Inspired by the story of King Canute - the 11th century king who tried to command the tide to turn back - Westgate Medical Practice in Dundee decided to stop fighting the tide and let patients have appointments when they wanted. Their findings are published in the Christmas issue of The BMJ.
Each morning, all patients telephoning for soon, immediate, or urgent care were invited to attend a daily appointment "pool" at 10.30am.
Reception staff invited patients, if they wished, to state the clinical problem and which GP they normally saw. Patients were advised that they may have to wait a little longer than usual when attending for a pool appointment.
When 20 patients had been booked at 10.30am, patients were advised to come at 11.00am and then the next 20 at 11.30am.
Initial evaluation of the new system found appreciative patients, a calm reception atmosphere, and improved work patterns for nursing staff.
"An unforeseen spin off is that our extended hours appointment demand is very low and we struggle to fill slots," say the authors. "Our local A&E team tell us they do not have any problems with our patients using their service inappropriately, suggesting we are meeting demand for acute care well."
There are always a basic minimum of four doctors available for the pool every morning and patient numbers range from as few as four or five to 60, explain the authors.
Since introducing the pool, the practice has also seen a marked increase in patients seeing their preferred doctor (from 74% in 2009-10 to 87% in 2011-12) - and now advises other practices how to implement the system.
The authors conclude: "We did not quite manage an evaluation free radical NHS change, but we did try, and we kept our feet dry."
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Journal
The BMJ