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At the heart of general practice since 1960

A dozen practice roles you may not have thought of

Want to expand your staff’s remits but are unsure where to apply their talents? Joannah Connolly asked a panel of five leading GPs for their innovative ideas and success stories

Want to expand your staff's remits but are unsure where to apply their talents? Joannah Connolly asked a panel of five leading GPs for their innovative ideas and success stories

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1 The practice manager as marketing director

With today's focus on the customer experience, and competition from private firms and Darzi centres, practices must market their services like any other business. And no business worth its salt would attempt this without a marketing director.

Dr Johnny Marshall says: ‘It's about the patient experience – every GP practice must seek ways to improve this. The practice manager can improve services using focus groups, and run marketing campaigns to target patients for services. This means getting the right patients in at the right times, cutting costs and improving productivity.'

2 The informaticist

Most GPs find it very hard to get evidence-based answers to day-to-day clinical questions within a useful timeframe. But why not give one doctor or nurse that responsibility? Not only can this give GPs their answers, but you could also sell the service on to other practices to generate income, says Dr Keith Hopcroft.

‘You need someone in house who's got the time and nous to sift through evidence and provide answers quickly. We trialled this a few years ago with great success – and it can be opened up to the locality. We faxed or emailed questions and got replies back within 24 hours. Nowadays there's so much information available and we all need to practise evidence-based medicine – it's a service waiting to happen again.'

3 The receptionist taking on a clinical role

Your reception staff may be looking for career development – and there's a wealth of opportunity. Take Dr Stan Shepherd's example – one of his receptionists was interested in taking on clinical duties at his east London practice. She trained as a healthcare assistant and now does the phlebotomy and runs the weekly anticoagulation clinic. Dr Shepherd says: ‘All these services deliver care closer to the patient. Delegating to a motivated healthcare assistant has been a huge success.'

4 The self-care expert nurse

The perfect list is a large one but where the patients stay away. Fewer patients in the surgery means lower costs and a better service for those who do attend. So how to keep patients healthy and at home? Dr Marshall suggests training a practice nurse or healthcare assistant to be the practice's self-care expert, educating attenders on managing minor illness and chronic conditions, so they don't reattend – or not as often. ‘You could send the self-help expert out into the community, running educational sessions to keep patients out of the surgery in the first place,' he adds.

5 The hospital co-ordinator

One way to improve the patient experience is to ensure they have a smooth journey through hospital services. Taking inspiration from the US, Dr Shane Gordon suggests you appoint your receptionist as a hospital co-ordinator with the remit of confirming appointments, sending reminders, setting up transport, ensuring transfer of information and planning the discharge process and after-care. Dr Gordon points to the huge waste of resources in the 20% of patients who fail to attend hospital appointments and claims that could be cut to 1%. Dr Hopcroft agrees: ‘I spend a vast number of frustrating consultations with patients purely to unravel the Kafka-esque problems of the hospital system.'

6 The in-house GP specialist

Each partner hones their skills in one or two specialist clinical areas and is used as another layer prior to referral – ‘like an in-house GPSI without the hoop-jumping', suggests Dr Hopcroft.

‘So, say, if you have a discharging ear and you might need to see an ENT consultant, I'll ask our resident ENT GP to see if they can sort you out.' This can cut referrals and also means patients develop a relationship with the most suitable GP for their needs – another tick for the patient-experience box.

7 The specialist chaperone-interpreter

It's happened to every GP – the need for a chaperone suddenly arises and you have to drag the nearest staff member in to help. Dr Marshall suggests practices appoint certain staff members as official chaperones, providing them with specialist training in the role. Where practice populations have a high proportion of non-English speakers, combine this with relevant language-training and the chaperone doubles as an interpreter.

Dr Niti Pall agrees: ‘Getting your staff to carry out roles like this is an excellent way to get value for money from them.'

8 The roving elderly care GPSI

This service is ripe for commissioning – a GPSI in elderly care employed by the practice but who doesn't hold surgeries in it. Instead, the GP goes to the community hospital and local care homes, assessing and treating elderly patients, offering continuity of care, managing end-of-life needs and preventing admissions.

Paul Bearman, general manager of WyvernHealth.Com, is commissioning just such a service for two Somerset pilots. And nearby Frome Medical Practice employs Dr Chris Wilson, an associate specialist in elderly care, who works at each of the three local care homes and Frome Community Hospital. He says: ‘It's an unusual role in that I'm employed by the practice, not the PCT, but it works. It is challenging, though, because I'm always on the move.'

9 The follow-up troubleshooter

One staff member is tasked with screening all correspondence from hospital to weed out patients having unnecessary follow-up appointments. This is a problem in patients with chronic conditions who are often seen every six months or so, often unnecessarily and almost always by a different hospital doctor, reckons Dr Hopcroft: ‘The hospital never thinks to discharge them back to the GP. But if there is a troubleshooter in the patient's practice following their progress, they can write to the patient and offer them in-practice follow-up instead.'

10 The receptionist as patient advocate

‘The receptionist is viewed by patients as a barrier – the person blocking access who they have to get past,' says Dr Marshall. ‘We need to develop receptionists as people who help patients access services.'

He suggests rebranding the role as patient advocate – ‘more of a customer assistant role', he says. Patients would go to them for help, and even build up a similar relationship with them as with their GP.

‘You could take it a step further and have the advocate perform basic tasks such as blood pressure checks,' adds Dr Marshall.

11 The quality controller

Dr Pall found the need for this role – and the person to fill it – came up unexpectedly. Her healthcare assistant was reading the PCT's specifications on minor surgery rooms and checked if theirs was up to scratch. It wasn't – and needed an overhaul. ‘It cost us an arm and a leg,' says Dr Pall.

The role was formalised as quality controller, and the healthcare assistant took responsibility for ensuring treatment rooms, equipment and instruments met required clinical governance standards.

Dr Pall says: ‘With the rise in PCT mystery shoppers, we can expect unannounced spot checks as well as the yearly instrument checks. If you have a system in place, you won't be running around like headless chickens trying to meet standards.'

12 The mental health expert nurse

Practice nurses are ideal to run clinics and often have expertise in certain conditions – but not usually mental illnesses. Dr Marshall says most practices have to get the community psychiatric nurse in, but having clinical staff with psychological training could be a more effective way of managing both psychological problems and physical problems with underlying psychological causes.

Dr Hopcroft agrees: ‘This is something I've been thinking about: first, using an audit package to identify high users. This would hopefully help primary care staff manage such patients – and perhaps create a role for an in-house ‘heartsink clinic' run by appropriately trained nurse or GP.'

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