Adopt a supportive rather than finger-pointing approach
When bad feelings are starting to surface it’s best to air them openly. But I would be tempted to broach the issue one to one at first, rather than rounding on the ‘slow consulter’ at a practice meeting.
Adopt a supportive rather than finger-pointing approach – you need to find a solution that allows you all to work together without any lingering resentment. I’d also acknowledge early on that while speed is important, it isn’t the only measure of a GP’s quality, and highlight the doctor’s other strengths (if there aren’t any, maybe it’s time for a different discussion). For example, doctors who consult more slowly tend to prescribe less and do more health promotion. They may also recognise and handle psychological problems better.
The GP may be well aware of the simmering tensions, and have their own ideas about causes and solutions. Do they have any personal problems? Are they seeing more complex patients for some reason? Are there any training needs that you can support? This might include: skills for dealing with patients presenting with multiple problems; training in how to close the consultation by ‘breaking rapport’; or a session on using the computer system more efficiently.
If these approaches aren’t fruitful, I might suggest that the GP does longer surgeries so that they see the same number of patients as the other GPs (this works well for me), or take on other practice responsibilities to compensate.
Dr Graham Easton is a GP in Ealing and senior clinical teaching fellow at Imperial College London
Present the problem clearly, using an audit as evidence
Carry out an audit of on-call surgeries to establish the facts, looking at timings and also types of consultations. This should give you the evidence you need to broach the topic effectively, otherwise the doctor might become defensive and deny the problem.
Consider whether this is a symptom of a wider issue. Does this doctor generally run late in normal surgeries? Are they struggling to cope and showing signs of burnout, or could they have an undiagnosed health problem?
Check with reception staff that patients are not able to influence which doctor they see. It could be that some patients perceive this doctor as a sympathetic ear and try to manipulate the system, making matters worse. If this is happening, impress on patients they will see the next doctor available when it is an urgent appointment.
Ask the practice manager to choose a suitable moment to talk to the doctor, perhaps with one of the partners. Present the problem clearly and honestly (using the audit as evidence), explaining the growing ill-feeling among colleagues so there is an incentive for the doctor to change.
Prompt the doctor to think of ways they could work more efficiently. For example, it may be that they are allowing patients to work through a ‘shopping list’ of complaints, rather than asking them to make another appointment. Ask the doctor what solutions they can come up with that would make the on-call situation more equitable for all GPs.
Dr Sarah Coope is a GP and associate at Healthcare Performance
It’s likely to be down to stress or fear of complaints
The two most likely reasons for this behaviour are burnout and fear of complaint and litigation. Maslach’s work on burnout suggests that work inefficiencies are a late feature of burnout – Pulse’s ‘Battling Burnout’ resource on spotting the signs could be a good place to start. Ask the GP to reflect on any recent cases that may have generated anxiety about clinical errors.
Start the process with a gentle conversation initiated by the partner with whom the doctor has the best rapport, using active listening skills to engage the doctor and establish their own awareness of the problem. Running an audit on your IT system will show you if a minority of over-running appointments are skewing the average times, or whether this GP attracts lengthy consulters and heartsink patients.
If the situation is caused by fear of a complaint, help the GP to reframe any past problems as infrequent, and a fact of medical life. Offer a significant event audit meeting, or less formal forums, where they can depressurise.
Address specific educational needs, especially on-call skills where more acute case management is required, in a professional development plan. Consider checklists and templates to structure consultations, which can reduce anxiety about complaints. Lastly, consider allocating other less pressured roles in the practice through which the doctor’s skills may be better expressed.
Dr Stephen Bassett is a GP in Swansea and deputy chair of the BMA’s sessional GP subcommittee
