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A few weeks ago my mother-in-law woke up with her heart rate all over the place. We phoned 111.

We were advised to go down to the surgery for an ECG. They were not sure of the problem and so were told we should probably go down to A&E.

We were there for five hours. It was really good care all round.

We were sensitively and sensibly prioritised.

I had an appointment and saw a physicians associate. They were very good.

As a result of that I needed to see the nurse. She arranged a next day appointment.

The nurse then said that the test needed to be done by a clinician as she couldn't do it. So I had another test.

Then I needed a blood test but the next available appointment wasn't for three weeks! The results from the first test showed that I might have a serious condition.

I've seen five different people!

Took me 2 hours to get through on the phone today! with the same repetitive music over and over again! You do get the option to request a call back, but if they cant answer the incoming calls how can they call you back! Ended up calling through dispensary, which still had a que but they got my query sorted! It should not be that hard or take that long to call your GP surgery!

If it's an emergency they're great. I went to my GP as I wasn't feeling well and they did two angiograms but they weren't happy with the results so they got an ambulance straight to the surgery.

It's difficult to get an appointment, even if you call early in the morning you can't get in. They just give you a phone appointment which I don't like.

They're brilliant. They're efficient, empathetic and their timekeeping is good. Very well organised and well managed. I get appointments ok with them.

They are good for vaccinations. It's not too bad for getting appointments, it does well considering the population. Because we're old we get prioritised. The nurses are good for injections.

I can get in to see them at Market Surgery very easily. I have no complaints.

Whenever I've been there it's been fine. Whenever I've had issues they've seen me quickly. The staff are all lovely. I've not had any problems. I've got a lot going on but everything I've been down there for has been dealt with very well. There's no rush there.

My issue is specifically about the appointments system – when you do get to see a GP at the Market Surgery it is a good service. Yesterday, I wanted to make a ‘routine’ GP appointment to discuss something that is worrying me a lot but could not be described as either urgent or life-threatening.

The practice has an online booking system for routine, non-urgent GP and other (e.g.

health care assistant) appointments. Yesterday, the system offered me no such GP appointments between 29 May ... and 27 July.

None. There were a multitude of Health Care Assistant appointments.

Today, things had changed. Between 30 May and 27 July, five 5 GP Face-to-Face sessions had appeared (as if by magic) and two sessions with an ‘Assistant Practitioner’ alongside more than 50 slots with a health care assistant (as before) and one session with a nurse.

I gratefully booked a GP appointment and I imagine the remaining slots will soon be taken. My immediate problem appears to be solved but the experience left me thinking...

The issue here is clearly the serendipity involved in securing a GP consultation for non-urgent, yet worrying, issues that could be serious and may need speedy diagnosis (to save greater costs for the NHS later on) yet cannot, at the time, be legitimately described as ‘urgent’ or life-threatening. Arguably, this type of appointment should be the bread-and-butter of GP practices and at the core of primary care.

Clearly, if this practice is offering somewhere between zero and 5 of this type of GP consultation slot between now and the end of July, it is not succeeding in this respect. What alternatives do patients at the Market Surgery have for booking a GP consultation? Well, the alternative is the all-too-familiar 8-8.

30 am lottery of calling the practice to declare an urgent condition, short of a 999 situation, in order to see a GP on the day. This – often somewhat demeaning – procedure will likely result (to be fair) in the patient being able to see a GP on the day, at least at this practice.

All fine and well, but surely many of these patients with ‘urgent’ issues would have happily booked online for an appointment ‘in a few days’ rather than having to declare – in effect – an emergency short of a 999 situation, had such a choice been available to them. No surprises here, I suspect, to patients of practices across the county but is it beyond the wit of man to solve the problem? One obvious solution would involve a demand-led rather than a supply-led approach e.

g. decide how many consultations of an urgent nature and of a non-urgent (but worrying) nature are actually required in Aylsham on a month-by-month basis and then ensure that the practice provides that number of urgentnon-urgent slots (I am assuming there is a wealth of data available in the practice NHS records to allow a good stab at doing this).

Perhaps consider also if the online booking system is fit for purpose. My guess is that when GP appointments are offered online they will always quickly fill up – the demand will appear to be insatiable.

Given this, how about dealing with all requests for GP consultations by telephone (Health Care Assistant or Nurse consultations can presumably happily be left to an online system) and distinguishing them as ‘acute conditions’ (something just happened, and I need to see a GP today) and ‘chronic conditions’ (something is going on that worries me and I would like to see a GP in the next week or so)? I realise that the elephant-in-the-room issue with a demand-led system is likely to be GP working practices and I know nothing about the constraints affecting the Aylsham practice in this regard. Nevertheless, it occurs to me that some hard decisions may be required that lie between the ‘rock’ of a demand-led appointments system and the ‘hard place’ of GP working practices (including practice ‘profitability’ and remuneration) and until they are made, patient frustration with a struggling system will only grow.