Castle PartnershipIn response to patient feedback from the National Survey results, Friends and Family results and a separate GP survey we asked an external company to undertake on our behalf, we have been reviewing our appointment system. From this we have made the following changes:
- Reopening the website to allow patients to book routine appointments.
- Reopening Airmid (formally SystmOnline) to allow patients to book telephone appointments.
- Removing the “Triage First” model introduced during the Pandemic allowing Reception staff to book Pts in face to face without the need of a telephone consultation first (please note that for some conditions this does still apply where clinically appropriate).
- An alert on the phone to inform incoming callers that we have reached capacity for the day.
All GP surgeries operate slightly differently. So we hope that by providing this information it will help highlight the changes made and to ensure that all patients are getting the most out of the appointments. Below is a FAQ to explain how the system works and how to book an appointment.
To start with it might be worth a quick precis of a few key points for you to be aware of.
Key Points
- Our face to face appointments are up to 15mins in length.
- Our telephone appointments are up to 10mins in length.
- For a telephone appointment we do not provide a set time, but you will be told it will be either AM or PM when you can expect a call back.
- Each Surgery has its own main telephone number and this is answered by staff at that surgery. Whilst we are one Partnership, we do ask that you call your registered surgery. We will only “join” the telephone lines together in extreme circumstances
- We have 15 GPs (General Practitioners) in total across all three surgeries and with our current registered patients this averages out to be just under 1,200 patients per GP. The Office of National Statistics states that in England the average number is 1,700 patients per GP (1).
- On an average week, the Partnership (not including Registrars, Nurse Practitioners or Physician Associates) provides, as a minimum, the following number of appointments:
Face to Face = 467 per week
Telephone = 578 per week
- Castle is an active training partnership and we teach medical students as well as Drs who are fully qualified, on the General Medical Council register and specialising in becoming GPs. These Drs are known as GP Registrars. They work on placement with us for a few months before moving to their next placement or fully qualifying as GPs and finding permanent employment. Over the past two years we have employed two GPs who started as registrars with Castle.
- The average wait for a pre-bookable GP appointment for any GP across the Partnership is (2):
Face to Face = 7 days
Telephone = 5 days
- GPs have appointments available to book five weeks in advance.
- We offer a set number of same day appointments to deal with acute issues.
- A Nurse Practitioner and a Physician Associate work closely with the GP team and see patients with acute, on the day, issues.
What appointments do you offer?
The Partnership offers of appointments that you can book with a range of fully trained staff. Often the first thought is that “I need to see a GP” however it may be more appropriate to book an appointment with a specialist staff member who can see you more quickly.
Within Castle we have the following clinical staff who are all able to see patients and reception can book you an appointment with:
1. Phlebotomist.
2. Healthcare Assistant.
3. Nurse.
4. Nurse Practitioner.
5. Physician Associate.
6. GP.
7. Pharmacist Technician.
8. Clinical Pharmacist.
9. Physiotherapist.
Who should I book an appointment with?
Our reception staff have been trained to follow strict guidelines on who best to book you an appointment with. We also have an in house system that will help determine the most appropriate clinician to book you in with. Staff are trained on a regular basis and work within their remit. If they are unsure they will seek advice from a clinician. Whilst they are not medically trained, the clinical staff rely on an effective reception team to signpost the patient to the right service. The reception team have the complete confidence of all the GP Partners and their clinical colleagues in the partnership.
For example, if you called due to back pain, but are otherwise well, then it would be more appropriate to book you an appointment with the in-house physiotherapist rather than the GP. If you were to be seen by the GP, they may refer you to the physio for an appointment as the physio is the specialist.
We want to make sure that you are seen by the right clinician as quickly as possible. Our in house system, created with GP Partners with clinical oversight, assists staff to help signpost where best to book you an appointment. Of course if you want to see a GP then we can book this for you but there may be a wait for this appointment and a possible further wait to be seen by a more appropriate clinician.
As a guide the list below gives an idea of what each clinical role in the surgery undertakes. Please note that this is not an exhaustive list:
- Phlebotomist = Blood tests. ECGs. Health checks
- Healthcare Assistant = Health checks. Dressings. Chronic condition reviews
- Nurse = Childhood immunisations. Complex dressings. Long term condition reviews
- Nurse Practitioner = Same day issues. Pt diagnosis and treatment. Complex reviews. Prescribe in their own name
- Physician Associate = Same day issues. Pt diagnosis and treatment. Complex reviews
- GP = Same day issues. Pt diagnosis and treatment. Urgent and Specialist treatment inc referrals to elsewhere
- Pharmacy Technician = Undertake medication reviews. Prescription or medication queries. Health checks. Long term condition reviews.
- Clinical Pharmacist = Undertake complex medication reviews. Consult and treat Patients directly. Carry out complex long term conditions reviews
- Physiotherapist = Assessing and diagnosing musculoskeletal conditions. Providing advice for Pts. Onward referral to specialist services if needed.
This is not the complete list but a guide for illustrative purposes only.
What is the difference between a ‘Same Day’ and ‘Pre-Bookable’ appointment?
