earlier access to FCPs.
LATENT: Locums do not have the right understanding of the FCP
role.
164 The ability for the FCP to inject was highlighted by the Management Partner as potentially increasing waiting times for a FCP appointment. Injection therapy was expressed to be a desirable skill for the role by FCP 1 and FCP 2. Nearly all the patients were accepting of the FCP injecting17. FCP 1 was practising injection therapy within the Practice, and FCP 2 was in the process of completing competencies to be able to inject as part of the role.
This Practice already had a GP injection therapy clinic that patients could attend. Both the Management Partner and FCP 1 were concerned that patients could wrongly perceive the FCP to be a treatment role. FCP 1 had first-hand experience of patients coming in primarily for injection therapy. The Management Partner hypothesised that this could result in FCP appointments being ‘clogged up’:
“What we don't want to do is get them clogged up … these appointments clogged up with patients who need joint injections because we already run a joint injection
session at the surgery that the GPs manage.” (Management Partner 1)
The benefit of an injecting FCP, as expressed by Patients 3 and 4, was the ability for a patient to get their injection sooner and thus resolve their MSKD earlier:
‘[An injecting FCP] allows the patient to get treatment that they may want, as I would certainly want, and hopefully clear the problem up a lot faster’ (Patient 4)
Patient 5 discussed her previous experience of only one GP being able to inject, and suggests previous longer waits for an injection:
“there was only one doctor who could actually administer the injection at that stage. So the fact that I could get it from somebody else was just amazing to me
and I was just so thrilled.” (Patient 5)
The practice now has a GP injection clinic and therefore the patient would not have been relying on one GP as she had previously.
The increase in waiting times was reinforced by FCP 1, who stated that there was a four week wait for a consultation with an FCP, whereas previously it had been between one or two weeks. However, she did not feel that patient satisfaction had been negatively affected as a result; partly because other services within the Practice ensured that patients could be
17 Except Patient 6, as injections were not discussed in the interview.
165 seen by a professional quickly. When asked whether an increase in waiting times may have been decreasing patient satisfaction she responded:
“Not at the moment, because it's only four weeks and I think people still think that's quite quick.” … “they started what they call an urgent care clinic” … “where
patients book in, just turn up and wait to be seen, and there's … so basically they can always get an appointment if they wait.”’ (FCP 1)
The Practice had a high number of locums, and it was highlighted that occasionally the new locums would start working in the Practice without being aware of the FCP role. The locums referred the patient to what they believed to be traditional physiotherapy rather than the FCP role which resulted in inappropriate referrals and an increase in waiting times:
“They [locums] might just think you're a…I've had incidences where they've just referred patients thinking it was a physio…traditional physio service.” (FCP 1)
As Patient 5 highlighted, it was the direct access and reduced wait that “clinched it for me to see her”. Receptionists were, therefore, encouraging the appropriate patients to access the role through highlighting the reduced wait:
“I said ‘Do I not see a doctor?’ ‘No’ she says ‘It would be better to see the practitioner and also it would be quicker’ because she had an appointment earlier
than the doctor. So I said fine.” (Patient 5)
However, the Management Partner hypothesised that patients with minor conditions, who would have ordinarily self-treated, may access the role:
“Sometimes waiting lists, though, can work the other way, so that if it's too easily accessible, then the patient may not value it or may just keep coming in for minor
things that they would otherwise self-treat.” (Management Partner 1) FCP 1 highlighted that waiting times had increased and there was now up to a four-week wait for an appointment. However, FCP 2 stated that it was up to a four-day wait for an FCP appointment and often there were on-the-day appointments. This may be explained by the cover-basis working hours of FCP 2.
Patient 1 disagreed with the Management Partner’s prediction of over-demand. He felt that the Medical Receptionists would offer the earlier appointments only to those most in need and that a two to three week wait may put off some patients who would be able to self-manage:
166
“If they were told they’d got a two-week-wait before they can see somebody they’ll
… they just wouldn’t bother phone … accepting an appointment, they’d try and rectify it themselves. But if it was serious enough they would say ‘Yes, I would see
the first practitioner’”….” It would all be down to the Receptionist’s decision and whether or not it was a situation where they had to see somebody immediately”
(Patient 1).
None of the patients reported anywhere near a four-week wait; Patient 3 stated that they were waiting 10 days, Patient 5 got a next-day appointment due to a cancellation and all patient responses highlighted acceptability of their wait.
See Figure 5.16 for overlap between theory areas.
Figure 5.16 - Rival 1 Overlap
Over-demand
Promoting the Role to Patients Receptionists making
patients aware of decreased waiting
times.
Patients tell others about the reduced
wait.
Accessiblity Decreased waiting
times for a FCP
consultation.
Perceived decreased wait for an FCP
injection.
167 5.6.2 Rival 2 - challenges faced by the Receptionists
Rival 2 was a threat to the theory area ‘Promoting the Role’ (see Figure 5.17).
Patient understanding of the FCP role may have been negatively impacted by a shortage of Medical Receptionists. Management Partner 1 highlighted that Practice A faced funding issues resulting in an inadequate number of Medical Receptionists to book appointments.
This may result in time challenges when explaining the role, which could have reduced patient understanding of the FCP. Staff responses did not highlight this, however, Patient 1 and 3’s responses support this hypothesis. Patient 1 felt the Receptionist had to “move on to the next patient” and Patient 3 was given no information on the role as they directly asked to see the FCP:
“They [Medical Receptionists] didn’t give me any information or discuss it because they thought I knew, because I walked in and said ‘May I have an appointment with
the musculoskeletal practitioner?’ So it must [sic] looked ‘Oh this guy knows it’ sort of ‘Wow! Quick’. They just gave me the interview.” (Patient 3)
5.7 Summary of findings
Key findings of Practice A’s analysis chapter have included patients evaluating the FCP role indirectly by comparing it to the more familiar GP role. Furthermore, patients had
expectations on whether FCPs should be able to prescribe or inject which influenced role acceptability. Findings suggested that greater access to service, for instance scans, resulted in patients perceiving the role to be ‘higher up’. Patients felt that a longer consultation Figure 5.17 - Rival 2 CMO
MECHANISM 2. CONTEXT
Shortage of Medical Receptionists due to funding issues.
3. RESPONSE