Time for a change? The process of lengthening booking intervals in general practice.

Longer booking intervals between appointments in general practice are generally seen as 'a good thing', and have a strong 'evidence base' to support them. Changing to longer booking intervals is regarded as a pipe dream by many general practitioners (GPs). This paper reports the process and outcomes of a change to longer booking intervals in one practice, identifies the key elements of the change, and examines lessons learned for the practice, to help other practices to do similarly. The most important factor in bringing about change was the influence of facilitation by outside parties; first, by management consultants who identified solutions to the practice's problems, and secondly, by recruitment to a research study. Other outside influences were an awareness of the success of other practices in changing to 10-minute booking intervals, and the increasing 'evidence base' to support such change. Internal influences on the process were a desire to change as a result a perception that the practice was under-performing, and the stress associated with this. As a result of the change, the number of doctor consultations fell and the number of nurse consultations rose, fewer patients reconsulted, and marginal improvements were reported on doctor and patient satisfaction. Other practices may benefit from such change; the use of management consultants as facilitators may instigate such change.