In the late 90s there was a shortage of general practitioners in the UK. I know because my practice was trying to recruit doctors. At the same time the demand for appointments with doctors was growing. Patients who thought they needed to see a doctor urgently often found it very frustrating. They were offered late evening appointments or ‘squeezed in’ to overflowing sessions with grumpy and stressed doctors. It was hard to keep on top of the demand and at the same time maintain morale in our practice. Something had to be done.
Our team noticed that there was a seasonal pattern to this demand for appointments. Most doctors were aware of this trend because there were specific weeks of the year when they avoided taking holidays. Our reception staff kept meticulous colour coded records of such ‘same day appointments’. When we entered this data on a statistical database there could be no doubt of a seasonal pattern with definite peaks and troughs. What’s more, we could predict the demand for ‘same day urgent appointments’ with reasonable confidence. At this point it may be important to stress that doctors in the UK are paid a ‘capitation fee’ for serving patients. That means they are paid an annual fee no matter how many times they see the patient. There is no monetary incentive to maintain the demand for face-to-face appointments. However that may be the only good thing that can be said of capitation, over the years the funder has used this payment structure to change the experience for the patient and not always for the better. Our salvation at the practice where I worked in the late 90s was born of the determination to serve patients better, but at the same time to maintain the enthusiasm and commitment of our doctors. We were sure we could do both.
Understanding that people have a fundamental desire to talk to the decision maker we settled on the notion of putting the doctor in charge of making the appointment. Patients who requested a same day appointment were offered a telephone consultation with a general practitioner initially. Not with a nurse, as happened in some practices, but with their doctor. We believed patients wanted to speak with a medical practitioner, not because the advice they received was necessarily better than that given by another member of the team, but because people in distress want a doctor. Whatever the reason it worked. Important policy makers noticed. Doctors could deal with most requests within a couple of minutes, offer a same day slot or something else without the need for face-to-face appointment. We calculated a 40% reduction in demand for such appointments. Patients loved it, reception staff loved it too (no more arguments about lack of appointments with irate patients) and doctors found themselves in control of their workload. What’s more we could prove that this simple intervention worked from the impact on longitudinal seasonal trend.
Telephone consultations are now routine practice in the UK. This innovation was born of intuition, it was led by local practitioners with a firm understanding of their patients’ experience. It required the courage and leadership to change accepted and ingrained ways of working, in order to make people feel better about engaging with their doctor. We didn’t require permission from committees, big research grants or publication in high impact journals to make a difference. It’s true that this didn’t seem to work everywhere, but in many practices this lean innovation made a huge difference.
By allowing patients to speak to their doctor when they felt they couldn’t wait our practice chose to treat this small minority of patients differently to those who were happy to make a routine appointment. We acknowledged that these patients had a need that warranted a creative solution. Perhaps you have a group of patients who would benefit from being treated differently too? Who knows you might even make your own working life more pleasant into the bargain.