Managing patient demand: a qualitative study of appointment making in general practice

Background: Managing patients' requests for appointments is an important ge neral practice activity. No previous. research has systematically observed how patients and receptionists negotiate appointments. Aim: To observe appointment making and investigate patients' and profession als' experiences of appointment negotiations. Design of study: A qualitative study using participation observation. Setting: Three general practices on Tyneside; a single-handed practice, a p ractice comprising three doctors and a seven-doctor practice. Method: Participant observation sessions, consisting of 35 activity recordi ngs and 34 period; of observation and 38 patient and 15 professional interv iews, were set up. Seven groups of patients were selected for interview. Th ese included patients attending an 'open access' surgery, patients who comp lained about making an appointment and patients who complimented the recept ionists. Results: Appointment making is a complex social process Outcomes are depend ent on the process of negotiation and factors. such as patients' expectatio ns and appointments availability. Receptionists felt that patients in emplo yment patients allocated to the practice try the Health Authority, and pati ents who did not comply with practice appointment rules were most demanding . Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information t o provide evidence that their complaint is appropriate and employ strategie s such as persistence assertiveness, and threats, to try and persuade recep tionists to grant appointments. Conclusion: Appointment making is a complex social process where outcomes a re negotiated. Receptionists have an important role in managing patient dem and Practices should be explicit about holy appointments are allocated, inc luding publishing practice criteria.