
Practice management
Reducing missed appointments
A systematic review explored the rate of missed primary care appointments, reported reasons for appointments being missed and the patients more likely to not attend appointments.
Patients were more likely to miss an appointment on a Monday. Some forgot, others couldn’t get time off work or find childcare. Those with a mental health diagnosis, multiple health conditions, in ethnic minority groups and those attending practices in areas of high deprivation were more likely to miss appointments.
o WiseGP actions:
How could you improve your appointment booking system to reduce missed appointments and increase your capacity?
Could your registrar audit missed appointments so you can target interventions to those most likely to miss appointments within your practice population?
As people are more likely to miss appointments on a Monday, could pre-bookable non-urgent appointments be scheduled on other days?
Do you have a simple accessible systems for patients to cancel appointments?
Do you make use of appointment reminder texts?
Read more about the research informing these recommendations here:
Implementing group consultations
Group consultations offer an alternative to one-to-one consultations for long-term conditions, providing clinical management advice, patient education and peer support. Clinicians enjoy facilitating these consultations, though significant work is required to initiate and sustain the approach and some patients may not be comfortable discussing concerns within a group.
WiseGP actions:
Explore at a practice meeting whether any team members have ideas for consultations that could be delivered at a group level. Would a PCN physiotherapist/occupational therapist group consultation be valuable to deliver falls prevention advice to elderly people scoring high for frailty within your practice?
Read more about the research informing these recommendations here: https://bjgp.org/content/72/720/e483
https://bjgp.org/content/71/707/e413
Identifying vulnerable patients who miss DNA appointments
Patients who miss more than 2 GP appointments a year are more likely to be vulnerable and have poorer health outcomes. Patients with more long-term conditions are at greater risk of missing multiple appointments, which is a strong risk factor for increased mortality. Repeated DNA’s should consequently be considered as part of the patient safety agenda.
WiseGP actions:
Consider having a proactive practice police for repeated DNAs. Ensure DNAs are coded and consider auditing DNAs and practice follow-up of patients with high DNA rates.
Read more about the research informing these recommendations here:
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1234-0
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30217-7/fulltext
