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Get on top of your time management

GPs have a duty to patients, colleagues and to themselves to manage time well, says Dr Melanie Wynne-Jones

If you are feeling pressured, take control. Take control by reflecting on your situation and working out what is going wrong.

A time log will help you to establish this. Divide your working day into 15-minute time slots and jot down exactly what you do, plus comments, as you go along (see box).

This should give you some insight into the situation. Are your (or others') personal habits or attitudes affecting your time management? Are you supremely efficient at all times, or do you procrastinate, try to do several things at once, or say 'yes' when you should say 'no'?

Are workloads evenly distributed, and do you have any protected time, or is poor management making life difficult for everyone in the organisation? If you suspect you are working too hard or your performance is falling off, talk to colleagues, friends, family or your own GP before your health is affected.

Many doctors overrun their surgeries with knock-on effects for the rest of the day. Better time-keeping could improve both your own and your patients' satisfaction levels. Are your appointments a reasonable length? Do you try to do too much, or find it hard to contain unreasonable patient or practice demands? Do you need to improve clinical or computer skills?

Taking practical steps

Starting on time with the necessary information and equipment to hand, minimising interruptions and asking patients with multiple, non-urgent problems to book another appointment will all help.

Built-in 'catch-up' gaps may reduce your stress levels (or simply defer the stress). Consider videoing your surgeries and re-analysing your consultation skills; it may be helpful to do this with a colleague or re-read books on the consultation.

Visits are a major drain on doctors' time and are usually only justifiable for the truly house-bound or terminally ill. Faced with threats or clinical concerns, it may be best to visit first and argue afterwards; but acceding to all requests will add to your ­ and the practice's ­ time pressures. Careful telephone triage is a safe way to decide if and where patients should be seen. Are you skilled and comfortable about refusing patients who demand visits inappropriately, or is this a learning need?

Other telephone calls should be stacked and dealt with during gaps or en bloc. Standing while talking is said to truncate calls; close the conversation down quickly once the point of the call has been achieved.

Incoming paperwork should also be 'triaged' ­ do now, do later, delegate or bin. Safe and effective delegation is a vital skill that can be learnt, as is saying 'no' to things you don't want to do.

Further triage 'do later' stuff into urgent/non-urgent, and have separate trays for less-urgent tasks such as letters, reports, information and circulars so you can find and deal with them quickly. This will also enable you to make the best use of spare minutes both during and outside surgeries, but time should be allocated every day to prevent paperwork from building up.

Maintain a retrieval system that works for information that should be kept: this might be a filing cabinet or the practice's intranet/document store. If you are a non-principal, you may prefer a personal digital assistant, laptop or briefcase; find out how to access practices' systems whenever you can.

Uninterrupted work is more productive, so be firm about protecting your time. Shut your door, ask staff to come back later, or hold calls until a certain time. Breaks should also be regular, scheduled and protected, but this may require a culture change if the practice fails to respect individuals' time or has inefficient systems that create unnecessary interruptions. Change is the practice manager's responsibility, but she will need doctor support.

Meetings should not squander skilled and expensive professionals' time: should stick to agenda, be skillfully chaired and result in a clear, minuted action plan.

Revisiting your time log will enable you to review the effects of any changes made. The process itself and the learning needs it identifies can also be incorporated into your personal development plan.

Possible activities

 · Consulting

 · Visits (including driving)

 · Telephone calls

 · Admin and paperwork (subdivide if helpful)

 · Meetings

 · Interruptions

 · Informal discussion

 · Social chat

 · Learning

 · Self-care ­ eating, breaks, exercise and so on

 · Time wasted by self (such as mislaid items, failure to delegate) or others (inefficient systems or individuals)

Melanie Wynne-Jones

is a GP in Marple, Cheshire

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