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10 steps to gaining control of your patient consultations

Constantly running late or finding it hard to get the job done? Dr Charlotte Jones has a step-by-step guide to transforming your working day

Constantly running late or finding it hard to get the job done? Dr Charlotte Jones has a step-by-step guide to transforming your working day



The epicentre of a practice is the patient consultation. It is our raison d'etre, and as such it needs protecting and nurturing.

Without our consultations, in which we are supplying our expertise, our patients would not get what they need, and neither would we.

Increasing demands from the profession's standard setters, heightened patient expectations and a system that presses constantly for ‘value for money' have shifted the balance away from the patient consultation, turning our practices into feeders of the beast that is the system.

Could taking a fresh look at the management of consultations in the practice help recalibrate the scale? Here is some advice on how to go about it.

1 Review appointment length

Make some time alone and question whether your consultations are long enough for you to feel you achieve what you regard as professionally satisfying.

Identify the barriers to achieving this. Do you feel constricted by the allocated appointment length in your practice? Do you have enough time to deliver the quality of consultation you would wish? The chances are that time will be an issue.

Repeat the exercise for your session length and your working week. Enter this as an item of reflective practice in your appraisal folder ready for revalidation – and that's two jobs done for the price of one.

2 Work out how much time you need

Your focus should centre around the factors that determine how much time you need. These will be doctor driven, patient driven and systems driven.

Explore all these factors and how they affect the time you need to do the job. Rule nothing out and nothing in. Instead, give yourself the luxury – and the time – to model an ideal scenario.

This will be a good investment when it comes to discussing the issue with others in the practice.

3 Review what affects your own performance

For doctor-driven factors, think about what makes you tick, what makes you effective and yes, efficient.

Refresh your Pendleton and Neighbour. Consider your IT and multitasking skills. Define ‘the job' and ask yourself what is it about you that stops you getting the job done.

For me, ‘the job' is about enabling patients to communicate their histories, their symptoms and their concerns (medically, psychologically and socio-economically), to examine them and create a plan, and to opportunistically identify any other health concerns.

This is a tall order in 10 minutes, where several of those precious minutes are spent looking at a screen and not at the person sitting beside me.

And it's hard to keep up the pace, consultation after consultation. I frequently feel pressurised and can find this interfering with my subsequent consultations, not to mention my work-life balance.

4 See the world as your patients do

To assess patient-driven factors, imagine yourself in their shoes. Think about what you would want from your own GP, and what you'd want for your partner or your child.

Try to translate that into the time you would want your doctor to take.

5 Put your practice systems under the spotlight

Identify the factors in your practice system that stop you getting the job done. These can be NHS induced or practice initiated, or of course a combination of both.

Does the system require that your consultations are only 10 minutes when you feel you need 20? Or do you need a range of flexible slots depending on the type of consultation?

Where does it say how long an appointment should last? Challenge the norms. Are DNAs a relief? If so, ask why.

If you're going to make time for front-line care, how can you steal it from elsewhere, and what would have to be prioritised? What determines how your practice responds to demands for information from your primary care organisation?

6 Discuss the need for change with colleagues

Get together with the other doctors in the practice. Ask everyone to share their views. Don't be tempted to jump for solutions at this stage.

Agree a rapporteur, and agree to meet again in a week or so to discuss an action plan. This is crucial as memories fade rapidly once you are back in the thick of delivering a service. Don't skip this discussion stage. It is fundamental.

Challenge the behaviours and reactions of your colleagues and let them challenge yours. As with many issues, if no one challenges, behaviours perpetuate.

And if someone says your practice doesn't need an action plan, that's a sure sign that it does.

7 Draw up a shortlist of ideas

In the time until your next meeting, choose three ideas to be your top priorities for change.

And choose another three to have up your sleeve, in case your first three meet resistance, or if your colleagues are more willing to consider change than you had expected.

8 Formulate your practice plan

If your practice manager wasn't at the previous meeting, invite them along. They will be key to putting the changes into practice.

Take your set of three priorities and assess them in relation to your own needs and your patients'.

Also assess them according to the needs of the system, but these considerations should be ranked last.

Now identify the challenges for the practice and address them. Do not fudge these. You've made time for change and you've done the crucial thinking.

Don't waste that energy. Formulate them into an action plan with recommendations and achievable delivery and review dates.

9 Consult on your ideas

Consult with your staff and patient group if you have one.

Explain the context and understand any concerns. Review the plan in the light of these concerns, and agree the final recommendations and time scales.

10 And away you go...

Implement your plan and review every six months.

Dr Charlotte Jones is a GP in Swansea and a member of the GPC

Our ten step guide will help you gain control of your patient consultation

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