Table 2.

List of examples of candidate always events linked to the patient's perspective and potential practice systems, measures and feasibility

N	Examples of candidate ‘Always Events’	What would it look like to the patient?	Link to care process?	How to measure—specific example (subset of patients?)	Feasibility
1.	“I want to be able to get through on the telephone to reception quickly”	▸ Telephone would be answered within 1 min. If the practice has a call queuing system—call transferred to operator within 1 min	▸ Technology—to direct phone calls efficiently to correct member of staff ▸ Manager to ensure enough staff are present to answer phones and prioritise this based on demand	▸ Measure time to answer phone. Performed by manager at several points through the day ▸ Time until speak to operator in call queuing system ▸ Patient satisfaction with access	▸ Yes but may have staff implications ▸ Technological solution may have cost implications
2.	“I want to access a doctor or nurse on the day when I have a problem that is important to me”	▸ When calling, patient is asked if they need to see or speak to a clinician that day	▸ A standard script is developed for telephone staff ▸ Staff ask all patients if they feel they need to see or speak to a clinician that day	▸ Observation of call handling ▸ Patient satisfaction questionnaire results	▸ This may be feasible depending on current systems and demand ▸ It may have staff and therefore cost implications
3.	“I want to arrange appointments around my family and work commitments”	▸ When patient phones for appointment they are offered appointments in advance at varying times through the day. This may involve waiting for appointments	▸ Appointment templates are added to the system in advance and include pre-bookable appointments at different times through the day	▸ Pre-bookable appointments are on the system 4 weeks in advance	▸ Yes
4.	“I want to be seen at or near to my appointment time”	▸ Patients are seen within 30 min of appointment time	▸ Staff warn patients if clinician is running late and they are offered another appointment	▸ Measurable in computer appointment booking system ▸ Data for average time after appointment time that patients are called into the clinician's room	▸ Not always possible, as clinicians may need to deal with emergencies or an urgent house call may be required that requires the GP to leave the practice. This may occur in a single handed practice
5.	“I want to see the doctor or nurse who best knows me”	▸ When the patient books an appointment, they are asked who they wish to see and are given an appointment with them. This may involve a longer wait	▸ Staff are to routinely ask this information and it is embedded within their telephone script ▸ Pre-bookable appointments are created for each clinician	▸ Observation by practice manager to ensure all patients asked this information ▸ Patient satisfaction questionnaire results ▸ Retrospective audit of who saw patient	▸ Yes
6.	“I want all practice team members to show genuine concern for me at all times”	▸ Patients feel they are able to speak freely, that staff show empathy towards them, allow them to speak and actively listen to them	▸ Staff training on communication skills and active listening. Use of empathy and key phrases for staff embedded in telephone ‘script’	▸ Enablement/CARE questionnaire for clinicians ▸ Observation of staff, patient satisfaction questionnaire relating to staff interaction with patients	▸ Yes
7.	“I want the correct treatment for my problem”	▸ Patient-centred treatment given that is evidence-based, when appropriate	▸ Clinicians with up-to-date skills. An active educational programme is in place within the practice to help identify and address needs. Learning and its impact will be included in appraisal	▸ Options may include case note review to assess if correct treatment was given, audit of outcome of referrals and review of prescribing data	▸ Yes
8.	“I want the clinician who sees me to know my medical history”	▸ Patients are made aware that the clinician knows their history. Not having to retell the whole story, being aware of the outcome of appointments, results and current medication	▸ Up-to-date clinical information including coding is correct. Protocols are in place for medicines reconciliation and results handling systems	▸ Patient satisfaction questionnaire results ▸ Audit of accuracy of coding ▸ Audit of medicines reconciliation and results handling bundles	▸ Yes