Primary Care Foundation Blog

These blogs are about the NHS - but also about numbers. I hope that they raise some interesting points that come from the data. Sometimes I suggest that the data doesn’t look right - but maybe it is. Please tell me when I have got it wrong (as we all do, however carefully we look at it) or when I have got hold of the wrong end of the stick. And especially tell me if you can see a rationale or logic for the picture that I describe that I have missed.

Thanks for your help - it is by challenging and correcting the data, the analysis and conclusions that progress is made!

For those that are interested most of the data comes from nationally reported data sets available to all - and most of the time the analysis has been done in Tableau. Because it takes so long for data to be published, some of the analysis is of old data. Please, if there are examples where there are better or alternative sources of data let me know about these too.

  • Home
    Home This is where you can find all the blog posts throughout the site.
  • Categories
    Categories Displays a list of categories from this blog.
  • Tags
    Tags Displays a list of tags that have been used in the blog.
  • Bloggers
    Bloggers Search for your favorite blogger from this site.
  • Team Blogs
    Team Blogs Find your favorite team blogs here.
  • Login
    Login Login form

If only ...

Posted by on in Primary Care Foundation Blog
  • Font size: Larger Smaller
  • Hits: 1454
  • Print

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice.  It is available here and will also be published in Health Care Leader.

If only …

Just over two years ago we were finalising a report for NHS England looking at workload pressure in general practice called ‘Making Time in General Practice’. I remember a tense discussion about how to present the headline issues from the report.  A senior figure in NHS England wanted to say that ‘more than a quarter of all GP appointments are avoidable’.  While this was one way of looking at our work, we wanted to emphasise that appointments were potentially avoidable, only if other services were put in place first.  If only there is investment in other members of the practice team, in improving communication with hospital services, new resources for social prescribing. If only.

We did moderate the message.  We also were supported to develop the key tool at the heart of this debate – an audit of potentially avoidable appointments – and 270 practice reports later, we have now been asked by NHS England to develop a simple to use, automated, free to use audit tool, for all practices across England.

To get this right, we have been surveying practices who have used the audit so far.  Amongst a lot of positive feedback was a concern from one GP that he was unclear whether the audit was intended as a way of measuring what GPs can avoid doing now, or what might be possible with further investment.  This gets to the heart of what ‘avoidable’ might mean.  Avoidable is a subjective term. Each clinician will have a different perspective on their own role, what others can do, the importance of continuity for different groups, what patients can do for themselves, and what other organisations could pick up for the practice. 

The key here, is to get people to talk. By talking it through together, the practice team can collectively develop a better understanding what has to be done by the GP, or what could be picked up by a nurse, the practice pharmacist or GP associate.  Or even what might be directed to others outside the practice.

We are actively encouraging practices to complete the audit based on how general practice could be –– not just how it is now.  So, if you had more colleagues in the team, a different skill mix, better links with local pharmacies, better information sharing with local hospitals – what could be done by others?

We also found out that more than half the practices that got back to us had made immediate changes after looking at the results of the audit.  Practices were improving signposting to get patients to the right person in the team, offering more telephone appointments, using care navigators, advanced nurse practitioners and clinical pharmacists more, or making arrangements with the local pharmacy to deal with minor ailments. 

This is impressive.  But what might this look like if the investment from the GP Forward View, when it finally finds its way to general practices, was spent on the things that really matter to practices?  Some STP areas have already been looking at the results of the audit in this way.  Not just as a way of individual practices focussing on redistributing their over-stretched resources now, but whole health communities investing in general practice as a sustainable way of building the NHS for the future.  Now that would really be something.

If you want to know more about how to use this free audit tool, either for your practice, a group of practices, or across your CCG or STP, go to or email Rick Stern at This email address is being protected from spambots. You need JavaScript enabled to view it.  


Last modified on


  • No comments made yet. Be the first to submit a comment

Leave your comment

Guest Friday, 22 June 2018

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay



Latest News

New on-line registration for the potentially avoidable appointments audit

The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE  and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.


What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.


Are there any simple lessons for practices looking to improve access?

A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  


Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE


Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.


We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.