How to address an increase in general practice call volume

As demand for GP appointments soar, Paul Bensley explores what can be done to address the number of calls doctor’s surgeries are receiving every day

CREDIT: This is an edited version of an article that originally appeared on Digital Health

The last few months have heralded a rising clamour amongst patients – and some sections of the national media – unhappy at the apparent difficulty in securing a face-to-face GP appointment. Irrespective of the clinical need for such an appointment, there has been a growing perception that GP practices continue to be ‘shut’ as we emerge from the pandemic.

This, of course, is inaccurate, reflecting a misrepresented view of the way modern primary care can and should be delivered with the support of digital technology. It also fails to acknowledge the huge patient demand for GP support, the challenges GPs face and the low morale currently in the profession. A recent plan from NHS England to widen access to GP services – including a new pledge to increase face-to-face GP appointments through a £250m winter rescue package – only served to further frustrate some GPs.

Of course, more appointments will equal more patients and one complementary measure to help deal with this, according to the pledge, is to improve practice ‘phone systems. Better telephony will certainly benefit practices and patients and level the technology disparity between practices nationally – but there is one immediate issue it won’t address. If more patients ring a practice, and there are not enough staff to take the calls and handle the appointments, those patients will need to wait, potentially leading to further frustrations.

The pressure mounts

NHSE statistics show that 86% of patients have had contact with their practice by ‘phone over the last year. During winter the volume of telephone calls increases. On Monday 4 October 2021, around 450,000 callers queued for an average of 9.1 minutes to speak to receptionists in their practices on our surgery connect systems; the majority of these were seeking to book appointments. Scaled up across England and Wales, we estimate that this equates to around five million inbound queuing calls. In total, assuming queuing facilities were available at their practices, patients would have queued on a single day for 760,000 hours to speak to someone.

Most of the time, particularly for patients calling surgeries with legacy ‘phone systems, individuals will spend their waiting time being informed of their place in the call queue and ‘entertained’ with music on hold. In some cases, they will have been greeted by certain information messages – COVID information or to dial 999 in an emergency, for example. Some patients will vent frustration when they eventually get through to their practices, extending call times further; this will particularly be the case if they don’t get the appointment they wanted.

The need to call a GP, as opposed to other forms of communication, is very unlikely to be replaced by other forms of communication methods. The demographics of those with greatest healthcare needs are such that the ‘phone will be preferred to online for many years to come – in which case, rather than magically eliminating waiting time for appointments overnight, it is important that waiting time is made as useful as possible for patients.

Worth the wait

Recorded information is the first thing practices should consider; what must we tell our patients, and what additional information may give them alternatives or reassurance? Many practices are playing long and compulsory introductory messages to patients before they are even permitted to join the queue, detailing triage process, physical access to the surgery, COVID policy and more. These run the risk of increasing frustration.

Some patients will respond less well to verbal communication and will prefer textual or online options. Some will not have English as their first language and, inevitably, delivery will be too fast for some to absorb and frustratingly slow for others. Playlists within queues allow succinct recorded messages to be rotated and punctuated with sufficient time for patients to absorb and action what they are being told. Information management systems can inform the practice which items patients responded to.

A patient’s needs may be best served by another service, perhaps a specialist option, rather than the surgery reception. Examples include 111, COVID hubs, pharmacies or ‘flu clinics. By offering informed choices alongside waiting times, patients can be given the option of taking control of their call. Many practices like to inform patients as to availability of certain resources – such as same day appointments, or ‘flu vaccinations. By allowing these updates to be made in real time, patients are not unnecessarily waiting for information, clearing the queue for others.

Some information is also better communicated textually, particularly if there is a link to an internet resource such as more information or an online consultation alternative. By identifying patients on mobiles, a message can be sent either automatically or in response to a patient request while waiting, potentially handling their needs. Alternatively, where a patient call-back option is implemented, patients can wait in a ‘virtual’ queue to be called back, meaning they hold their place in the queue whilst they get on with their day.

Self-serve and patient identification systems that allow patients to book and cancel appointments automatically have been around for a while. However, there are downsides to allowing patients this level of control through ‘phone services, particularly when demand is high. The process for identifying a patient must be very robust; a calling number is insufficient where households share a ‘phone, for example, and the risk of disclosing patient information, even within a household, must be considered. However, it can be beneficial to allow patients to cancel an appointment automatically without having to wait in a queue to do so. Again, this is another example of where a relatively simple digital provision can make a big difference.

If the future involves meeting patient demand with the help of technology, then so too does accepting reality and dealing as best as we possibly can with the challenges facing general practice.  Though these solutions do not remove the issue of patient demand for appointments, they do help to reduce patient waiting time, frustrations and, potentially, call volume – a worthwhile measure for practices as they tackle the challenging months ahead.