How to manage rising workload
Struggling to keep up? Six GPs share their advice
Workload, our looming CQC inspection, patient complaints and GP-bashing in the media have cast an air of gloom over the whole team and created a siege mentality, particularly at reception. How can we foster a more upbeat, ‘can-do’ attitude in our staff, without coming over as too corporate or unrealistic?
When aiming to improve staff morale it is important, if possible, to organise time out for the whole team without the distraction of the telephones constantly ringing.
Then each team member, including GPs and clinical staff, should be asked to explain what they see as their role in the practice team and to list the barriers that they face to delivering a quality service. Everyone should be asked to suggest how a team approach can be developed to address those barriers.
A member of the patient participation group could also be invited to give a view that might identify issues staff are not aware of. In my experience, this can result in positive feedback rather than concentrating on all that is ‘bad’ about the practice. Teambuilding in this scenario is vital, and there are a number of ways of doing this – including getting in an outside facilitator. But this can be stressful for some and simply organising a social event can be as effective as it allows team members to see each other in a relaxed environment.
Some practices have used customer service training for their staff and this can be useful. But it’s important to get a trainer who understands the general practice environment rather than one who provides generic training that may not be appropriate.
It’s important to remember why we became GPs in the first place, and what role we are there to fill for our patients. It’s likely that practice staff across the country regularly hear GPs moaning about their patients and their jobs, which is likely to result in them viewing their own roles in a different light. Many receptionists see themselves as the barrier to protect their GPs from rising demand, and treat patients accordingly.
However you decide to approach the problem, it’s important that GPs are seen to lead from the front and set the tone. If you are constantly in a negative state of mind how can you expect anything different from your staff?
Dr Dean Marshall is a GPC executive team member and a GP in Midlothian.
While it can be difficult to take time to think about why your systems are not working, doing so is vital if the situation is going to change positively.
First, review demand in your practice: all calls (appointments, home visits, scripts, results), paperwork (hospital letters, discharges and pathology results, requests from the area team and CCG/health board, enhanced service requirements, forms and court orders), teaching and training requirements, and GPs’ external roles. Review your appointments systems – do they still suit your needs? Look at the services you offer and check they are still worth doing. The BMA’s new guidance Quality First provides a list of GPs’ contractual obligations in chapters 10 and 11.1
Second, discuss the outcomes with your team. Set up ‘quick win’ solutions such as online appointment booking or script ordering, booking kiosks, or flexibility in rotas to ensure sufficient numbers of staff are on at peak times. Is there work you can stop doing? You will probably need a locum to cover the time this will take.
Third, focus on longer-term projects to manage demand, and keep your staff involved – they often have great ideas. Try brainstorming solutions at teambuilding sessions or outings.
Fourth, ask neighbouring practices if there are ways you can support each other – for instance, sharing information and resources to prepare for CQC inspections, adopting efficient working processes or strategic co-working (the GPC has specific resources on this). Ask your LMC and area team if they offer any practice management advice. Lastly, keep your patients informed and involved – they are a valuable resource.
Dr Charlotte Jones is a GP in Swansea and chair of GPC Wales.
Our admin staff are overwhelmed and we GPs are drowning in paperwork. How can we reduce the workload?
Our practice – list size 6,900 – noticed that the burden of paperwork had risen over recent years and we have managed this by reviewing the administrative pathways that generate this day to day. We evaluated what is actually necessary, delegating each task to a named administrator so they can act quickly, empowering all staff to pass work to the delegated person or decline it if inappropriate. We have three administrators, including a customer services co-ordinator and an administrator co-ordinator. We have also ensured that the pathways involved have as few steps as possible.
We have also set up our own work-saving actions in Docman and EMIS, to ensure the correct person gets each task. For example, when a letter informs us of a patient’s non-attendance at a hospital appointment, we have a template letter on EMIS advising the patient about the action they should take.
Not every incoming letter needs to be seen by a GP. For example, copies of letters to patients informing them of their appointment time can just be scanned into the records, not sent for a doctor review.
Finally, we refer to PALS any query from a patient about a hospital attendance or admission that does not involve an immediate response (for example a query about what medicines to take) rather than answering it ourselves. Start with the recently released Quality First BMA guidance to find what work you can and should pass back or on to other organisations.1 Have a process to facilitate this.
