WellBN Appointment Data Response to The Argus Newspaper Article
GP appointment data has been available from NHS Digital since October 2018 – Appointments in General Practice – NHS Digital. Data collection has become more sophisticated recently to allow greater analysis though information gathered remains experimental and there are issues about poor data quality and coverage – Appointments in general practice: supporting information – NHS Digital – alongside interpretation and qualitative context.
The local Argus newspaper released an article on 16th September 2023 – Brighton and Hove: Thousands waited more than a month to see GP | The Argus – describing waiting times to see GPs across the city. But the headline figure used relates to all types of appointments and not just seeing a GP, so it will include appointments for both urgent and non-urgent activity and anything from having a blood test, to a telephone appointment with a Nurse Practitioner for a rash or fever, or a Practice Nurse for a routine smear or follow-up after an operation for a stitch removal.
WellBN was noted to have the highest appointment waits longer than 28 days for an appointment at 976 patients in July, though in contrast WellBN offered the most same day appointments at 4,816 patients during the same month. WellBN was top of the ‘waiting list’ apparently but noting that a ‘routine’ appointment may be appropriate for some issues or at the request of the patient. Other practices may not allow pre-bookable appointments beyond on-the-day so this will skew data and potentially make other practices appear ‘better’ performers and cannot be used to compare performance. In fact, this type of appointment access restriction is being monitored and negatively viewed by NHS England. Some practices, however, may have to modify their appointment system considering their practice population characteristics, e.g., those who provide healthcare to the homeless or student groups.
Information provided by NHS Digital is broken down into all appointments, un-scheduled care appointments described as those not usually booked in advance, and appointments categorised by healthcare professional. Data may not be capturing information which reflects the actual way of working within a practice, for example triage contacts such as the Klinik system used at WellBN. Frequently data provided by the NHS should be used with caution and should not be used to make judgments on practice performance whether than comes from statistics from chronic disease monitoring (QOF), vaccination rates, or appointment data.
During the pandemic, WellBN offered a huge increase in appointment availability, alongside all practices, where appointment demand increased by about 20% in the period prior to the pandemic and two years later noting the challenges associated with COVID-19, as well as providing COVID-19 vaccination during the pandemic. Some NHS England statistics quote up to a 33% increase in demand in some regions during late 2019 compared with late 2021. WellBN has been responding to an approximate 30% increase in demand comparing the last few months to the previous year with July 2023 face-to-face appointment activity up 26.4% compared to a year ago and a slight reduction in telephone appointments by only 3.7%. Remembering that WellBN merged two practices on 1st July 2022 and all COVID restrictions had ceased a few months before. Monthly appointment activity is published regularly and available at each practice site, though the figures don’t exactly match those from NHS Digital changes in trends of equivalent data is appropriate.
WellBN offered 14,448 appointments during July 2023, followed by 9,625 by Charter Medical Chater which is a larger practice by approximately one-fifth more patients. This big discrepancy might demonstrate inconsistencies about recording all patient contacts. Accurately recording our patient and non-patient activity has been an important focus on being able to accurately assess our workloads.
Another way of looking at the data is related to practice list size rather than absolute numbers. WellBN had 25,060 patients registered in July 2023, so adjusting for list size WellBN is in fact 5th on the 28-day appointment waiting time and 8th out of the 29 Brighton & Hove GP practices providing same-day appointments and remains the same ranking at 8th for an appointment with a GP at 28 days or more. Interestingly Arch Healthcare who provide services for the city’s homeless have the highest in both same-day and pre-booked 28-day appointments for both all needs and seeing a GP which reflects their approach to manage this group with specific needs and limitations. It could be interpreted that the higher-ranking practices provide a greater range of appointment availability to enable access.
NHS Digital has provided practice level data for monthly appointment numbers, waiting times, type of appointment booked, and healthcare professional seen
WellBN provided the highest same-day appointment availability in Brighton & Hove in July 2023
WellBN ranked 8th out of 29 Brighton & Hove practices for providing same-day appointments, adjusted for practice list size
WellBN ranked 5th out of 29 Brighton & Hove practices for 28-day appointment waits, adjusted for practice list size
NHS Digital information is considered experimental and there are concerns about data quality and coverage, therefore should not be used as markers of performance
Data available may reflect unique characteristics of the practice population and individual ways of working within a practice, and therefore needs greater levels of analysis than numbers alone provide, so should be interpreted cautiously
In response to the current challenges:
WellBN has provided a huge increase in appointments from before the pandemic and has continued to do so despite limited resources
WellBN has adapted to the increased pressures by adopting a patient flow system, supported by Klinik, and a clinical team and utilising newer ways of working
WellBN has recorded the data as required by the NHS in the format requested as well as monitoring its own data
Written by Dr Francis Richards