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 concerning patient access, from appointment booking to non-attendance (DNAs).

Phone skills

Poor communication and perceived rudeness during phone calls are a common cause of complaints. Patients can also become irritable or anxious if they're kept waiting on hold, or if they have to navigate a convoluted automated system.
Consider regular training for reception staff to maintain their phone skills, including checking the identity of the caller, actively listening without interruption, being courteous and remaining calm.
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 covering points such as patient confidentiality, staffing levels, documenting calls and emergency contact numbers. This policy should be regularly reviewed and updated.

Triage and phone consultations

Although phone triage is a useful way for clinicians to determine the level of urgency of cases and allocating patients according to need, the process must be properly thought out.
Non-clinical staff taking down patient details for a GP call-back should have the appropriate training.
Staff working at reception should be mindful of the need to protect patient confidentiality during phone conversations if there are other patients in the waiting room who may be able to hear the conversation.
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 phone calls are recorded.
Document calls made to the call-back service, in case there's a problem or complaint or it's questioned during a CQC inspection.
Clinicians who are triaging patient phone calls should ensure they have the requisite training, skills, experience and indemnity in place.

Home visits

Publicise your policy on home visits on your website and in your practice literature, making it clear the service is usually for patients who are 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, this may include asking patients to submit a request early in the day, where possible, to give practices advance notice) as well as 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 missed appointments

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 most circumstances, removal should be a last resort. GPs are contractually obliged to have given the patient a warning for the same reason, 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 (phone and online)
the practice's commitment to answering phone 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 missed appointments
how to summon medical help outside practice hours.

For advice on conducting remote consultations, read our guide here.

Managing practice appointment systems

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