Dr Nicola Waldman is a GP in Merton, south London.
This requires a solid management team with clearly defined roles. It helps to specify these roles in each staff member’s job description (particularly for managerial and admin staff) and for everyone to understand that nursing and reception staff should take on board some responsibility for running the practice.
For instance, at our practice, one member of reception staff has agreed to undertake smear test recall, Read coding and review, all of which is overseen but – importantly – not done by a partner. One nurse chases the smoking indicators in the QOF and ensures we are meeting thresholds. Another member of reception staff undertakes Read coding for safeguarding, and arranges the fortnightly meeting and agenda. Each person has a ‘second in command’ to cover illness, plus a GP supervising. Having a specialised coding and scanning team can also help, with different areas of the QOF delegated among staff.
Once you’ve decided to make these kinds of changes, let the nursing, clinical and managerial line managers tell their own teams about new workload initiatives, and explain the rationale behind them. For example, if patients start demanding appointments for NHS Health Checks, it helps if the staff know what health checks are, why patients want them and which patients are being targeted for them. Going forward, stand up and question any new initiatives and, if necessary, use your LMC for support. And don’t forget to cost all your private paperwork appropriately, because this may disincentivise some companies from requesting unnecessary, cumbersome reports.2
While you wait for these changes to deliver some relief, support one another and identify colleagues who are struggling and who may need additional help, and perhaps share some of their roles with other team members.
Dr Susie Bayley is GP in Derby.
I’m getting home later and later every night and my home life is suffering. How can I manage my time better?
Sit down and write out a typical day, listing how many sessions you work. Try to establish whether your ‘pressure point’ arrives when you open your inbox in the morning to a huge mountain of results that need to be processed or whether you feel stressed if you run late in the evening. Then write a ‘wish list’ of things that would help you finish on time.
Sometimes, individual measures can help – putting a 20-minute break in the middle of your surgery might stop you running behind. Although it extends your surgery by the same period, if you finish on time it may be worth it.
If your IT system allows remote access, sometimes it can give you a better balance to leave work on time, see your family, then spend an hour in the evening catching up remotely rather than staying at work.
The current trend to reduce sessions until you can deal with the workload is always a possibility, but may not be financially feasible, or the practice may not have capacity to do this.
If there is one single area that seems to generate a lot of work, such as high numbers of home visit requests or filing lots of blood results, look at whether better triage or reallocation could deal with this.
Talk to the other doctors to establish if they are all feeling the same. Consider encouraging the other partners to write their own list of pressure points so you can work together to improve things. For example, it may be more effective to allow allocated time for one partner to deal with urgent admin each day rather than you all running behind. Involve your practice manager if this is a logistical workload issue and consider looking at formal programmes such as Productive Primary Care.3
It may also be that your home life has stresses that are affecting your performance at work. If you feel you are already suffering from burnout or showing symptoms of depression, speak to your own GP.
Dr Zoe Norris is a GP in Hull.
Adopting simple techniques can speed up your admin work. Only process a task once – but complete it the first time, rather than putting it in a stack to be done later.
When processing results, look at and action all the abnormal ones first. Then rattle through the list of normal results at a faster rate.
Ask your practice manager to be as selective as possible with emails sent to all GPs – for example by filtering out circulars and alerts from other organisations that do not usually need to be read.
Ask your receptionists to decline calls from pharmaceutical companies and any unnecessary callers.
Get a voice recognition dictation system, and once you are slick with it, you will be able to complete your letters quickly (preferably at the end of the relevant consultation).
When you are off duty, ensure that colleagues do not telephone you unless it is really impossible for them to wait until you are back at work. You must be able to concentrate fully on your family without work worries intruding in to your personal life.
Taking the work computer home is not a simple solution, as work simply spills into every moment. If you choose to do this, make sure that you switch it off once the vital jobs are done.
I am not convinced that taking training courses in time management is a good option, as most of us have already worked out how to get through the patients, the paperwork and the telephone calls as efficiently as possible.
Dr Fiona Cornish is a GP in Cambridge.