Not all our appointments are book on the day – many can be pre-booked in advance. Pre-bookable appointments include:

• Nurse/HCA appointments
• Medical reviews with Clinical Pharmacists
• Diagnostic physiotherapy assessments
• Mental health practitioner/MIND appointments
• Mother and baby 8-week checks

Traditional ‘GP’ appointments (predominantly those now carried out by our minor illness team, GPs and GP trainees) are, however, not pre-bookable. Reasons for this include:

• DNA (did not attend) rates are much higher for pre-bookable appointments as people forget/feel better and do not cancel meaning lost appointments
• It allows flexibility when clinicians call in sick at short notice or need to work from home as long clinic lists do not need to be rearranged
• We can match expected demand for appointments with clinical capacity
• Allows flexibility in the day for things like home visits
• It has reduced waiting times

You can! Contrary to popular belief fuelled by media coverage, we have never stopped seeing patients face to face, even in the height of the covid pandemic. We do operate a ‘phone first’ system meaning each consultation starts with a phone call but if an examination is needed a face-to-face appointment will be booked the same day. Please note that you can ask for this either at the time of submitting your online consultation request or when speaking to your clinician. Benefits of this system include:

• We can allocate the correct amount of time to each appointment as this system allows us to block out longer periods of time for more complex consultations
• We can prioritise those with the most urgent clinical need
• We can arrange to see patients in the most appropriate space (some patients with certain conditions/symptoms need to be seen in an isolation area)
• It optimises our room space

One of the challenges we face is that our building is over 20 years old and was designed for up to 12,000 patients – at the time of writing we have around 17,800 patients. There are often days where there are not enough consulting rooms for all the clinicians that we employ to work that day. This means some GPs must work from home or out of a shared consulting space, with several clinicians having to share an examination room for the day. If everyone was seen face to face, it would dramatically reduce our appointment capacity as we would be so limited by rooms.

Hopefully this isn’t always the case, we aim to be able to offer routine appointments at least up to 11:00 but this is not always possible. It’s worth remembering that in years gone by when all appointments were booked by phone, it would take a long time for appointment requests to come through due to the time taken to answer calls. Now that appointment requests can be made online via Engage Consult from 07:00, it’s not unusual for there to be 100 appointment requests before our phone lines have even opened. We set the limit for medical consultation requests to match the number of appointments we have available for the day, aiming to keep this to within BMA recommended safe limits. Several factors impact on staff capacity including:

• Staff illness
• Training
• Clinical Meetings (we need to carry out regular multidisciplinary meetings about things like safeguarding, cancer care, palliative patients, complaints, significant events, quality improvement activities – these are both contractual and help us to provide high levels of clinical care)
• Staff holidays (we mitigate this as much as possible with locum cover, but this is not always available)

If we reach a safe limit for the number of patients, we can consult with we will ask you to contact us back on another day unless your problem is urgent. You may also be directed to 111 for advice. Our priority is to provide a safe service with is not possible with limitless appointments each day.

We are always looking for high quality clinical staff to join our team, but the sad truth is that there are national staff shortages across a range of clinicians including GPs and nurses. We have a good record of recruitment and retention but aren’t immune to the issues seen countrywide. In addition, we are so short on room space there is almost no scope to recruit further until we have new estates.

We have tried to think creatively to maximise the existing space we have within the building as well as looking for opportunities for outside additional space. Changes over the last few years include:

• Increasing the number of staff working from home
• Converting office space into a telephone consulting space for multiple clinicians
• Renting a separate building for our covid and flu vaccinations
• Renting separate office space for our administration team

These are all short-term solutions, and we continue to work with our local heath board to try and find a longer-term solution including capital funding.

We have tried several ways of organising appointments over the years and all have their pros and cons. The truth is that there is no perfect system that works for everyone. We have tried to design a system which is safe, efficient, and effective. Most of the difficulties faced in any system are to do with the simple fact that demands on General Practice outstrip capacity. We always welcome feedback and are continually looking to adapt and modify to offer the best healthcare we can.