Table 1

Project PDSA cycles 1–5

PDSA cyclePlanDoStudyAct
PDSA 1Understand appointment system in a meeting with GP.Discussed with GP what the appointment system was like before, what changes have been made and the reasons behind the changes.Predictions met. Change in system is introduction of shorter, pre-bookable ‘review’ appointments.Find out more about day-to-day use of system (observation and interviews with admin staff).
PDSA 2Admin staff interviews and non-participant observation of the appointment system in use.Non-participant observation to understand how the appointment system works.
Admin staff interviews to understand their opinions on the system.
Facilitators and barriers of the appointment system established, opinions on online and review pre-bookable appointments.
Flow chart, cause and effect diagram and a driver diagram of the system made.
Predictions met—admin staff-like review appointments.
Collect data to see if administrative staff workload has decreased as predicted, to complement the findings from interviews and observation periods.
PDSA 3Collect data on administrative staff workload. Predictions were that workload had decreased.Data collected on number of calls received by the practice between 08:00 and 09:00 4 weeks pre-intervention and 4 weeks post-intervention (23 Sep 2019) using the website ‘Netcall’.Prediction not met —number of calls remained the same pre-intervention and post-intervention.
Wilcoxon and Mann-Whitney tests conducted to determine statistical significance of result.
Monday was busiest day.
Run chart created.
Collect post-intervention data on whether patient demand for appointments is being met or not.
Collect pre-intervention and post-intervention data about clinician workload.
PDSA 4Collect data to determine whether the intervention met patient demand for appointments. Prediction was that patient demand is being met.Data collected on the percentage (%) of patients phoning between 08:00 and 09:00 who receive an ‘on the day’ appointment.Predictions met—patient demand is close to the target with 93% of patients receiving an appointment when they phone for one between 08:00 and 09:00.Collect pre-intervention and post-intervention data about clinician workload.
PDSA 5Collect data on clinician workload pre-intervention and post-intervention.
Prediction was that there was an increase in number of GP/ANP appointments available.
Data collected on the number of appointments available per day pre-intervention and post-intervention, and the weekly staff rota of the GPs and ANPs in the practice.Predictions met—there was a 43% increase in the number of GP/ANP appointments available in the practice.Collect data on the clinicians’ opinions on the intervention, including the increased number of GP/ANP appointments available and shorter consultation time for review appointments.
  • ANP, advanced nurse practitioner; GP, general practitioner.