Ruli Pennington has been senior healthcare writer at Healthcare Innovation Monitor since 2013. She is an occasional contributor to Information Daily and Public Sector Digital. She is passionate about better public services and women's football.


More than 1 in 4 GP appointments can be avoided - new report identifies ways to cut bureaucracy and ease pressure on GPs

“Making Time In General Practice” a report commissioned by NHS England and produced by NHS Alliance and the Primary Care Foundation judged that 27% of GP appointments could be avoided if there were changes in the system around them. 

The report also estimated 1 in 6 of the patients in the study could have been seen by someone else in the wider primary care team such as clinical pharmacists, practice nurses, physician assistants or by using simple techniques to care for themselves.

 The report states:

  • 6.5% of their appointments could have been seen by another professional within the practice;
  • 5.5% could have been seen by community pharmacy or the patient could have been given support to deal with the problem through self-care;
  • 4% of appointments might have been dealt with through social prescribing / navigation.

Responding to the report Simon Stevens, Chief Executive of NHS England noted the importance of “freeing up time for practices to work together, improving communication between general practice and hospitals, unlocking the potential for the whole system to work together, as well as supporting changes and improvements within individual practices."

In particular the report calls on NHS England to streamline the payment systems that GPs use to simplify and speed up how much time practice managers spend on entering data. Interviews with practice managers have revealed that payment has become a bigger burden since Clinical Commissioning Groups and local authorities have been commissioning services from practices.

Problems with hospital booking are also a concern, often caused by a patient failing to attend their outpatient appointment and meaning an entirely new GP referral is required.

Immediate practical steps to cut down on bureaucracy suggested by the report include:

  • Patients who are unable to attend a hospital appointment should be able to re-book within two weeks without going back to the GP.  Booking and rearranging hospital appointments should be simpler without the patient needing to go back to the GP.
  • Practices should employ a wider range of staff within the practice team, with the decision on the type of staff left to the discretion of individual practices and federations;
  • NHS England will work with doctors to streamline communication, particularly between hospitals and practices, and reduce the workload of processing information within practices;
  • Practices should free up time for GPs and other leaders in the practice to think through how they can work differently, learning the lessons from the PM’s Challenge Fund sites and the Vanguard sites as they become available – creating the ‘headroom’ needed to plan new ways of working and clinical innovation;
  • GP federations should be funded to work across their practices to build practical social prescribing projects that offer real alternatives to taking up GP time with patients whose needs can be better met by other kinds of support in the wider community;

Dr Jonathan Serjeant, GP, co-director and co-founder of Brighton and Hove Integrated Care Service said "If applied quickly, the recommendations set out in this report, particularly those around extending the GP team to incorporate other health professionals, will help reduce the current levels of bureaucracy GPs face on a daily basis.

The Ockham Practical Steps GP Programme is designed to support “changes and improvements within individual practices” and help practices to extend "the GP team to incorporate other health professionals" and to create the necessary headroom to both deal with the pressing problems and plan for the future.

The Ockham Practical Steps programme supports practices in tackling the four major challenges facing general practice today:

ON-THE-DAY DEMAND - The Practical Steps programme supports practices in identifying and implementing new ways of working and provides practical support and mechanisms for practices to better manage the growth in on-the-day demand.

GP and PRACTICE STAFF RECRUITMENT - The Practical Steps Programme offers support in identifying and implementing innovative solutions to tackle recruitment problems.

OPERATING AT SCALE - The Practical Steps Programme offers support in identifying and implementing the benefits and necessary changes to prepare for and move into operating at scale.

BUILDING COLLABORATIVE PARTNERSHIPS - The Practical Steps programme helps practices to build supportive and constructive relationships with other organisations including joint working with the local community trust, accessing support from the voluntary sector and, accessing the full range of support from CCGs.

For more information on the Practical Steps programme or to request a prospectus please contact Joe Tibbetts E: or T: 0121 643 9802

To read the full Making Time in General Practice click here


Ockham Healthcare is an independent, change enabler working with early adopters and change leaders within a range of healthcare organisations. Part think tank, part consultancy and wholly focused on helping healthcare professionals develop and deliver change programmes, Ockham is unique in its approach to innovation, integration and leveraging the potential of digital communications to sustain and further develop a health service that remains free to all at the point of need.

Ockham specialises in research and data acquisition and analysis that enable it to make recommendations at a grass roots and a national level.  Ockham is committed to sharing learning and building independent, free to access, on-line resources that can help solve problems at a national level.  Ockham associates are expert in managing on the day demand, solving the GP recruitment connundrum, preparing for growth and collaboration to build the new professional networks.


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