Reducing demand. Step 1- Understand who comes to the practice.

“Only very exceptionally do patients seek help when they do not need to. Some are ill-informed and some are not very bright but they still need to be seen and looked after. Hardly anyone gets up in the morning and thinks it will be fun to go to the doctor’s”. GP

In the Academy we work on reducing demand. Whilst we know that this takes a redesign of the whole system of primary care, many practices are immediately concerned about appointment systems, and struggle to lift their eyes beyond this immediate pressure.

This blog looks at the very best way to learn and organise in general practice. See separate blogs which address in more detail radical ways of organising Primary Care.

Step One – Understand your Demand

You need to know how many appointments you need every day. Sounds obvious but many practices have no idea.

We do this mostly using online diary forms. The advantage is that we co-design these with practices to secure the best approach for them.

The webforms are:

• A one page web form for GPs and reception

• Completed after each appointment or reception contact

• Tracked for one week

The GP / nurse form includes:

•  first estimate of the size of “moveable” demand at the practice

The reception form includes:

• Flow and nature of appointment requests – by hour of day, by day of the week

• Distribution of requests (days ahead requested)

• Proportion of named(continuity) requests that we manage to satisfy

These diaries produced excellent data for the practice to be able to compare between themselves and to see data within their own practice .

Examples of outputs

• A high level view of appropriateness of appointments that come through to GPs – this provides a long-term ambition for re-allocation and reinventing how demand is handled at the practice

• Here blue = appropriate, all other colours = potentially moveable / do-able by someone else.

• Variation in judgments of the above by GP – a basis for deep discussion about how demand is handled at a practice

• The shape of demand coming into reception – its timing, nature. Variations in demand at reception by time of day – how does this vary and how does our ability to allocate appointments vary after the morning peak? And how these requests for appointments are handled.? Is there any navigation to otehr servicsand at what level?

• Seven different practice examples shown below varying from highly peaked (90% of demand arriving in the first hour) to calmer and spread out during the day, driven by overall availability and hte ability to pre-book slots.

You can do this data collection manually using receptionists armed with tally charts and calendar but using a simple webform is easier and simpler and generates data directly.

Doing this comparably with other local practices means you can start to review how you allocate appointments, and manage demand. This really helps practices understand their own culture and stretches their options.

Its really helpful to review the nature of the demand (same day) as well as the volume.