Intended for healthcare professionals

Education And Debate Modernising the NHS

Patient care: access

BMJ 2000; 320 doi: (Published 10 June 2000) Cite this as: BMJ 2000;320:1594
  1. Mark Murray, healthcare consultant. (
  1. 2209 Capitol Avenue, Sacramento, CA 95816, USA

    This is the fifth of seven articles

    Delays for access to care plague our healthcare systems. These delays cause patient dissatisfaction, contribute to staff dissatisfaction, and may lead to worsening clinical outcomes. They are also expensive: patients often consume scarce resources while waiting, there is a cost in maintaining any waiting list; the longer the wait the higher the “fail to show” rate, which represents unused capacity; and, finally, there is the risk that patients waiting will arrive with a more costly clinical condition.

    Access to care can be improved. Improving access involves looking at system flexibility or capacity. There are three fundamental methods of gaining capacity in a system of care.

    Summary points

    Delays plague all healthcare systems, causing discontent, consuming resources, and worsening clinical outcomes

    Most waiting systems rely on distinguishing between urgent and routine cases and so maintain two queues

    Real improvements in access come about when there is only one queue and it is short enough to ensure prompt treatment for urgent cases

    Improving access involves determining the demand and applying resources to match it or reduce it

    Gaining capacity

    Firstly, many current systems are characterised by schedules that are filled far in advance of the delivery of care or service. Demand arises from the population served. This demand is generally stratified into “urgent” and “routine” queues. Urgent demand is managed by overfilling an already saturated schedule or by sending that demand to another venue for resolution. Routine demand is put to the end of the queue. Overfilling a full schedule or sending demand to another venue or to the end of the queue infuriates patients, overburdens providers of care, and often just postpones the needed care or service.

    Secondly, other systems gain capacity by predicting demand for urgent care or service and holding capacity in anticipation of this need. …

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