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Br J Gen Pract. 2009 October 1; 59(567): 779.
PMCID: PMC2751923

Early experience

Geryl Rees
Heaton Mersey Medical Practice, 460 Didsbury Road, Stockport, Cheshire, SK4 3BT

Ten months ago our practice commenced an ‘extended hours’ service intended to serve patients unable to attend the surgery during working hours.1 Some colleagues chose to work an evening surgery while I elected to start early. I can remember back in October 2008 the first patient, an 80-year-old retired gentleman, arriving yawning and bleary eyed for a review of his regular medication. Upon asking how he was he replied, ‘Terrible doctor, do I really need to come this early to see you? They said it was the only slot left!’.

Now almost 1 year into the extended hours we decided to review its usage. We looked back over the last 6 months of a once-weekly 07.40 Tuesday surgery start.

Between 1 March 2009 and 31 August 2009, 34 pre-8 a.m. appointments were booked. There were four DNAs, 14 appointments for new problems, and 16 for follow-up and ongoing patient management. The mean age of patients was 44 years with no patient older than 66 years and the youngest aged 16 years. Five patients had taken up early appointments on more than one occasion. The majority of appointments were for women, 24/30 (80%).

The ratio of women to men is in keeping with the rest of my morning surgery appointments for the same 6-month period 638/846 (75%). Although the numbers involved are small, DNAs for the early morning appointments was 12% (4/34), twice the rest of the morning surgery, 5.6% (50/896).

Although the DNA rate will need to be reviewed in the future, it certainly seems that early starts suit particular patients well, as is indicated by repeated booking of these slots by some of them. It is apparent that patients of a working age are those taking up these appointments and the reception staff must be thanked for their role in helping the adaptations to the new surgery times. As the dark winter mornings draw in, we will see if these trends continue.


1. Department of Health. Final guidance: extended hours access scheme directed enhanced service. (accessed 14 Sep 2009)

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners