Introduction of an appointment system in a general practice: surveys of patients and staff.

To aid discussion on the introduction of an appointment system in an inner city practice with a 'walk-in' (non-appointment) system, we surveyed, firstly, patients' and staff members' attitudes to appointment systems, and secondly, aspects of the functioning of the current system. Of 250 patients in the first survey 73 per cent were against appointment systems while 24 per cent indicated that they would consider registering with another practice if such a system were introduced. Adverse comments about appointment systems greatly outweighed favourable ones. Staff members perceived clear advantages and disadvantages of both methods of consulting e.g. the 'walk-in' system was thought to be stressful due to the unpredictable workload but thought to reduce the demand for housecalls. Appointment systems were seen as giving staff more control over consulting but as less flexible for the patient. In the second survey of 352 patients, 17 per cent estimated a wait of 10 minutes or less for their consultation, 62 per cent estimated it as 10 to 20 minutes and 21 per cent as more than 30 minutes. Further, 68 per cent of patients estimated that their consultation lasted five minutes or less and 27 per cent indicated that the doctor seemed rushed. As a compromise between the wishes of patients and the needs of staff, 'walk-in' morning surgeries and appointment-only evening surgeries are now offered.

Evaluation of a practice information leaflet.

Over 10 months 5,000 practice information leaflets were distributed in a practice in Glasgow. The leaflet was principally evaluated by assessing patients' attitudes to and use of leaflets and changes in their knowledge about the practice. Changes in the pattern of consultation with the practice nurse and the timing of incoming telephone calls were also measured. Most patients read, kept and referred to the leaflet and reported it to be useful. Those who had seen the leaflet had significantly greater knowledge (mean knowledge score 7.5) on 15 questions on practice organization than two comparison groups: the base-line study sample (mean knowledge score 5.2) and those in the follow-up sample who had not seen the leaflet (mean knowledge score 5.7). Improvements in knowledge were statistically significant for 10 out of 15 questions. Two changes of behaviour were noted, increased self-referral to nurses (37% of new consultations at follow-up were self-referred compared with 29% at baseline: P = 0.05) and the timing of incoming telephone calls was more in line with practice policy (for example, 23% of calls for repeat prescriptions were made between 12.00 and 16.00 hours at follow-up compared with only 11% at baseline, P less than 0.001). The leaflet was judged to be useful.

Perceived versus actual consultation patterns in an inner city practice.

Consultation patterns in a practice with no appointment system, situated in a socially deprived area, were examined to confirm or refute one doctor's perception that the consultation rate was much higher than average. Seventy five per cent of a sample of patients (n = 394) had consulted in the previous year. The mean annual consultation rate was 3.8 (range 0 to 29) but the median was 3.0 and the mode 0. Among 222 patients consulting over one month the mean annual consultation rate was 10.0 (range 0 to 47) with a median of 9.0 and a mode of 6. The duration of consultation (n = 506) varied from one to 25 minutes (with mean, median and modal values of 5.3, 4.0 and 4 minutes respectively) and 53% of patients received between one and four minutes. The overall consultation rate was not high, particularly in view of the socioeconomic deprivation of the practice population, and the doctor's perception of excessive consultation was explained by the high consultation rate among attenders. The consultation pattern, particularly of males, was not conducive to a preventive approach. The mean was a poor descriptor of the average consultation rate or duration.