How to manage time effectively
GPs are busier then ever – so good time management is increasingly important, says Dr Peter Moore
It's amazing. Dr Who can travel throughout time anywhere in the universe but still only has one episode to save mankind. The BBC will not allow him to take an extra five minutes to stop the Cybermen or the Daleks.
If Dr Who finds it difficult to create extra time no wonder it is impossible for us lesser mortals. We are humble GPs, not timelords.
In the same way that the staff budget is a limited resource, so is time. If we employ a secretary to count QOF figures, we do not have the money to increase nursing hours to check blood pressures. It may be possible to squeeze some funding by cutting personal income or reducing other services but it will create problems at work and home. Time, like money, is also a limited resource which must be spent carefully. We may be able to make time by going in early, getting home late or cutting other clinics but at a cost to patients and family. For most GPs, the timetable is full. We can take on another role but should also ask: 'What am I going to give up to fit in the new job?'
To avoid overspending time or money we need to look at our own behaviour. General practice is busy and stressful but it is unreasonable to expect patients to accept the excuse 'I always run late'. Why do you run late? Starting punctually helps. Also how is your strike rate? Are you booking eight patients an hour when you consult at six? Early in our careers we develop a natural consultation speed. This ingrained behaviour is difficult to change. It is more sensible to book surgeries that fit in with your rate than try to change behaviour. And it is illogical to argue that time does not allow you to lengthen surgeries. It is better to finish a surgery at 11am on time than 11am half an hour late.
Otherwise intelligent doctors sometimes think that, if they consult at eight an hour and book at eight an hour, they will have time between patients to fit in extras, phone calls or check who won the 2.30 at Newmarket. The maths does not work.
Don't be distracted
Running on time means not getting sidetracked. Unless there is a clinical need it is more logical to put extras, phone calls and booking the cat into the vet at the end of the surgery or allow gaps to fit them in.
Do the staff know when it is reasonable to interrupt a consultation? One colleague went into his morning surgery telling the staff he was going to audit interruptions. For the first time ever he was not interrupted.
Effective delegation can create time. How many patients could be sorted out equally well by the nurse? How many pieces of paper could be dealt with by administrative staff? We do not expect our accountant to personally add up all the figures.
But detailed planning in general practice is as realistic as planning where the pigeons are going to land in Trafalgar Square. There will be days when the PC packs up, the worst heartsink produces her first genuine illness and a partner breaks a leg. In these cases, the GP must do what is necessary to speed up without compromising quality of care.
Patients, media and politicians believe that when we are not seeing patients we are relaxing on the golf course. Although we know this is not true, do we allocate time for all the other essential jobs? When are we going to sign and check prescriptions, dictate letters, ring back patients, read and respond to post and results, insurance reports and all the other mountains of paperwork? Most of us do this over coffee or take it home. We are not concentrating and mistakes will be made. Life is less stressful if time is set aside for paperwork or routine phone calls.
So how do we decide what tasks need to be done now and what can wait? It is possible to ask two questions about every task; is it urgent and is it important? If it is urgent, do it now; if not, leave it for later. If important, spend time; if not, do it quickly. If important but not urgent, allocate time in the future. If urgent and not important do it now, quickly. If neither – why are you doing it?
Time management is a skill. The theory can be taught but carrying out effective time management requires practice. And some of us never quite master it. A golf pro can teach the theory of hitting a ball, I can even understand the logic, but the ball seems to have other ideas. But knowing the theory means there is a chance the odd shot goes the right way. Understanding the theory of time management will not make the GP with a hopeless sense of time into one obsessively punctual, but it might help their time-keeping move in the right direction.