Current issues with phone access and booking appointments

We are – on an ongoing basis – receiving more incoming calls than our team have capacity to answer. We provide large volumes of appointments and these are fully booked every day, despite recent increases in our clinical team.

We’re analysing our data on an ongoing basis to try to best quantify the gap between demand and our appointment capacity, but one thing is apparent. Demand for primary care in Musselburgh is typically outstripping the health system’s capacity to meet that need, and there are more people needing an appointment, than each appointment available. This has been the case since well before Riverside was encouraged asked by the NHS to take over the collapsed Eskbridge Practice.

This means that some people are being left without the expert support from their GP that we desperately want to offer, and we recognise the depth of feeling in the community about this.

We’re doing absolutely everything we can to try and improve the situation, including:

Working as hard as possible to make sure we’re fully staffed at all times, with locum cover if needed:

  • four new GPs have joined the Practice this year (Dr Maeve Chestnutt, Dr Michael Slowey, Dr Anne Money and Dr Hannah Astle) with Dr Lucy Milner due to join us in July. Two GPs are due to return after maternity leave this year, and we’re still recruiting for a further 0.5 (2 days a week) GP. There are not enough GPs in Scotland to fulfil Primary Care needs nationally, so recruitment is challenging – in this environment, it’s great to see that so many GPs have chosen to join us this year. We must keep them here in Musselburgh.
  • The BMA recommendation is for 1 full-time GP to 1,600 patients, which is what we have in place at Riverside when fully staffed.
  • Three Nurse Practitioners have also joined us in 2021, along with a specialist paramedic in 2020.
  • We’ve also recently recruited two more people to our call handling team, to replace team members who have moved on to other roles.
  • We hope appointment numbers will increase slightly in the autumn due to all the above changes – but will not increase further after that, without the changes described below.

The number of clinical sessions our doctors, nurses and other health professionals provide has been stable for the last three years and we think is broadly comparable to other Practices, proportionate to the number of patients we have.

We’re also doing a lot of work to improve our phone system and the way we manage the calls we receive, including:

  • Led by our new Clinical Manager, our new Nurse Practitioners and experienced Reception team are building a ‘triage hub’ so we can better assess the concerns people have over the phone, and book them in for an appointment with the most appropriate health professional, at the most appropriate time. We want to move to this system, rather than returning to our old ‘same-day or pre-booked’ system, which often saw the first available pre-booked appointments being four weeks away. We hope to move to our new triage system this year.
  • Increasing our community education efforts, so people better understand when they should call us and when they should contact different health services that are best suited to their needs on that day.
  • Moving to an online booking system for nurse appointments and blood tests, to bring convenience for patients who are online and freeing up the phoneline for those who need it.
  • We think we can slightly increase the number of calls we can answer – but on our busiest days we can receive almost 100 calls within the first 5 minutes of opening, so we cannot – with the best will in the world – answer them all. Even if we were able to answer all incoming calls or moved away from the same-day service, there wouldn’t be enough appointments to book patients into.

We must be clear about a number of things:

  • All of these changes will take time and will not improve the situation overnight.
  • Once all of the recruitment mentioned above is completed, we will be at the limit of people we can employ at the Practice: the number of appointments we then have available will not substantially increase, without wider health system change.
  • Our team here are dedicated, 100% focused on patient care, and already working at the limit of their capacity.
  • The situation we and the people of Musselburgh find ourselves in currently is not a result of the way the Practice is run: improvements can always be made and we’re committed to making them, but demand is simply far greater than our ability to meet it.

The way forward

The Practice met with Colin Beattie MSP in March and June 2021, along with the East Lothian Health & Social Care Partnership, Community Councils and our Patient Participation Group, all of whom have expressed their willingness to work collaboratively with us to bring change.

We’ve made clear to all the pressure we’re experiencing and the impact this has for people in Musselburgh, and for our staff.

We’ve also made clear the changes that need to happen if people in Musselburgh are to have their health needs met – namely, a rapid move to put in place the changes outlined in the 2018 GMS contract, to relieve what’s been recognised as an unsustainable workload in General Practice.

These changes were agreed in 2018, yet in 2022 we’re still some way off seeing some of them become a reality.

These changes include the movement of urgent care, pharmacotherapy (prescriptions), vaccinations and community nursing away from General Practices, to come instead under the control of local health & social care partnerships. This will allow GPs to focus on their role as expert medical generalists, working to improve the long-term health of both individuals and the wider community they serve.

More people will be moving to Musselburgh in the coming years, so it’s ever more urgent that we ask those overseeing the planning of these developments, how the healthcare needs of these new residents are going to be met.

We’re committed to working with our colleagues at NHS Lothian, our elected representatives and local community groups to bring these much-needed changes, and call for our patients to lend their support too.

Advice for patients

At this time when we’re extremely busy:

  • Please consider whether you need to speak to a GP before you call, or whether you should be seeking care from more appropriate health professional. These might include your pharmacist, a minor injuries unit, the CWIC mental health team, CWIC physio team or CTAC community nursing team.
  • If you do need to speak to a GP, please read our appointments page for advice on the best time to call to book, and how to make sure your phone appointment runs as smoothly as possible.
  • Please use our online services as much as possible, including our online prescription service and online registration. Please check the expected timelines on our prescription page first, before calling us. Our test results page has information about the process for these: please read it before calling us if you’re unsure.
  • Call 999: in a life-threatening emergency
  • Call 111:
    • If the Practice is closed and you have a medical concern which you feel needs immediate attention
    • Before going to A&E, if you feel able to
    • To access a Minor Injuries Unit