician is appropriate to deal with the matter and pass the details to them for action. This may also include appointments serviced on our behalf by the “Hub” who provide additional access for practices locally.
- How to deal with matter raised. Throughout the pandemic the practice has worked in accordance with the guidance from NHS England, which remains that patients should only be seen face to face when it is clinically necessary. Contrary to the urban myths circulating, the practice has seen patients face to face on every day during the whole of the pandemic. The Clinician may deal with the matter and send a message (for example that from the information provided they have been able to prescribe and a prescription has been sent to the usual place for that patient.) They may make a telephone consultation, or a video consultation. They may decide that they need to see the patient face to face and ask the admin team to book an appointment. Or they may make a telephone consultation and based on the discussions, decide that they need to see the patient, in which case they will book an appropriate appointment themselves.
- When/how quickly the patient needs to be seen. A response may not be the same day. The triage team may decide that a particular Clinician needs to review a matter, in which case it will be booked with them when next available. (Refer again here to the note under whether it is appropriate to be seen in general practice regarding urgent matters.)
Pre pandemic, there were X appointment slots available each day and when they were gone, they were gone. Post pandemic, the number of patient contacts is significantly increased. But it cannot ever be infinite. So when the capacity available has been fully booked for the day, both eConsult and the telephone bookings are turned off. The practice cannot continue to take referrals from patients, that it has no ability to fulfil. Patients will at that time be advised to call again the following day, or redirected to more urgent services if that is appropriate.
Patients are also asking when things will return to “normal”. The way the practice is now working is the new “normal”, there will be no return to pre pandemic methods of contact. With the expanded clinical team, clinical triage is the appropriate way for the workload to be distributed and entirely in line with what happens elsewhere in the health service.
The systems have continuously evolved throughout the pandemic, we understand things are not perfect. The practice has always and continues to work to the guidance set by NHS England. As things continue to change, we will refine and adapt our systems, but it is not expected that there will be any return to previous systems.
In order to try and serve patients better, the telephone system has now been centralised to a dedicated telephone team at Istead Rise, following the installation of a new telephone system in early August 2022. Staff training is underway and new staff have been recruited and further posts are currently being shortlisted, to increase the call handlers. It is anticipated this will be fully operational in September 2022. This will release our front desk teams to deal just with patients in front of them rather than having to multi task and will be of great benefit to everyone.
If you are confronted by a serious problem such as severe chest pain or profuse bleeding call an ambulance (Tel: 999).