Today, we’re speaking to Dr Jamie Scuffell, GP and NIHR In Practice Fellow at King’s College London.

Title of paper: Patterns in GP Appointment Systems: a cluster analysis of 3480 English practices

Available at: https://doi.org/10.3399/BJGP.2024.0556

GP practices in the UK are using a wide range of different appointment systems to meet patient demand and improve access. This cluster analysis of NHS appointment data from 56 million appointments and 3480 English practices demonstrates two predominant models of primary care delivery. ‘Same day’ practices tend to fulfil appointments on the same day using GP telephone consultations. ‘Routine care’ practices tend to employ non-GP staff members offering face-to-face appointments and longer appointment wait times. ‘Same day’ care practices had younger and more urban populations.

Episode transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00 .640 - 00:00:54 .360

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the bjgp. Thanks for listening to this podcast today. In today's episode, we're speaking to Dr.

Jamie Scuffle, who is a GP in South London and an NIHR In Practice Fellow at King's College London. We're here to talk about a really topical issue in his new paper here in the bjgp.

The paper is called Paper Patterns in GP Appointment A cluster analysis of 3,480 English practices.

So, hi, Jamie, it's really great to meet you and talk about this work, I guess, really just to start, as you point out in this paper, each practice has their own systems and strategies to manage appointment booking. But how do you think that this impacts on access and patient appointment booking in each practice?

Speaker B

00:00:55 .000 - 00:02:17 .300

Yeah, it's interesting because I think, as you say, appointment systems have developed even further, really, since COVID and we've ended up with this a quite interesting diverse range of implementing appointments across the country, across England at least.

And I suppose the things that have changed are, you know, if you phone up a practice now, actually, you might not even phone them up, you might submit an online consult, you might be triaged, you might see not a gp, but a range of other professionals as well. And also it might not be done face to face, it might be done by telephone or online.

In fact, there's a new appointment system range of things that have happened across England, and actually there's some evidence that that might relate to access in some ways. So we know lots of people who don't speak English struggle to navigate that system of getting an appointment, for example.

And we also know from the qualitative evidence that there's some digital exclusion as well with appointments. So, yeah, so I think there's lots of issues with access and how that relates to appointment systems.

And so far what we've done is looked at components of the appointment system and how that then affects access. But what we haven't really done much of is looking at the appointment system as a whole and how that might affect access.

Speaker A

00:02:18 .180 - 00:02:33 .200

Yeah.

So in this study, you wanted to look at patterns of primary care delivery in English GP practices, and you used this Appointments in General Practice data set. Can you tell us just briefly what's available in this data and what you were looking at here?

Speaker B

00:02:33 .360 - 00:03:20 .700

It's a tremendous data set and I think could be very useful. So every English GP practice for every day of the week publishes up to NHS England.

The appointments that have Happened for the day across lots of different categories, actually, so across whether they've been attended or not, or not attended, whether they're face to face or telephone or home visits or online also if they're GP or non GP appointments. And the sort of. The real clincher that is brand new is looking at appointment lead times as well.

Whether these appointments were booked same day or whether they were booked more in advance when the data is good enough, which is an. If it's a very, very useful data set.

Speaker A

00:03:20 .780 - 00:03:43 .720

Yeah, so you looked at data from about three and a half thousand practices this year. So as you mentioned, you weren't able to look at all practices due to quality issues.

But just talk us through what you were looking at here and I guess, yeah, just start us off with telling us what you found and perhaps we'll get into how you group the practices as well into clusters. But yeah, tell us a bit more about what you found here.

Speaker B

00:03:43 .720 - 00:05:23 .440

What we wanted to do was take a set of measures, I suppose, of an appointment book.

So for every practice we said, well, actually we might define their appointment book by the proportion of people who see a GP or the proportion of people who have a telephone consult, or the proportion of people who are booked same day and seen same day. And we kind of came up with actually about 12, in the end, 12 measures of an appointment book.

What we then wanted to do was kind of group together practices with similar characteristics and we picked two different types. I suppose these were the two poles at either end of the spectrum.

And the two poles are that there's a more traditional, what we've called a routine care group of practices, and this is about two thirds of the English practices that we included.

And the appointment characteristics they had were they are more likely to book in advance appointments rather than booked on the same day, more likely to be face to face appointments, interestingly, more likely to use not just GPs but also non GP appointments for delivering care. So they're the big categorization of the routine ones.

So longer wait times, more likely to use non gps and more likely to have face to face appointments.

And then I suppose there's the sort of the more the newer style of appointment system, which we've called the same day appointment system, and that's more likely to be led by GP telephone consults that happen and are booked on the same day. And in this case, same day appointment availability is quite substantially higher than the routine care practices.

Speaker A

00:05:23 .600 - 00:05:34 .560

And you found that actually there was quite a lot of difference within the practice population and where the practice was based on these two sort of clusters. So the routine and the same day practices as well.

Speaker B

00:05:34 .960 - 00:06:59 .980

Yeah.

It's absolutely fascinating that it's not just differences in the appointment systems, but actually there are underlying differences, not just in the practice populations, but also in the workforce associated with each of those practices. So the practices that were same day, much more likely to be in urban serving urban populations rather than rural populations.

Also, this might just be an account of. Because they're more likely to serve urban populations, they also serve more ethnically diverse populations.

Interestingly, no big differences between deprivation. And then also the same day practices have a very slightly younger population overall than the routine care practices.

List size is also slightly bigger with those same day practices compared to those that have a more routine approach. Also, differences in workforce.

The number of direct patient care staff, full time equivalents per 10,000 people on the practice books is a bit higher in the routine care cluster than the ones who are delivering same day care.

And the differences are that actually GP levels are pretty much the same, but the routine care cluster employs more nurses and more nurse practitioners and also employs slightly more administrative staff.

Speaker A

00:07:00 .540 - 00:07:19 .490

Yeah.

So you work as a GP and I just wonder from your own experiences whether what you found in this data reflects what you know or understand sort of on the ground and whether you had any insights from your own work, which might sort of explain why there are these differences, or if you had any thoughts about that.

Speaker B

00:07:19 .650 - 00:08:44 .140

I did a whole load of locoming when I finished training, actually. It was fascinating to go to a dozen practices over a period of time and look at how the appointment system was set up.

And I think when you're an individual GP behind a door, seeing patients, it's sometimes quite hard to anchor yourself in the wider picture of what's happening at other practices, even the one just down the road.

So I think it's quite interesting to think about how especially the slightly more bigger practices where I work in South London do tend to have had a more of a same day approach to delivering appointments and have also been a little bit more telephone, triage, telephone first in their approach for a longer period of time.

So I think the, I mean, one of the challenges of when you clu