Primary and urgent care survey - getting urgent appointments with a GP

We wanted to explore different options for seeing GPs when an urgent, on the day appointment is needed. Currently, there are more requests for appointments than are available.

This was one of the areas of great concern in the comments and one of the most often quoted ‘improvement’ required was trying to get an urgent appointment.

Improve the system for making an appointment. Continuous dialling from 8am until you eventually enter a telephone queue is not good. Especially if you are already feeling unwell. An online booking system would be great.

Make getting an appointment with a doctor easier not having to telephone early morning to be told all that days appointments are filled.

Quickest appointment times. I work full time have to sit by phone at 8am in morning waiting in a queue not knowing if I can even get an appointment. Cannot keep getting days off work just to see if I can or cannot see anyone. Most of the time end up seeing the nurse who to gets advice from the doctor. Really not good enough.

We offered people a range of options and asked them how acceptable they would find them using a five point scale ranging from not at all acceptable to ideal.

The most acceptable option was seeing their own GP in a nearby practice – with nearly a quarter thinking this is ‘ideal’, followed by being called back by a nurse or GP to give advice or decide if an appointment is needed. Few people felt that these were not at all acceptable. Over 80% found dropping in and waiting to see a GP acceptable. Seeing a different GP in a nearby practice was acceptable for just over two thirds. The least popular option is to have trained reception staff to ask questions and triage patients – one in five thought this was ‘totally unacceptable’ and a further 16% thought it as only a last resort.

Table 12: Urgent GP appointments

% not acceptable at all only as a last resort moderately acceptable acceptable ideal moderately, acceptable & ideal
To see your own GP in a nearby practice (n=5,718) 4 7 10 55 23 88
Have a GP or nurse call back and give advice or decide whether you need an appointment (n=5,761) 6 7 19 54 15 88
Drop in and wait to see a GP (n=5,642) 4 15 20 47 14 81
To see a different GP in a nearby practice (n=5,622) 14 19 18 42 7 67
To have trained reception staff ask questions about your condition so they can direct you to the best support (n=5,648) 20 16 22 35 7 64

Figure 9: acceptability of different approaches to urgent appointments

Higher proportions of young people, men and carers of children found this form of triage more acceptable than the general population. Higher proportions of these groups were also interested in having a nurse or GP calling back. Lower proportions of older people and those with physical disabilities were happy to be called back.

Comments about these options were varied. There were some strong views about receptionists asking about their condition – approximately 150 comments about this.  Many perceived them as gatekeepers and there were objections about discussing personal details, and criticisms about the quality of interaction with receptionists.

Receptionists would need to have a better attitude than they have at present.

Receptionists are extremely unhelpful - I was once told that there was no way I could see a doctor. Eventually I saw a doctor and he explained how serious I was and I was in hospital for 6 days. But I felt neglected by the receptionist.

I'm not happy discussing personal details with anyone other than a Doctor.

I was going to say it was unacceptable to have a receptionist questioning you about the problem but I suppose it is no different from the NHS telephone line system - although that doesn't work very well in my opinion

I am quite happy with my GP but I do not like my symptoms being judged over the phone especially by a receptionist

In terms of being called back by a nurse or doctor, some comments were made that it needed to be a doctor rather than a nurse.

Only the doctor calling me back though because if it was anybody else, they would just say they would get the doctor to call me back which is a waste of time - especially as this is meant to be an urgent situation.

Would only want the GP call back to discuss symptoms - a nurse calling back is not really acceptable.  If it is something I'm worried about then I want my doctor not the nurse or the receptionist.

If you can't see your own doctor, any will do. You can't pick and choose in an emergency.

really good overall  - may be just a consultation needed over phone rather than have to come into the surgery when problem is quite minor

Stop using the triage phone system for allocating appointments The current service at my GP  requires the patient to wait for a doctor to phone and decide if an appointment is needed.  It deters me from seeking help for a long-term condition, that I'm sure could be managed better

Having access to an appointment within 3 days with any GP/ nurse practitioner in my own practice - I work and need to plan my days, it is not possible to receive a phone call at work to discuss if I need an urgent appt.

My GP surgery has just started a system where you have to have an appointment to speak to your GP on the phone before you are even allowed to make an appointment to see them. I think this is an incredible waste of their time and mine so the one thing would be to scrap that system.

Less telephone consultations, more access to one-on-one GP appointments. And, I hate to say it, but friendlier reception staff with a better telephone manner - the way in which I have been spoken to on the phone has made me nervous about calling.

We wanted to assess how people would feel about seeing other professionals in an urgent situation as an alternative to seeing a GP, see Figure 10 (and Table A4 in appendix 1). This question was only asked of those who completed the phone survey as the different professions and their background needed to be explained clearly.

Over two thirds found it acceptable or ideal to see an advanced nurse practitioner, followed by half being happy to see either a paramedic or physician’s associate.

Figure 10: Acceptability of seeing alternative professionals (see Table A4 in Appendix 1 for details)

There were a range of comments relating to this – some were saying if it is urgent they will see anyone, whereas others felt they needed to see the GP in any circumstances.

Provided that I could get good advice I would be happy to see most of the alternatives.

If it was an urgent same day appointment you needed, you obviously need to see the very best person i.e. a doctor and none of these fit that bill.  I wouldn't have much confidence in them and would probably end up going to A&E and I'm sure half of this exercise is to try and reduce people going to A&E.

 One of the key issues was the level of training and competence of the practitioner:

Medical knowledge would be a factor with all concerned.

Some people had experienced seeing either physicians’ associates/junior doctors in hospitals, or seeing nurses and had positive, or negative experiences of this which flavoured their response:

When I was taken ill in February, the paramedic doctor was not helpful, he said that I was fine and I ended up being taken into hospital the next day by an ambulance. I had to be operated on, he did not know that I had a hernia.

I'm not thrilled by some of these ideas but I have been treated by a physician's associate and she seemed really together

I am happy with seeing other people as long as they are well trained, but I always prefer to see my own Doctor.

I've dealt with physician's assistants when I have a regular hospital check up and they are superb.

People were concerned that if they were not suitably trained and could not make a correct diagnosis this would be a waste of time.

It all depends what level of training they are brought up to.  If all they do is look at you and then say you need to see a doctor, that would be very frustrating and a waste of both my time and theirs.

Looking at different groups, the analysis shows that a lower proportion of people who visit the GP more often – i.e. those who have seen their GP four or more times in the past year, find it acceptable to see any of the alternative professionals, than those who visit less often. [16] In terms of age, those aged over 60 are less happy to see an advanced nurse practitioner than those who are younger.

A smaller proportion of people with physical disabilities found it acceptable to see an advanced nurse practitioner, pharmacist or physician’s associate.

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