The following example is a GP practice which has introduced a capped system whereby the practice sets aside a specific number of urgent appointments and routine clinics per GP session per day.

The system has been negotiated with the GPs in the practice to meet growing demand and allows GPs to adjust their own clinic time and control administrative workload. Below we detail how the capped system is broken down between different appointment categories.

How it works

Routine clinics:

The routine clinics consist of a specified number of appointments (morning and afternoon):

• x number of 15 minutes face-to-face appointments
• x number of 10 minutes telephone appointments
• x number of 10 minutes usual routine GP appointments, which doctors can use to arrange appropriate follow ups.
• x number of 5 minutes sick note requests slots

Most GPs provide an equal split between telephone and face-to-face bookable slots and choose how to use their appointments – dependent on patient need/complexity and preference.

The routine availability for each clinic has slots ranging from 3–14 days – but no further ahead as this increases the risk of DNAs.

The admin team proactively books patients in for their dedicated 6-week Mother and Baby appointments and patients with skin conditions are booked in with the GP who has specialist dermatology expertise – maximising GPs areas of interest and where possible, avoiding the need for referrals and lengthy hospital waiting lists.

Finally, to free up GP time, the pharmacy team supports the practice by dealing with medication reviews and queries.

Urgent on the day problems (DUTY):

There are a set number of urgent appointments available per GP per session. Once capacity is reached, additional urgent appointments are added at the GP’s discretion. The practice keeps urgent appointments separate from routine GP lists with a dedicated team providing urgent on the day care. This consists of doctors and one paramedic, doing a mixture of home visits and urgent face-to-face reviews.

Urgent appointments:

All appointments are telephone appointments first. Face-to-face reviews are arranged where appropriate.

When capacity is reached, patients are signposted to NHS 111, the local walk-in centre or pharmacy, as appropriate. Care navigators are trained to book a walk-in centre evening appointment for patients themselves, if this is appropriate.

Any home visits, palliative patients or other health professionals are put directly through to the duty doctor, even once capacity is reached. Similarly, care navigators will speak to the duty doctor regarding concerning patients (e.g., young child, acutely unwell, vulnerable adult), and an additional urgent appointment may be provided.