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A LACK of communication between general practices and the public about the availability of same-day appointments could be driving more people to seek medical help at emergency departments.
Leanne Wells, CEO of the Consumers Health Forum of Australia, told MJA InSight that this disconnect was fuelled by assumptions on both sides — GPs assume patients know they can get a same-day appointment, and patients assume they can’t, leading them to the emergency department (ED).
“We need to encourage practices to communicate their availability to the public, and promote the message that general practice is the home of family care and should be the first point of call”, Ms Wells said.
She was commenting on a study published this week in the MJA which found there was extensive availability of same-day GP appointments for mildly ill children. (1)
The researchers used a “secret shopper” method, with research assistants posing as parents seeking appointments for their children. They telephoned a random sample of 225 general practice clinics within three Melbourne Medicare Local catchment areas, including urban, suburban and rural locations.
They found a high availability of appointments across all three catchment areas. Overall, same-day appointments to see a GP were offered by 78% of clinics contacted. Nearly half of the clinics contacted had appointments available within 4 hours, and about three-quarters offered bulk-billing for paediatric appointments.
The researchers said their results indicated that increasing attendances for children at EDs were unlikely to be driven by a lack of GP appointment availability.
“It is possible that a perceived lack of primary care appointment availability may be a contributing factor in some ED presentations”, they wrote.
Dr Sue Harrison, a rural GP in Victoria and spokesperson for the Australian College of Rural and Remote Medicine, splits her time between a general practice and an ED, and sees firsthand that many patients do not take advantage of same-day GP appointment availability.
“People like the idea of just going to an ED to get help, but normally around 50% of the patients I see in the ED could be treated by their GP”, Dr Harrison told MJA InSight.
She said a factor that could be feeding the public perception about a lack of GP appointment availability was that some patients preferred to see a particular doctor.
“If they want to see me on the day I work in the ED, obviously this is not possible. But if they are willing to see another GP [at my practice] then they can get a same-day appointment.”
Dr Frank Jones, president of the Royal Australian College of General Practitioners, told MJA InSight that the misperception about a lack of same-day appointments also stemmed from a shift in public focus away from acute medicine towards management of the growing burden of chronic illness.
“The mass media has contributed to this perception too, by telling stories of people who can’t get in to see a GP.”
Dr Jones said that general practices were increasingly providing more ways for people to make GP appointments.
“Patients can access these in various ways, from face-to-face, over the phone, or online. I think modern technology has a lot of potential, and GPs could make use of social media to allow people to make appointments that way.”
Dr Jones said it was important to develop public education initiatives to make the community more aware that GPs were not only there to help manage chronic illness, but that they “can and do provide acute care”.
Dr Harrison agreed, calling for the wider adoption of an awareness campaign run by Queensland Health that provides resources to help the public determine which problems can be treated by their GP and when they need to go to the ED. (2)
However, Ms Wells warned that, even with more public awareness campaigns, there was a real danger that the number of people not going to their GP for non-urgent conditions would increase anyway.
“In the current climate, the good access to GP appointments and availability of bulk-billing is being put at risk by the [Medicare Benefits Schedule] freeze.”
She said the freeze would create a barrier to primary care, resulting in either more people going straight to the ED for assistance or not seeking medical attention at all.
(Photo: Monkey Business Images / shutterstock)
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I can report contrary to the research!
I never got a same day GP appointment! Sometimes had to book week before to get a reasonabe time. In emergency ended up in hospital indeed! Looks like some of us need a crystal ball to look through when we need to consult a GP or must consult GP.! I am in an inner suburb.
HealthEngine.com.au allows patients to book a GP appointment from their smartphone, without having to make a phone call. Patients can choose an available time that suits them.
There is another option for ensuring the perception of same-day appointments being unavailable is overcome – utilise other health professionals in the area that would commonly have first-contact with a patient.
In the instance of young children, this will include maternal health nurses, community health centres, and most common of all, pharmacists. These health professionals will often see patients before they attempt to see a doctor. Knowing the availability of same-day appointments can ensure that these health professionals can refer to your surgery.
I would recommend contacting all of the health professionals in the area that are likely to see a patient (parent) before they access ED, to ensure they know your surgery’s availability and policies on making appointments available for walk-in patients. Contact them weekly, and notify them of other programmes you are running whlie you are at it.
In addition, being available during weekends will go a long way towards improving the public perception that your surgery is available for same-day appointments (after all, people don’t schedule their illnesses for week days). In the case of rural practice such as Dr Harrison (which happens to be the same town I practice in), contact with other local health professionals to inform them of any change in practice hours will be essential. The first few weekends might be under-utilised, but once it is known that there is greater availability, weekend appointments will be busy as well.
Same day appointment with a specific GPs in Perth is almost impossible to get.
I wonder whether the researchers requested appointment times after school or at times compatible with parental work commitments. I’m sure a visit to ED after work is sometimes chosen in preference to a day off to see the GP.