NEWS: GPs advised to use waiting lists

As reported by GP Online, BMA guidance suggests GP practices adopt waiting lists to better manage patient demand and ensure urgent cases are prioritised

‘The vulnerable patients that are sick will get seen,’ BMA England GP committee deputy chair Dr Samira Anane said. ‘And those that can wait will need to wait due to the fact that we don’t have limitless capacity.’

The BMA’s safe working guidance, which is in the process of being updated, now includes advice on waiting lists. It says: ‘There has been pressure on GP practices to provide near immediate assessment and management of all patient problems regardless of actual clinical urgency. This is impossible to maintain and not required by the GMS contract.’

It highlights that under the GMS contract practices are only obliged to ‘provide for the reasonable needs of their patients’ and ‘assessment of urgent problems’.

Safe working guidance

The guidance advises that any patients that can wait should be placed on the waiting list ‘if safe capacity for appointments is exceeded for the day’. ‘This will allow GPs to focus their resources on those with the greatest need,’ it adds.

The BMA recommends that to deliver safe care GPs should have no more than 25 patient consultations in a day and that practices move to 15-minute appointments.

Dr Anane said that the way practices introduced waiting lists would be different according to their setup and patient population, but that clinical prioritisation – which could involve a ‘red, amber, green’ system – was key.

‘You’ll have your urgent [patients] and you’ll distribute those, and then you may have the ones that might be able to wait a couple of days,’ she said.

Dr Anane said that safety netting was an essential part of running a waiting list. Patients on the list should be given ‘really clear instructions’ about when they need to contact the practice if their condition worsens and understand that ‘they can come and bother you’ if they need to, she said.

General practice waiting lists

The BMA’s guidance says that waiting lists based on clinical need is ‘an approach that exists in secondary care, even if it means that patients with non-urgent problems may wait a number of weeks for an appointment’. It points out that introducing waiting lists simply ‘formalises the already existing informal waiting lists for patients that cannot get an appointment at a convenient time’.

The BMA has also advised practices to move away from a ‘duty doctor’ system, which it says effectively means they are dealing with uncapped demand. Instead, it recommends they make use of care co-ordinators and appropriately trained reception staff to direct patients to suitable alternatives, where possible.

Dr Anane said that introducing waiting lists might be a ‘little bit scary’ for some practices, but if done safely it could help them better match demand to capacity.

Cap on appointments

She suggested that moving towards a cap on appointments per doctor could be a gradual process, where the number of consultations a GP carries out in a day is reduced over time, arguing that this could help boost continuity of care and even improve patient satisfaction scores.

She also recommended that practices make use of the wider healthcare system to help alleviate pressure.

‘We often feel like we’re a sponge, that we end up taking the pressures and the spillover from other parts of the system,’ she said. ‘But actually, there are other parts of the system that we should be using that may be more appropriate. So use other providers within the ICB.’

Last year’s England LMCs conference voted in favour of establishing waiting lists for routine appointments, which delegates said would help to quantify demand and hidden workload.