Appointment audit frequently asked questions

This audit was developed as part of a research project commissioned by NHS England and the initial results were published in 'Making Time in General Practice' available at http://www.nhsalliance.org/making-time-in-general-practice/ It helped create the evidence base for the recent 'Forward View for General Practice'. Initial results suggested that, on average, 27% of appointments in general practice were potentially avoidable if other services and support were put in place. NHS England is now committed to extending this work by funding support for practices - so there is no direct cost to the tool that makes it really easy for you to see how many of your appointments might be avoidable and that helps you explore how you might be able to do something about it.

Below you can find the answers to a series of frequently asked questions about the audit. If you have further questions, please email us at admin@pcfaudit.co.uk.


What is the point of the audit?

It is designed to help you look at the current workload in your practice and whether you could manage it in a way that reduces the pressure on your clinical team. It is a simple tool for measuring how many of the appointments with GPs, nurses and other clinicians in the practice, could, potentially, be managed in other ways. The point of auditing what is happening in your practice is to look at how by making changes, either within the practice or across the local health system, you can free up clinical time and offer better care to patients.

What are the different types of potentially avoidable appointments?

They vary, from people who you think don't really need to be seen at all, to those who need better advice and self-care, to patients who could be seen by other members of the practice team, or by other services such as pharmacies, or patients who have non-medical needs that would be better met by different types of support in the local community. The audit tool categorises the different options in a clear and simple way. There is a blog http://www.primarycarefoundation.co.uk/blog.html on our website that discusses some of the different views about which might be considered to be potentially avoidable.

What are the benefits for the practice?

The audit provides clear evidence of how you work in your practice, rather than relying on assumptions and anecdote, and offers potential options for reducing your workload. The real benefit is generally found in the discussion and debate across the practice team as you make sense of the results and think about the best way to make improvements.

How do we get the results?

The audit provides both instant feedback for individual clinicians as well as a more comprehensive report for the practice as a whole. As soon as a clinician completes the audit they get instant feedback on screen about how their results compare to the national benchmarks. And once everyone in the practice team has completed the results, you will receive a report that compares the results from clinicians across the practice team, makes comparisons with results across the Country, feeds back your reflections at the end of the audit and offers suggestions for how you might be able to make improvements and further support, if you need it.

What will the results tell us?

The results provide three different types of information. First, they highlight the different perspectives across the clinical team within the practice - there are often striking differences between individual GPs and nurses. Second, it shows how your practice varies from other practices, as we benchmark your results against all other results received so far. Thirdly, you can view the comments from clinicians as they undertake the audit and a brief review at the end, all of which should inform a wider discussion across the practice team.

How long do we need to run the audit for?

We offer you the choice - there is a screen when you set up the audit that allows you to decide whether you want to carry out the audit over a couple of day, a week or a longer period. We recommend that data collected for a few sessions from each clinician provides a really useful basis for the discussion and learning

How easy is it to use and how much of my time will it take?

The audit has been designed to be quick and as simple as possible to use. GPs quickly become familiar with the categories and then It takes no more than a few seconds after each appointment to decide whether the appointment was avoidable and, if so, how it could be avoided.

Is the audit just for GPs?

No. Although the initial audit was largely carried out by GPs we think it makes sense to review appointments across all members of the clinical team - so GPs, nurse practitioners and nurses as well as other roles, such as practice pharmacists, or physician assistants. Although it can be used with HCAs too we usually find that the nature of their work is such they have little opportunity to suggest alternatives.

Can we use it as an audit across a wider group of practices?

Yes. We think that it makes a lot of sense to look not just as results within the practice but across a wider group of practices. So we welcome interests from GP federations or networks, CCGs or LMCs - in fact any group of practices working together who would like to look collectively at reviewing the results. The results can feed into a session to support mutual learning and development as you begin to work more closely together. It is likely to add greater value as some of the solutions to reducing workload within your practices may involve working collaboratively with others, as well as developing new services with your local CCG.

What are the wider benefits of this work?

We hope there will be two broader benefits to extending this audit. The results should help inform local commissioning decisions as part of wider discussions across the local healthcare system as you look at how you can transform care through the local STP. It will also help inform national policy as NHS England looks at the best way of offering additional support to general practice and the health system as a whole as part of the Five Year Forward View, just as the initial audit played a part in shaping the Forward View for General Practice. As part of this, we intend to prepare regular summary results available at a national level, to help inform local commissioning and national policy making.

Will the results be confidential or are they shared more widely?

We can provide more information about survey governance and security. In short, the data entered by clinicians and their scores is fed back to you within the practice but will not be presented in a way that allows the practice or individuals to be identified except as you have agreed (for example in some areas results are shared across a cluster or locality for the purposes of comparison, but we seek confirmation that this has been agreed before allowing this).

Who is managing this audit?

The audit has been designed and is being run by the Primary Care Foundation. The data is being received and analysed using tools developed by Methods Analytics. For more information about both organisations, you are welcome to visit our websites. For the Primary Care Foundation, please go to http://www.primarycarefoundation.co.uk/ and for Methods Analytics please go to https://methodsanalytics.co.uk/.

What do we do if we have other questions or need more support?

if you have any further questions, or you would like to discuss any of this further, please email us on admin@pcfaudit.co.uk and we will get back to you as soon as we can.