We are very busy on Mondays.
We have some ideas why and have over time tried to accommodate this increased demand for our services on a Monday by providing more receptionists to man the phones that day as well as making sure all the Doctors, including the part-timers, are available that day.
It is increasingly difficult to manage what we see as disproportionate extra demand on one day though.
All the Doctors and the Nurses have Surgeries that you can book ahead of time.
If you want to see any Doctor, routinely, then the next appointment is I think in 2 (working) days time.
If you were to ring today to book to see me personally, the next appointment is about a week away.
All the Doctors get booked up like that.
If you haven't had the foresight to book an appointment anticipating an illness a week away then what you'll do is ring in when you actually feel ill to see if you can see a Doctor (or Nurse).
So...to balance this, each day we allocate 3 sessions of Doctor time to manage this "same-day" need.
In the mornings we have one Doctor able to see patients in a same-day Surgery with 18 or 20 appointments.
Another Doctor is manning the phones -madly ringing people back to discuss the problem they rang in with to see if it can be dealt with on the phone, by the Nurse, deferred a day or two... or some other way. Seeing if we can't manage the demand.
In the afternoon one Doctor does both tasks.
Most days this is fine, but Mondays is getting a bit crazy.
Last week Dr Frankland dealt with I think 110 phone calls in the morning session.
Most other days it is a mere 50 or so in the morning.
The Doctor in the afternoon session is seeing patients who have been booked in to see them as well as trying to triage telephone calls, so that can be pressured too.
(btw I do sometimes wonder why patients ring in to see the Doctor but leave ringing til 5pm? Why didn't they ring earlier in the day?)
You could argue that we just need to provide more medical staff to cover the demand...
We feel though that we have enough cover, it is just that the distribution through the week is excessively skewed.
If we were to take another doctor out of their routine work to cover the excess demand on a Monday then they would have fewer appointments for the routine investigative and preventive work that we do.
What I think we want to avoid is a situation where we make accessibility variable (that is to say, better on a Monday), because that then begins to support the need for people to ring in on a Monday. If there are Doctors available and there is demand then I feel it would in the end only escalate the situation. What we would rather do is see if we could modify the patients' behaviour. To this end we have begun to think what are the basic guidelines for accessing a Doctor.
Something like:
1. Consider when you need to be seen. Being seen the same day it occurs to you to ring isn't always necessary
2. Try to plan ahead, even if just a little.
3. Consider even if you need to see the doctor face to face... a phone call might well do. Or an email. Or see the nurse. (the nurses are all very good)
4. Try to keep seeing the same Doctor for ongoing conditions. It does help. But you will probably need to book further ahead. (Vide supra)
5. Consider leaving phoning til later in the week. It should still get sorted out, whatever it is.
Any others you can think of...? - might be nice to add a comment to the blog for this... I have, after all, written this purely from my own perspective and feedback is appreciated.
4 comments:
Probably one major reason for very busy Monday's is the length of time since the surgery was last open. If a problem crops up over the weekend then patients have all weekend to worry about it, generally making the problem much worse than it is and causing even more stress related problems. Patients could be encouraged to use the national helpline if only it were any good!. To have to wait two or more hours to even talk to someone and then get advice which is indecisive to say the least. Then anything from four to six hours wait to see a doctor if the person you spoke to sees fit. A decent,reassuring, and competent out of hours service would in my opinion relieve a lot of Monday pressure.
on ringing at 5pm, i suspect that many of us ,or maybe i speak just for me, have an internal dialogue before we even call in! this is exacerbated by chronic conditions, or fear of being percieved a hypochondriac or anuisance, the call at 5 may be the result of a day of dilemma, and realising that there is a potential other night of worry, so at the last minute we call in.
Not really anonymous (S. Burgess), but can't work out how to use other "signatures". I agree with last comment. A "wait and see" attitude is the one I take which means that I wait until I have to to 'phone in, meaning (usually) later in the day if things haven't improved or look as if they are getting worse.
The Practice is perhaps a victim of its own success in the area of over-the-phone advice. My own experience has been really positive and I estimate that a call takes less than a minute compared to a ten minute appointment slot. As a patient, I want to do what's most efficient for myself and the doctor, so it really is for the Practice to agree the best way of having patients contact the surgery for diagnosis/prognosis and advice. I will follow wahtever protocol is agreed! Is there a nurse practitioner who can triage us?
The morning phone-in slot which all the doctors have at least once a week is an excellent idea but it is very frustrating to hang on the line for 15 mins or so while in a queue and then be cut off when the allotted time is up!Especially as some doctors only have one session a week. Would it be possible for the doctor to phone back the patients in the queue who are cut off, later in the day? This would involve some way of checking who was in the queue! Maybe a secretary could take the phone-line for a few minutes and inform the callers. Or could we send the doctor an e-mail which they can read at their convenience?
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