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​​​​Beckett House Practice moves to 15 mins appointments


The CCG knows the issues that most of our practices face. The challenge of large patient lists, long waiting times for appointments and not enough time for the doctor to spend with each patient. Beckett House Practice in North Lambeth is hoping to resolve these issues by offering 15 minutes for all routine appointments. After three months a pilot for this work is looking very encouraging. Waiting times for appointments are significantly down and there has been a dent in the practice’s did not attend figures.

Moving towards change

Changing the system means changing how people work and what they expect. Sandra Connolly, Beckett House Practice Manager (and Chair of North Lambeth GP Federation), spent at least a week’s worth of time auditing and scrutinising patients’ attendance patterns to work out the best way to implement a different appointments system.

Sandra says: “This is all part of our move to offer patients a range of options for receiving care, and for in-surgery appointments not to be seen in isolation, but as part of a mix of routine and emergency appointments, telephone appointments, using the GP Access Hubs, online bookings, as well as direction to community pharmacy for minor ailments and self-care.“

“Our principle is to see any patient that asks for an appointment, without triaging first. We didn’t want to change that - we want to keep it straightforward for a patient to see a doctor if they feel they need to. But we did need to find a way to manage the number of patients and the long appointment waiting times they faced.”

Acting on the research

The audit revealed that the practice needed to do more to manage peaks in activity. They had previously added more emergency appointments to each session, but in reality only half of the available emergency appointments were being used. A duty doctor system for emergency appointments was in operation. This meant that at times a doctor was extremely busy but there were also quieter times where emergency appointments were empty. On the one hand this allowed the practice team time to get on with other administrative work, but they were not available for routine appointments for an ever-increasing number of patients. The audit also showed that phone appointments were not being used enough when they would have been appropriate.

The review led to the following elements in their new approach:

  • There would be no duty doctor solely for emergency appointments

  • All routine appointments are 15 minutes long, including those requiring interpretation which account for 20% of appointments

  • Emergency appointments are 10 minutes

  • Telephone appointments are 5 minutes

To achieve this, a lot of time was spent adjusting the total number of appointments in order to optimise doctors’ time. The practice measured patterns in demand for emergency appointments and keeps enough emergency appointments back. When it is quieter there is more time for doctors to fit in phone appointments. In addition, making use of the GP Access Hubs has given the doctors comfort and confidence in changing the previous system. If bookings are filling up the reception team knows that an appointment at an Access Hub can be offered. The hubs have helped to provide the practice with breathing room to test out a different way of working and currently appointments booked at the hubs are the equivalent to one extra session per week.

Using the time differently

The GPs had worried most about abandoning the duty doctor system for emergency appointments but now Sandra says: “They love it!”

GP sessions are slightly longer than previously – an extra 10 minutes in the mornings and 15 minutes in the afternoons. But in reality because previously appointments were often running late, their sessions were in fact sometimes longer than they are now.

“They were also used to having unbooked emergency appointments so there was time for other work,“ says Sandra. “Changing the system has meant doctors using their time differently. We are now utilising every minute of a session, but there is a lot less late running which is great for the patients and for the doctors.”

And what about the patients?

“We didn’t tell the patients about the change to longer routine appointments as we wanted to test how it worked in a normal day, without their raised expectations . We did however discuss the plan with our PPG Chair and with the patient listening group. We are monitoring the Friends and Family Test cards and will look at the results of the next patient survey. We have historically had very low scores on waiting times in the practice,“ says Sandra.

Once the pilot has been reviewed, with further involvement of the PPG, there are plans to launch the new system to patients within the practice.

The new system has reduced appointment waiting times from three weeks to eight days and there is a decrease in the number of emergency appointments booked. The practice’s very high DNA rates are currently 3% lower than before the new appointments started – although they admit they still have a long way to go.

“What’s been most interesting and encouraging is that the number of repeat appointments has gone down – perhaps because people are getting seen more quickly and have longer to discuss their concerns,” says Sandra. “We are seeing more unique patients. There have been 150 more people seen in the surgery since implementing the change than in the same period before, indicating that with this system more patients have a better opportunity to get an appointment.”​

If you would like to know more about how Beckett House Practice implemented their changes please contact Sandra Connolly at sandraconnolly@nhs.net.

Please share this with your practice teams to see if this is something you might be able to do locally. 


If you have developed any examples of good practice please let us know - contact Una Dalton via unadalton@nhs.net​.