Improving access to appointments at Laurie Pike Health Centre.

BACKGROUND: Rising demand makes it increasingly difficult for patients to access appointments. Laurie Pike Health Centre (LPHC) operates a predominantly same-day booking policy in order to manage appointment requests from its 18 000 patients. We sought to quantify the number of requests, in order to estimate the unmet demand. AIM: 1) To estimate the met and unmet demand for same-day appointments; 2) To assess how capacity for same-day appointments compares to demand; 3) To analyse how well LPHC is utilising its available appointment slots. METHOD: We created a data collection tool to count the total number of patient requests by type. We grouped types into four categories: 1) medical appointment requests; 2) sick notes and results requests; 3) other appointment requests (such as healthcare assistant, nurse); and 4) admin/other. Category-specific percentages were applied to call log data to estimate the number of appointment requests per category. Capacity was measured by counting the total number of same-day GP/advanced nurse practitioner (ANP) appointment slots. Consultation records for GP/ANP appointments were analysed to assess the appropriateness of the booking. RESULTS: Estimated average demand for same-day GP/ANP appointments was 222 per day. Average same-day capacity was 112 slots. After introducing pharmacist and video consultations, average capacity increased to 194 slots per day, a shortfall of 28 appointments. Consultation records indicated that 41% of GP/ANP appointments could have been seen by other practitioners; for example, musculoskeletal practitioners (14%). CONCLUSION: GP/ANP appointments alone cannot meet patient demand but a diversified workforce might. Alongside this, efforts to improve care navigation may free up to 41% of GP/ANP appointment slots.

Clinicians didn't reliably distinguish between different causes of cardiac death using case histories.

BACKGROUND AND OBJECTIVES: Routine statistics and epidemiologic studies often distinguish between types of cardiac death. Our aim was to assess agreement between doctors on cause of death given identical clinical information, and to assess agreement between a physician panel and the original cause of death as coded on national statistics. METHODS: Clinical information and autopsy reports on 400 cardiac deaths were randomly selected from a defined population in the West Midlands, UK. A panel of eight clinicians was assembled, and batches of 24-25 cases were sent to pairs of these clinicians who, blinded to the certified cause of death, independently of each other assigned underlying cause of death. Physician panel decision was achieved by consensus. Levels of agreement were assessed using the kappa statistic. RESULTS: Reviewers agreed on cause of death in 54% of cases (kappa = 0.34). Consensus decision of reviewers agreed with death certificate diagnosis in 61.5% (kappa = 0.39). Agreement was higher if an autopsy had been performed (kappa = 0.49). CONCLUSION: The process of identifying underlying cause of death is of limited reliability, and therefore, limited accuracy. This has implications for design of epidemiologic studies and clinical trials of cardiovascular disease.