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Nigel's surgery 77: Access to appointments and staff competence
We have updated this issue of Nigel’s surgery to give more information about who may be suitable to see each patient and levels of staff competency.
We look at access to appointments under our key question of how responsive a provider is.
Each GP practice should determine:
- how many appointments it should offer each week to meet the needs of patients
- who is the most suitable person to see each patient
Number of appointments
We do not have a formula or ratio for the number of appointments GPs should provide. Different populations have differing care needs, and this care is provided using different staffing models. Practices take differing approaches depending on their circumstances, staff, and population need.
We consider how responsive services are to people’s needs, and how well they meet these needs. This includes key lines of enquiry (KLOEs):
- R1: How do people receive personalised care that is responsive to their needs?
- R3: Can people access care and treatment in a timely way?
We also consider how the staffing levels and skills mix promote and deliver safe care and treatment:
- S2.1/S2.2: Managing risks
Who is suitable to see each patient?
Appointments are increasingly offered by a range of different professionals. These may include paramedics, pharmacists, physiotherapists, advanced nurse practitioners, physician associates, and others.
We consider whether staff have sufficient skills, knowledge and competence to deliver effective care and treatment, including KLOEs:
- E3: How does the service make sure that staff have the skills, knowledge and experience to deliver effective care, support and treatment?
- S1.5: Do staff receive effective training in safety systems, processes and practices?
Competency levels and supervision
Practices need to demonstrate how they are assured that staff can demonstrate the appropriate level of competency for patients they provide care and treatment for. This includes those employed on a temporary or locum basis. Practices should:
- follow safe recruitment practice (KLOE S1.4)
- identify and respond to staff learning needs, including management and support (E3)
- provide mechanisms for staff development (W3.6)
Particular attention should be paid to monitoring staff competency in certain settings. For example:
- out-of-hours services - all clinicians’ work must be audited. This is a national quality requirement. Consultations should regularly be reviewed against set criteria in order to ensure safe practice
- urgent care settings - it is important to audit antibiotic prescribing, especially when this is carried out by non-medical staff
There are different models of supervision in clinical settings. This includes one to one supervision, peer supervision, group supervision, or a combination of these.
Managers and staff should develop and use the most suitable model for their setting. A ‘one size fits all’ approach is not necessarily appropriate, as clinical teams, and individual roles and responsibilities, can vary considerably.
Professional registration is mandatory for certain healthcare professions:
- Nurses - Nursing and Midwifery Council
- Paramedics and Physiotherapists - Health Professions Council
- Pharmacists - General Pharmaceutical Council
Physician associates can register through the Royal College of Physicians. This is voluntary and can be considered good practice.
Services should make sure that staff are suitably registered when appointed, and throughout their employment. They should support staff to fulfil the requirements of registration, including the necessary continuing professional development and revalidation.
A nurse or other allied health care professional (for example therapists and dieticians) may not be suitably qualified to treat the full range of patients they may encounter. Examples include working with children, pregnancy, terminally ill patients, and mental health.
Services must have suitable pathways in place to deal with such patients in an effective and timely way. This includes providing support for staff where needed.
- Last updated:
- 13 April 2018