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10 ways to deliver efficient patient care

The Improvement Foundation's Melanie Lawless offers bitesize advice on streamlining services, cutting unnecessary consultations and reducing waste

The Improvement Foundation's Melanie Lawless offers bitesize advice on streamlining services, cutting unnecessary consultations and reducing waste

In the second half of our two-part business report, we continue to examine how to run a profitable practice. Last month we looked at boosting income; this second part focuses on achieving efficiency savings

The Improvement Foundation's Melanie Lawless offers bitesize advice on streamlining services, cutting unnecessary consultations and reducing waste

1 Analyse productivity data

Data accessed though a practice's clinical systems offers GPs a valuable tool to review existing working practice and find ways to improve productivity. Monitor staff turnover rates and the amount of profit attached to the work each does. Analyse QOF and prescribing data for areas where achievement could be improved or costs reduced. And analyse referral figures - one GP could take responsibility for logging Choose and Book data into a spreadsheet, categorising it by specialty and reviewing a specialty each month to identity areas where referrals could be reduced.

2 Streamline patient access

Improving systems for patient access can give a practice greater control of how it delivers care by managing and effectively scheduling staff resources. This can reduce the administrative time spent managing patient backlogs and waiting times. Telephone management of appointment requests can reduce face-to-face consultations by up to 50%. Repeat-prescribing requests can be handled by email or websites. Information on a practice website may also reduce the need for telephone queries.

3 Redesign practice roles

Some of the inefficiencies in practices exist because working patterns are out of date and no longer reflect what is required by the service user. You could deepen your clinical role by becoming a GPSI or create a role for a healthcare assistant. Map out your current processes to really understand who does what at each stage in the patient's journey through your practice. Get a clear understanding of the amount of time staff are in clinical settings providing direct patient care. Ask your team to contribute by keeping activity diaries logging what they do and when. Look for mismatches, such as practice nurses spending half their time completing administrative tasks.

4 Promote self-management

GPs are well placed to encourage patients to self-manage to minimise consultations. You could provide practice-based support groups and group education sessions, or signpost patients to support available in the community or online. Ensure practice staff keep a list of local support networks. Make patients aware of condition-specific self-management courses and ensure initiatives such as the Expert Patient Programme are accessible. Try to be encouraging - and remember putting up notices may not be enough.

5 Cut unplanned admissions
Unplanned hospital admissions can have high cost implications for practices, but there are schemes available to reduce unplanned admissions and 'excess bed days' by integrating health and social care. The Improvement Foundation has, for instance, been working with GPs, PCTs and social services to develop the Unique Care approach - linking up frontline staff around the needs of a practice's registered population. There is evidence this type of approach can cut admissions by 20% and bed-days by 40%. Contact the Improvement Foundation for further information.

6 Avoid unnecessary follow-ups

Look at the services your practice provides or commissions and identify opportunities to reduce unnecessary follow-ups.

Avoid duplicate follow-ups in patients with more than one long-term condition. Many patients with diabetes or CHD also have hypertension and often will be seen in more than one clinic. Consider introducing 'one-stop shop' clinics where the relevant referrals and tests are all made in one visit.

7 Maximise use of PBC

Practice-based commissioning can allow GPs to configure new and more efficient services. It's important you undertake an assessment of the benefits of developing a service in the community - and the demand for it - before going ahead. Analyse activity data and compare yourself with other practices in your PCT to identify key areas for prioritising effort. It can be useful to do this in conjunction with a patient group or representative. Develop a business case as part of your PBC plan, which can help identify inefficiencies early on.

8 Review chronic disease care

About 80% of GP consultations relate to long-term conditions so they have a huge impact on practice efficiency. Good chronic disease management is an area that will not only optimise QOF performance but also has large potential to free up resources and reduce GP appointments. Keep accurate registers of your patients with long-term conditions and introduce systems to maintain accuracy of coding and to monitor hospital admissions, referrals and results of investigations. Develop proactive call and recall systems to identify patients who need review and ensure those who do no reply are followed up. Look at different ways of contacting patients, such as email or text.

9 Listen to patient feedback

Evidence shows practices that seek the views of patients and act on the findings produce more accessible and efficient health services.

The key areas on which to seek and address patient feedback include:

  • access and waiting
  • information provided on health promotion and prevention of illness
  • choice of healthcare professional, time of appointment and treatment option
  • approachability of all practice staff
  • cleanliness and comfort of the premises
  • safety and privacy of the practice.

10 Monitor payment systems

Much of the money earned in general practice comes as a reward for good clinical care, either from the PCT or through PBC arrangements. It's important to monitor these contracts closely because the payment systems can be very complex. Delegate someone in the practice to be responsible for this. In many cases the best person may not be a GP. A great deal of practices offer training to practice managers on financial management or employ business managers who keep a track of their payment systems as part of their role.

Melanie Lawless is executive director of policy at the Improvement Foundation. For details go to

Maximising profits

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