The UK is getting to grips with the endlessly difficult issue of improving primary care. Bottlenecks at GP level can be overcome, some doctors have found. With better efficiency comes improved health. Waiting to see a GP in Britain has become a logistical nightmare, but some are forcing radical change.
Telephone on a Monday morning and you will be lucky to be offered an appointment for Thursday afternoon. The few "urgent" slots rapidly fill up, leading to an adversarial game of "my problem is worse than theirs" being played out between patients and practice staff.
Dr John Oldham is a Derbyshire GP. He is also head of the National Primary Care Development Team for England and Wales, which is heading a drive to improve access to GPs and primary-care services.
"Advanced Access is about appropriate care and not about instant access to healthcare," he says. His team's slogan - "Doing today's work today" - was met with scepticism by some practice managers and senior partners. They fear an insatiable patient demand and do not share the Primary Care Development Team's conviction that demand is predictable provided that the following steps are taken:
Understand the demand for access to a particular practice
Change the handling of that demand
Match the capacity of a practice to patient needs
Make contingency plans to sustain the system
So what does this mean in practice? One of the pilot sites for the programme is a six-partner practice in a semi-rural area that looks after 11,500 patients. The wait for a routine appointment had been between three and five days, with huge pressure on same-day "urgent" slots. As a result, only 60 per cent of patients were being seen when they wished.
Having introduced Advanced Access, including altering the way they handled demand on a Monday, the practice's busiest day, and creating a dedicated telephone-consultation service, practice staff say that both their own and patients' lives have become easier.
Significantly, overall demand has not increased, and the number of people not turning up for appointments has dropped from 120 per month to 20, freeing up almost 17 hours' consultation time each month.
Oldham says the initial pilot results have been outstanding. Dealing with same-day requests through the telephone-consultation scheme has reduced the number of subsequent face-to-face consultations by up to 50 per cent. Doctors now plan follow-up consultations - usually arranged to check on the progress of a treatment - as telephone calls or schedule them for days other than Mondays and Fridays.
In some practices, patients now e-mail requests for repeat prescriptions or queries about ongoing treatment - and receive prompt replies.
One practice that dedicated a programme of change to the self-management of asthma achieved a 90 per cent reduction in emergency hospital admissions for the condition. The implication of such changes for the management of chronic disease is huge, according to Oldham.
"By eliminating the distinction between important and routine," he says, "our programme has exposed a hidden capacity within the primary-care system, which has benefited both consumers and care-givers."