There are two main types of appointment you can book for a Nurse Practitioner, Physician Associate and a GP. These are either Same Day or Pre-Bookable.
Same Day:
These are appointments that are released at the start of the day for Physician Associate, Nurse Practitioner & GPs. The reason is it allows for a limited number of appointments to be booked for issues that are acute and may require same day treatment. Depending on the day will depend on how many same day appointments are offered. This will be influenced by clinical staffing as well as the day. For example we will have slightly more same day appointments offered on a Monday than we do on a Wednesday to cover any issues that may have happened over the weekend.
The number of same day appointments must be limited as it is clinically unsafe and unstainable for staff to have a ledger of appointments that has no end. Both the British Medical Association and the European Union of General Practitioners advises that a GP should have no more than 25 patient contacts per day to deliver a ‘safe level of service’ and they advise that anything over 35 contacts for routine issues would be considered an “unsafe level of service” (3) .
This is why when we reach capacity there is now an alert that will inform patients that we have reached our “Same Day Capacity.”
If you call we may offer you:
- A pre-bookable appointment if appropriate.
- Suggest that you contact NHS 111 for help and advice.
- Suggest that you access the Walk in Centre on Rouen Rd that operates a sit and wait system.
- Suggest that you access a local pharmacy for minor illness advice or treatment.
Please note: Online booking requests should never be used for booking same day appointments. Please call the surgery if you want to be seen the same day.
Pre-bookable (sometimes referred to as routine):
We have appointments available at least five weeks ahead that can be booked into, and both face to face and telephone appointments are on offer. We suggest that the best way to book these is via the website, or by phone if you are not able to use the website for any reason. Further information on this is below.
How do I book an appointment?
There are two main ways in which you can book an appointment:
1. Phone.
2. Online – via website.
3. Online – via Airmid (formally called SystmOnline).
book via phone:
To book an appointment on the phone, simply call your registered surgery number (there is one for each of our three surgeries) and request an appointment. Our phone line is open from 08:00 to 18:00 Monday to Friday.
As with all surgeries we are at our busiest on the phones from 08:00 to 10:00. If you do not wish to book a same day appointment, please call after this time when the phonelines do tend to quieten down slightly so you will not hopefully have too long a wait.
On the phone you will be asked to confirm your identity and what the problem is. Whilst you do not have to give specifics why you are calling, it does help ensure that you are seen by the right clinician. If you do not want to give a reason, then please feel free to say it is ‘personal’ and we will note that on the appointment.
To help manage demand we suggest that you contact the surgery by phone for either a same day appointment or if you do not have access to the website to make a pre bookable appointment online. The reason we ask this is to free up the phone lines as much as possible for patients who may need to get through for a same day appointment.
book online via website
To book an online appointment you can do this from the website by clicking on the Appointments tile on the front screen (in red) and then the “Get help for any health problem” button.
The online service is for pre-bookable, routine appointments only. It is not for same day appointments or home visit requests. For those you will need to call the surgery directly.
The online appointments system is open from 07:30 to 12:30 Monday to Friday and closed outside of these times at present.
All requests are reviewed and a member of the team will call you back to discuss your request and book you an appropriate appointment. As this is for pre-bookable appointments only we do ask that you give us 48 working hours to process your request and come back to you. There is no need to call the surgery if you have submitted a request online and you have received a confirmation email. Please only call us if you have not heard back after 48 working hours.
Staff will not review the online requests until the afternoon as this allows them to focus on answering the phones for same day requests.
book online via Airmid (formally SystmOnline)
We use a clinical system called SystmOne which is developed by a company called TPP. Part of this system allows access for patients to be able to book appointments directly with a GP. The system used to be called SystmOnline but has been renamed Airmid where you can download a smartphone app or use it from a web browser.
At present we have telephone appointments available for patients to pre book via the app directly 24 hours a day. Over time we will be looking to introduce some other bookable appointment types, for example some types of blood tests, to be phased in during 2023.
To find out more information and to download the app, please visit the link below.
Airmid: https://tpp-uk.com/products/airmid/
What if I need a home visit?
If you are too ill to travel to the surgery you can request a home visit. This must be done on the phone and not online. Please make sure that we have received your request before 10:30 to arrange a visit. This will enable the GP to prepare and to discuss your request with the other GP when morning surgery is finished.
After 11:30 your visit will be dealt with by the duty GP for that day.
If you believe your need for a home visit is urgent, please tell our receptionist. The receptionist will ask you for some details of the problem so the degree of urgency can be assessed. Details will be passed to a GP, who may telephone to discuss your situation prior to visit.
We may also refer you to the Home Visiting Service (HVS) once the request has been reviewed by a GP in surgery. The HVS is a Primary Care Network service where we can ask another GP or Nurse Practitioner to attend. This allows doctors to remain in surgery seeing more patients.
What is/was Triage First?
Triage first was the name given to the system used during the pandemic whereby reception staff were not able to book in patients face to face with a GP but patients were booked into a telephone slot first.
With the new appointment system we have removed the need for all appointments to be triaged by a GP first. This means that for most issues you will be able to book a face to face appointment.
There are a few exceptions to this, and these will be explained to you if relevant when you book.
