Managing practice appointment systems

As demand for GP appointments continues to rise, GP practices are under pressure to find innovative ways to meet patient demand without compromising safety or overloading the system.

It's important to consider the medico-legal implications of all practice policies and procedures which concern patient access, from appointment booking to Do Not Attends (DNAs).

Standard local rate

• Patients should be able to call the practice on a number that charges the standard local rate.
• Since April 2010, there has been a veto on practices entering contracts which involve the more expensive 084 telephone number. Practices employing this number risk being in breach of contract.

Telephone skills

• Poor communication and perceived rudeness during telephone calls are a common cause of complaints. Patients can also become irritable or anxious if they are kept waiting on hold, or if they have to navigate a convoluted automated system.
• Consider regular training for reception staff to keep their telephone skills up to scratch, including checking the identity of the caller, actively listening without interruption, being courteous and staying calm in the face of aggression.
• Set a target for answering calls within a reasonable timeframe, and make sure there are enough staff available to answer the phone at peak times.
• It's a good idea to have a practice phone policy which covers such points as patient confidentiality, staffing levels, documenting calls and emergency contact numbers. This policy should be regularly reviewed and updated.

Triage and telephone consultations

• Although telephone triage is a useful way of determining the level of urgency of cases and allocating patients according to need, the process must be properly thought out.
• The telephone triage process should have a full written protocol, which includes red symptoms such as weight loss or a persistent cough.
• Non-clinical staff taking down patient details for a GP call back should have the appropriate training.
• To protect patient confidentiality, calls should be taken where they can't be overheard rather than at a reception desk in the waiting room.
• Those callers who only want to discuss their concerns with a health professional should be able to do so.
• For practices providing a call-back service - where patients can talk to a health professional or be allocated an emergency appointment - the clinician assigned this duty should have access to the patient's records and make the same detailed clinical notes that would be expected in a face-to-face consultation.
• Let patients know if your telephone calls are recorded.
• Document calls made to the call-back service, in case there is a problem or complaint or it is questioned during a CQC inspection.
• If nurses in your practice triage patient phone calls, make sure they contact the MDU membership team to let us know.

Home visits

• Publicise your policy on home visits on your website and in your practice literature, making it clear that the service is usually for the housebound or seriously unwell and encouraging patients to use the system appropriately.
• Your policy should set out how people can request a home visit (for example, if they need to call the surgery before a particular time), explain that a doctor or nurse may contact them to assess the urgency, and make it clear that their preferred doctor may not be available.
• Keep a full note of such conversations in the patient's record.
• There should also be a clear protocol in place to confirm the patient's address details and document the visits in the records.

Online appointment bookings

• Practices are contractually obliged to provide secure online access to services such as booking and cancelling appointments.
• Reserve an appropriate percentage of appointments available to be booked online. This will depend on the characteristics of your local population.

Text reminders

• Text reminders are a cost-effective way of tackling the problem of missed appointments.
• Seek patients' specific consent and opt-in before texting. Explain clearly what information will be texted and the security arrangements in place.
• If the information is serious or important, such as requests for urgent follow-up, consider alternative or additional methods of communication.
• Details of text messages sent to or received from patients should be noted in their medical record, including the date and time of transmission, the content of any message and details of any reply.

Responding to DNAs

• Make sure your practice has a clear and consistent protocol for prioritising and responding to missed appointments, and keep a record of any steps taken to follow up with the patient.
• Even if a patient persistently misses or is late for appointments, it would be difficult to justify their removal from the practice list.
• Speak to the patient to determine whether there are any underlying causes for not attending appointments, such as confusion about the appointment system or anxiety.
• In the majority of circumstances, removal should be a last resort. GPs are contractually obliged to have given the patient a warning in the previous 12 months.
• Keep a clear and detailed note of any incidents that led to the removal, any steps taken to resolve the situation, the specific reasons for the removal and the process of removal that was followed.

Appointments policy

Your appointments policy should be available on the practice website and in the waiting area. It's also a good idea to communicate the policy to new patients when they register. The policy should include the following:

• surgery times and extended hours sessions
• types of appointment available, such as urgent, advance, 'arrive and wait', practice nurse, travel clinic, etc
• appointment booking methods (telephone and online)
• the practice's commitment to answering telephone calls within a certain time and whether calls are recorded
• requesting home visits and the circumstances when they are provided
• whether patients can request a double appointment
• how to cancel an appointment
• practice statement on DNAs
• how to summon medical help outside practice hours.

This page was correct at publication on 10/09/2019. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.