This site is intended for health professionals only
Saturday 1 October 2016
Share |

Why practices should support extended access

DEBBIE RAVEN
Chief Operating Officer, The Practice

When you're feeling unwell, many things can make you feel better. But hanging on the phone or queuing at a health centre, only to be told there are no doctor's appointments, are not on that list.

Government plans
In a bid to rectify this, the new coalition government recently announced that patients should have greater access to their GPs in the evenings and on Saturdays and Sundays. I couldn't agree more with this sentiment.

Prior to the election, the Conservatives promised to give all patients the right to see a local doctor every day of the week between 8am and 8pm, and this is now being put in place.

This new out-of-hours commitment means that clinicians must be willing to work more flexibly by offering more appointments at times that better fit with patients' needs. The abolition of practice boundaries also means being available to patients not only living locally, but also to those who work in or are visiting the area.

Challenge
Aiming to revolutionise the way people receive healthcare in the UK, every practice needs to provide a flexible working pattern that serves their patients better, but also engages with the needs of the whole surgery team including GPs, nurses, receptionists, etc.

Co-operating and accommodating the work/life balance of each employee is a tricky process to say the least; every individual has different requests, so scheduling shifts is a task and a half.  However, these shake-ups should not be rejected, as in the long run this new system will enhance the quality of patient care.

Difficulties between staff are expected to arise due to new shift patterns, especially in this day and age when 70% of our lives are spent working. So the experience needs to be a happy one and we must enable our employees to "tailor make" their shifts as far as possible to fit in with the rest of their lives. For example, we must accord female GPs returning to work and nurses developing their careers the flexibility required to bring up a family. Providing a flexible working pattern is integral; and that is why this is such a rewarding and worthwhile process for all involved. 

Implementation tips
A surgery's number one priority has and will always be having a patient-centric approach. By offering an 8am-8pm service, 365 days of the year, we have noticed significant advantages. Giving patients more flexibility in when and where they can see a GP or specialist clinician, this system reduces waiting times and ultimately will offer greater value for money to the NHS, freeing A&E departments to deal with acute and life-threatening conditions. It's a win-win situation. 

As Chief Operating Officer, I deal with the needs of our employees and with longer hours involved in running new-style GP-led health centres with their associated walk-in services. I need to be on the ball in satisfying each and every one of my staff members, within reason, while also meeting the needs of the services we run.

In our experience this can be achieved by looking at the capacity needs and demands of the GP centres at different times of the day and on different days of the week – shifts can be organised accordingly. We look at a lot of patient data every week and staff our centres based on trends; capacity management is the key in order to manage the influx of patients at different times of the day making queues less likely.

As patients are able to walk in and see a doctor without booking an appointment, and also don't need to be registered, we have found implementing a Queuing Theory minimises the queues and provides flexible capacity to keep up with everyday demands.

We have found that by accurately working out shift patterns required throughout the day, and recruiting specifically for these shifts, we allow our GPs and nurses to pick the slots most suited to their home life.

For example, if staff have children then a system should be in place to allow them to stipulate which shifts work best for them. This approach ensures the least impact on people's lives so that the work/life balance is kept. Often, GPs returning to work following maternity leave will find it easier to cover evenings and weekends due to childcare issues.

However, it is also important to ensure that shifts are allocated fairly and that everyone takes a turn at working the more unpopular times of the day if they are not all filled by choice. In our experience, adopting this approach and ensuring all team members' requests are recognised and met as far as possible promotes more harmonious working within the teams.

Future
We hope the new government plans allow GP centres around the country the ability to offer an improved service, providing better patient care and contacts, satisfying their needs and giving patients and clinicians a wider choice. This extended access to healthcare resources is great news for both patients and GPs alike.

However, as noted, shifts need to be managed effectively in order for this to be truly successful. The government is aiming to offer a service better matched to patient and community needs, and we eagerly await other clinics to get involved to help maintain high standards and create an even higher-quality community-based care solution.


Debbie started her career as an NHS nurse in the north-west of England and quickly rose through the ranks to Director of Nursing in Buckinghamshire. She is now Chief Operating Office for The Practice.

Your comments (terms and conditions apply):

"In principle this does not seem unreasonable. However, from my reading I believed that continuity of care came at the top of patient's priorities which surely this system could not cater for?" – Paula Elliott, Derbyshire

"In most parts of the country Darzi Centres have not been a success due to the fact that they address a 'London' problem. I would not be surprised if most are decommissioned when commissioning responsibility is handed over to GPs. Ms Raven refers in her article to 'government plans'. She obviously has not heard the new in phrase 'bottom up'" – Allan Stewart, location withheld