Suitable Patient Guidance

Improved Access (IA) is primarily intended to improve access to routine GP services for patients who find it most challenging to access general medical services in core hours.

It is not intended to replace Urgent Care services, and unwell patients requiring an urgent review should continue to use 111 and DDOC, MIUs or A&E.

Patients value and benefit from continuity of care, and so there are many patients with routine needs who will best served by seeing or speaking to a known GP in core hours.

IA is also not intended as a shop window for dissatisfied patients looking to doctor shop. Examples of patient groups who are the target demographic for IA slots are:

  • Working Patients
  • Carers
  • School age children and students with long commutes
  • Patients who work away during the week

Examples of patients who are not the target demographic and would be more suitable to see their own GP in core hours

  • Older or non-working patients who are able to attend in core hours
  • Medically complex patients
  • Socially complex patients especially where there are safeguarding concerns
  • Patients with significant mental health problems
  • Patients needing review of an ongoing situation already well known to their GP
  • Patients who are very frequent attenders already

The Out of Hours nature of these appointment means that in many surgeries they will be occurring during times of very low staffing without access to a full range of staff or facilities.

This exposes staff working IA slots to increased risk, especially where patients are unknown to the clinicians involved.

It is important that groups of patients who are more likely to be a risk to staff, or to put at risk the service through excessive or inappropriate use are not offered IA slots, either in their own or other practices.

For consultations that might involve an intimate examination it is highly likely that a chaperone will be needed for the protection of both the doctor and patient.

Examples of patients who should NEVER be booked into IA slots are:

  • Patients with a history of violence or verbal abuse
  • Patients who are known to be sex offenders, or who have any record of sexually inappropriate behaviour towards staff
  • Patients with a history drug seeking or manipulative behaviour
  • Patients who are suffering with severe mental health difficulties
  • Patients with a history of vexatious complaints

The fundamental questions for reception staff who are considering offering an IA slot are:

Would I be comfortable seeing this patient with only minimal support staff?

Would a clinician seeing this patient for the first time without any prior knowledge be able to meet this patients need given the complexity of their situation?

Credit to Dr Liz Crawford, Woodbury Surgery who developed this guidance for the East Devon Health group