Why focus on this?
There is enormous pressure on appointments, especially with GPs and ANPs. But what if some of their booked appointments could be avoided?
As far back as 2015, national research was showing that some of the work being done by GPs was potentially avoidable.
In an audit of 5,000 consecutive routine appointments, GPs rated 26% to have been avoidable if the practice had handled the patient’s need differently.Making Time in General Practice (2015). Primary Care Foundation and NHS Alliance.
More recently, 4 local practices audited their routine GP appointments and found that 24% were ‘wholly avoidable’ and a further 24% were ‘partially avoidable’. Even relatively small changes in how patients’ needs are assessed and signposted can have big benefits for patients and the practice.
What can be done
In practices who have examined their data and their access systems, the following potential improvements are repeatedly identified:
- Get information about the patient’s need when they first contact the practice
- Redirect administrative queries away from clinicians
- Enhance the effectiveness of signposting in reception
- Make most appropriate use of additional roles, social prescribing and other local services
- Improve continuity
Enhancing care navigation is part of the RAFT access actions. Read more here.
The BSol Avoidable Appointments Audit
A rapid and simple way to measure how many GP appointments could be handled differently, improving access for patients and managing workload for practices.
The PSU has developed:
- a simple online data collection form. It generally takes a clinician less than 5 minutes to complete this for a half day session.
- a practice results dashboard. This presents the overall proportion of avoidable appointments together with analysis of the specific areas for improvement.
Practices can use the steps below to plan their approach.
As part of the RAFT programme, practice managers will receive an email invitation with a specialised link to register the clinicians you want to use the audit. This will be sent after the first meeting of the locality collaborative.
The audit is designed to assess appointment usage for GPs and ANPs. A future version is planned which will be relevant to other clinicians.
The suggested approach for the practice is as follows:
- pick a week when clinicians will collect data
- brief everyone in advance
- ask each clinician to complete the audit for a day where they have the most ‘routine’ appointments
- send a reminder to all clinicians about the audit at the start of the day they will be collecting data, and at the end of each session
3 Enter data
For the clinician:
complete a form on the online audit for each non-emergency appointment you have on the specified day
- it is recommended that you do this in a batch at the end of the session, although it is possible to record each appointment as you go, provided you leave the web browser open with the audit page
for each appointment, record your personal judgement about whether this appointment was potentially avoidable – either entirely or for part of the work you did in it. Could this appontment with you have been avoided today by being handled differently? This is about your clinical judgement, so don’t overthink it.
- if you think the appointment could have been avoided, please use the additional boxes that will appear to indicate how it could have been handled differently. These boxes are optional, but the information they provide is invaluable for prioritising improvements in the practice.
- where practices record that better management by secondary care would have avoided an appointment, the anonymised data will be gathered across the whole of Birmingham and Solihull and provided as evidence to the ICB.
4 Review the results
When the practice registers for the audit, you will receive a specialised link to view your results dashboard. This cannot be viewed by other practices, but you can export it to support discussions as well as for your own evidence for QOF and CQC.
The results of the audit tell you two things:
- how many of our GP and ANP appointments could potentially be freed up?
- what areas should we prioritise for improvement?
As part of each locality RAFT collaborative practices will have the chance to discuss their results and develop plans for making improvements. This will enable full achievement of the relevant QOF requirements.
Key points to note:
- This is not a performance audit. There are no ‘right’ answers. It provides an assessment of the areas where you could make the biggest improvements in the practice – it’s a conversation-starter. The results do not indicate failures of staff in the practice but might point towards fruitful areas for improving processes, guidance or training.
- This audit does not gather any patient-identifiable data. The anonymised results are aggregated and made available to staff in the Provider Support Unit who are working to support localities’ RAFT programmes. This enables them to support conversations in networks about opportunities for change. It is not a performance management tool and practice identifiable information will not be shared with regulators or commissioners without express permission of the practice. It is not envisaged that this will ever be sought.
- The results from this audit can be exported for use as evidence in your practice’s QOF and CQC submissions and personal CPD. As part of the RAFT programme, the Provider Support Unit will present the ICB with anonymised aggregate data about the burdens on general practice appointments caused by secondary care management.