Intended for healthcare professionals

Feature Christmas 2014: On the Wards, in Surgery

The King Canute GP appointment system

BMJ 2014; 349 doi: (Published 11 December 2014) Cite this as: BMJ 2014;349:g7228
  1. Ron Neville, general practitioner,
  2. Simon Austin, general practitioner
  1. 1Westgate Medical Practice, Westgate Health Centre, Dundee DD2 4AD, UK
  1. rondelnev{at}
  • Accepted 10 November 2014

Ron Neville and Simon Austin’s practice decided to stop fighting the tide and let patients have appointments when they wanted. Would they be submerged?

Our practice, close to the North Sea, had a major access problem. After mergers and development of a large multidisciplinary team we found our prebooked general practitioner appointments were overbooked and we were reliant on adding extras to every surgery. This led to discontinuity of patient care, protracted telephone calls between patients and reception staff, and a practice culture of pressure and stress. We needed to make a change.

Recent major changes to the health service—the Quality Outcomes Framework1 and the Health and Social Care Act2—have been introduced without testing. We thought we might follow suit. However, we thought recent health secretaries, although dogmatic in imposing their will on the NHS, lacked the charisma of true leadership, and so we turned to an 11th century king for inspiration.

In AD 1028 King Canute tried to command the tide to turn back. History records that the king of all lands surrounding the North Sea got very cross, wet, and made a hasty retreat. Every day, in general practices across the country, dedicated practice teams get very cross when they are yet again unsuccessful at meeting the daily demand for appointments and the incoming tide of patient demand and expectation. What could we learn?

The big idea

King Canute could have kept his feet dry and his reputation intact if he had reflected for a moment, consulted with his courtiers, and moved his throne back up the beach to the high tide mark. From there he could have surveyed the North Sea every day and sat comfortably as the tide ebbed and flowed.

We decided to retreat to the “high water mark” of patient demand. In keeping …

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