Front of house staff crisis

Dear Patients, We would like to bring to your attention that we are currently facing a workforce crisis within our Patient Navigation (Reception) team. We have two members of staff on long-term sickness leave and two who have recently resigned. This represents a 40% loss of capacity within the team. We immediately began the recruitment

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Patient pathways explained

COVID has forced us all to change, and we at the Practice have responded. We think our current system keeps you safe while COVID is still at large, but we believe it has real benefits for life beyond COVID as set out below.

A question we hear often on national and local media channels is. Why can’t I have a GP face to face appointment?


Note we have been seeing patients all through the pandemic were necessary or where requested but only after being appropriately screened first to ensure safety. This is called a triage first system. 

The adoption on our current system, which has been in place for the past 18 months, it was a Practice decision, with government and profession BMA/ RCGP supporting guidelines helping us to set our safe processes. We regularly receive feedback via different sources that the majority of our patients feel we offer an excellent service which is reassuring. Further details on our current system and FAQs can be read below.

Our reception and clinical teams have seen an increase in demanding and abusive patient contacts recently. Note our Receptionists must work from a consistent set of Practice rules on what they can and can’t offer. Please respect this. We will be stepping up our Zero Tolerance policy. Going forward we will be recording all telephone calls and will write to those patients that overstep the line. If there are multiple instances this could result to a deregistration from our Practice list. If you have any frustrations these are not to be directed at our staff but instead written or verbally communicated to our Managing Partner, Philip Heiden.   

Our systems

Accurx Patient Triage
Our preferred initial contact is using Accurx Online Patient Triage, available via our website. https://www.stpaulssurgery-winchester.nhs.uk/contact-primary-care-more-conveniently-online/

Telephone appointment
If you cannot use online consult with us then please call reception, but please note these requests are not responded to any quicker. The Receptionist will ask you some basic questions to see if they can solve your problem, and if not, ensure that they put you down for the right member of the clinical team.  

If your query is Routine (not clinically urgent for today) your will be offered the next available telephone appointment with your named GP for continuity, this is generally within 2-4 days. If your medical problem is clinically urgent for that day, then one of the duty team will call you.


The GPs can conduct a thorough assessment over the phone, and may ask you to send in photographs, or convert to a video consultation. Some things, however, do require an in person appointment and they may therefore ask you to attend the surgery. 

We feel that this provides the greatest continuity for our patients which has been shown to improve the quality of care and patient satisfaction.

Frequently asked questions

Why can’t I book directly with a GP face to face?  Various reasons

Infection control measures. Pre pandemic we would have 20-30 unscreened patients sitting next to each other in our waiting room with little information of their risk factors known, Possible to have a query measles patient sat next to a pregnant woman. COVID has opened the NHS eyes as to how poor our infectious diseases control measures were. Going forward we wish to clinically screen all patients prior to an onsite appointment to keep everyone safe.

Right patient, Right time, Right Place. Pre pandemic our routine waiting time for a GP appointment was 10 working days and patients would self-select who they saw and when with very little clinical input or signposting upfront. On the day of the appointment, it was sometimes apparent that the patient should have either been seen earlier due to their symptoms or in fact seen by another clinician who has greater experience in their problem field. Accurx online triage or a clinician within 72 hours provides safer care and care navigation provides less wastage of appointments as patients are directed to the right clinician first time.  

Make every contact count. Pre pandemic we used to operate on 10 minute appointments and tried to focus on just one medical problem per appointment. Patients and clinicians felt rushed by this set 10 minute consultation timing and conscious they were keeping others waiting who are being delayed past their appointment time. With our new way of working there is more flexibility in spending longer with some patients to complete all their needs/concerns in one appointment and all feel less rushed.

Better use of Did Not Attend time. Pre pandemic when we were purely face to face appointments, if a patient DNA’d then our clinicians time would be wasted. This could be up to an hour per day per clinician. Now that we are telephone triage based, time is not lost as we can move onto the next patient.  

Patient convenience. Pre pandemic we use to operate on a timed appointment model. Often clinicians would run late due to unexpected emergencies within their clinics. This caused patient delays. Being telephone based you can continue to carry out your day as you normally would, until we phone.

Estates issues. Pre pandemic we would spend a lot of our time responding to car park complaints, incidents and issues. Our car park is small for the size of the premise we have and the population we serve. Despite warning patients of this, a lot still try to park onsite, run late and/or get frustrated before their appointment. The majority of consultations don’t require a face to face so this frees up car parking for those that do and together we are all reducing the carbon footprint.

 Why when I want to speak to a GP am I offered another clinician type?

Right patient, Right time, Right Place. Pre pandemic our routine waiting time for a GP appointment was 10 working days and patients would self-select who they saw and when with very little clinical input or signposting upfront. On the day of the appointment, it was sometimes apparent that the patient should have either been seen earlier due to their symptoms or in fact seen by another clinician who has greater experience in their problem field. Triage via eConsult or a clinician within 48 hours provides safer care and care navigation provides less wastage of appointments as patients are directed to the right clinician first time.  

GP stands for General Practitioner. By its title they are generalist of all clinical fields but not specialists in them. An MSK first contact practitioner physio is upskilled to know more in depth about musculoskeletal problems and Pharmacist about medication side effects, etc. It should be seen as a positive offer to see a specialist rather than a diversion away from your GP request.  

The Primary Care team over the past few years has significant grown in specialities and this is a vision of the government also (more community-based specialist care). In Primary Care we now employ

  • Advanced Practice Nurses –prescribers dealing with acute conditions and minor illness
  • MSK first contact practitioner physios –Musculoskeletal conditions
  • Clinical Pharmacists – Medication queries and reviews
  • Health and Wellbeing – Mental Health conditions
  • Paramedics – Acute visiting and admission prevention or planning

Why can’t I be given a time when you will call me?

Make every contact count. Pre pandemic we used to operate on 10 minute appointments and tried to focus on just one medical problem per appointment. Patients and clinicians felt rushed by this set 10 minute consultation timing and conscious they were keeping others waiting who are being delayed past their appointment time. With our new way of working there is more flexibility in spending longer with some patients to complete all their needs/concerns in one appointment and all feel less rushed.

Local delivery system support – reducing bed occupancy.  Clinicians clinically triage in order of urgency determined by the problem and symptoms known to them passed on by Accurx online triage or Receptionists. It is sometimes obvious that a patient may require hospital treatment and the earlier we send them in the more chance the have getting home the same day. If sent in later they have to stay in overnight which is distressing for the patient and their family but also impactful of struggling hospitals and costly for the NHS.

Your Health is important We believe your health needs should be prioritised. If you have made contact with us and wish for NHS advice and treatment then we ask that you keep your phone on you, on loud and be prepared for a call throughout the day. We encourage all employers, where possible, to be flexible around health appointments and telephone calls. If you have preferred times throughout the day that suit better please make our receptionist aware of this and we will try out best to call within said period but this cannot be guaranteed.    

Recent Patient reviews/ engagement

Although we wish to please all our patients, all of the time, its evitable that our processes won’t be for everyone and unfortunately, we can’t have a different process for all. We listen to and regularly engage with our patients to source the majority view.

  • February 2022 practice patient satisfaction survey results = 9.1 / 10 Star rating from patients (477 respondents)
  • Many 5-star compliments left on NHS choices

Philip Heiden

Managing Partner @ St Pauls Surgery