I have been told you are at capacity. What do I do now?
Like all services, we can only provide what we have available. It is clinically unsafe to have an appointment ledger with no defined limit. Whilst we will also do our best to try to find a solution for you, this may mean you are not able to see a clinician on the same day. For that we do apologise as we do not want to stop any of our patients from accessing our service.
However when we do reach capacity you will be offered a range of alternatives to help. These being:
o Offer a pre-bookable appointment if appropriate.
o Suggest that you contact NHS 111 for help and advice.
o Suggest that you access the Walk in Centre on Rouen Rd that operates a sit and wait.
o Suggest that you access a local pharmacy for minor illness advice or treatment.
Whilst this is the same for many GP surgeries both locally and nationally we understand the frustration in being told you are not able to book an appointment on the day. We will always try to help as much as possible but it is an unavoidable truth that we will reach capacity.
What do I do if I have a query or issue with my medication or prescription?
The Partnership has a dedicated Prescription Hub that is staffed by trained Prescription Clerks and Pharmacy Technicians and a Clinical Pharmacist open from 09:00 to 17:00 each day. To speak to a member of the team, please call the surgery and press Option 2. You can also submit a range of forms online to either request medication, prescription synchronisation or a general medication query such as:
- When you should take it and what to do if you miss a dose.
- What the possible side effects are, and what to do if they occur.
- Change in medication after hospital visit.
- Expired medication.
- Stopped medication.
- Holiday Requests.
- Private Prescriptions.
- Urgent medication.
- Request for medication not on repeat.
- Increase/decrease in dosage, i.e., wrong amount issued.
- All chemist queries.
- Batch medication queries.
- Electronic prescriptions.
- Online prescriptions.
- Organisation that sends in medication request (3rd party).
- Minor reactions or general guidance.
To access these forms online, please click HERE;
How do I order my repeat prescription?
You can order your repeat prescription in a number of ways. Either:
- Via our website by using the form HERE;
- Via Online Services (Airmid, formally ‘Systmonline’) using your login details HERE
- Via your pharmacy if they have a repeat prescription service;
- Via the NHS App;
- Via email to: nwicb.prescriptions.castlepartnership@nhs.net
- Or by returning the repeat slip to the surgery and handing to Reception.
We do not accept repeat prescription requests over the phone. The reason for this is that often medication names are complex and discrepancies can occur. So that is why we do not accept repeat requests over the phone. It can take up to 48 hours for your prescription to be ready. We will always try to ensure your prescription is ready as soon as possible, but we do say that 48 (working) hours is the maximum you will have to wait.
We do accept repeat prescription requests up to 7 days in advance to allow you suitable time to ensure you have enough medication.
During Bank Holidays please allow extra time & hand your prescription in early. You should never leave it until the last minute to submit your prescription.
Do I need a medication review?
Patients on repeat medication will be asked to see or speak to a doctor, nurse practitioner or practice nurse at least once a year to review these regular medications and you will be informed of this and you will receive a reminder to book your review appointment. This will depend on the medication you are prescribed. If you are unsure then please speak to the prescription hub for more information.
Please ensure that you book an appropriate appointment when you are notified to avoid unnecessary delays to further prescriptions. If you are unsure if you should have a review or when it is due, please speak to the prescription hub for more information.
Prescription fees
- View the cost of prescriptions on the NHS website.
- You can also find out if you are entitled to free prescriptions.
Zero tolerance for abuse
Whist we make every effort to try and ensure that you are seen as quickly and efficiently as possible the sad fact is that we have seen an increase in abusive behaviour towards our staff. This is primarily directed to the reception team when some patients are not able to get what they would like.
Whilst we recognise that this is a minority and not the majority of patients, the abuse staff have to face is not acceptable. This ranges from swearing, threats and in a recent incident physical violence and damage to surgery property.
Abuse can take many forms including saying to staff that “if I die, it will be your fault.” This is often levelled at reception staff by patients unhappy if they are unable to get an appointment on the day. This places an unacceptable amount of stress and worry on our staff who try to help as much as possible.
All calls are recorded not only for us to learn from any mistakes we make but to also ensure that where a complaint or abuse needs to be investigated, it can be backed up with evidence. Likewise all surgeries have CCTV in their common areas for the benefit of patients and staff alike.
Any breaches of the partnership zero tolerance policy will be dealt with swiftly and robustly. This may mean removal from the partnership and having to register elsewhere. Where appropriate we will always involve the Police and seek action through the courts, if required, to protect our staff.
We will make sure that you are treated compassionately and respectfully and our staff deserve the same.
References
1 – (accessed 23/02/2023) – Trends in patient-to-staff numbers at GP practices in England – Office for National Statistics (ons.gov.uk)
2 – This data was taken from SystmOne on the following dates to provide the average 04/02/23, 08/02/23, 11/02/23, 14/02/23. This is intended as an example only on the assumption of the next free appointment with any GP at any location. Requests for specific GPs will vary in length depending on working patterns, teaching, surgery list size, A/L, etc.
3 – (accessed 23/02/2023) – https://www.bma.org.uk/media/1145/workload-control-general-practice-mar2018-1.pdf