Results from Stage 2 may look like:


The phones are very busy particularly on Monday and Tuesday mornings. There is sometimes a 4-minute wait on the queuing system. Appointments available often run out by midday and then there are only emergency slots. The telephone staff are sometimes stressed by this and also find it difficult to do other work at peak times. Some doctor’s appointments are booked up before others and appointments for one doctor are described as “gold dust”. We have to ask patients “is it urgent” when we run out of “ordinary” appointments. This is a problem most Mondays. Patients ring for results adding to the telephone traffic.


  • Patients don’t get seen 
  • Patients get frustrated
  • Some patients play the system “yes its urgent” – this tends to be the same patients
  • On the other side of the coin some patients would never say it was urgent
  • Telephone staff get stressed
  • Difficult conversations with patients when there are no appointments.


  • More telephone lines
  • More telephone staff
  • More appointments
  • Different appointment system (eg some appointments becoming available at 12 noon)
  • “Scripts” to be written for dealing with patients when there are no appointments for Dr X 
  • Telephone staff heightened awareness when unable to offer an appointment
  • Dedicated telephone staff
  • Could a doctor be available to telephone triage if there are no appointments
  • What about a telephone system that tells the patients where they are in a queue?
  • Only give out results at 2-4 pm
  • A telephone system that gives “press 1 for appointments, 2 for results etc.
  • Ban Mondays!

After a break there should be a plenary session. Each group in turn can briefly present further detail and possible consequences and then suggest their solutions. Careful note taking is vital in this session – there will be some quick wins that can be enacted quickly, others where further planning and investigation can take place and some ideas that cannot be resourced. They may be recorded as:

Quick changes

  • Dedicated telephone staff – agreed that staff will be exclusively available for answering telephones between 8 and 11am
  • Results to be given out in a dedicated time window 

Longer term changes (to be scoped by small working parties)

  • New telephone system – looking at messages, redirections and more lines
  • Re-examine the appointment system - Telephone triage?
  • Scripts to be written for telephone staff
  • Training for telephone staff re awareness when no appointments

Once this has been completed for all steps there will be many suggestions for improvement. The facilitator should close the meeting with a plan of action to take some of the suggestions forward. The suggestions should be recorded and a further follow up meeting arranged for a few months later, where the changes are examined to ensure they are for the better!



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