Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

How we launched a 'named GP' scheme for all our patients

Dr Iain Redmill explains how his practice saved time and cut paper work by assigning all their patients a ‘named GP’

After the merger of two large practices, forming a practice of 16 partners and circa 25,000 patients, we noticed our continuity falling.

This was affecting us negatively when interacting face-to-face with patients, but also to a much more pronounced degree when managing paperwork, such as letters, repeat prescriptions, queries and reports.

The GPs in the practice wanted more continuity to improve their job satisfaction, safety and efficiency, and patients told us they valued it because and because it provided more joined-up and individualised care.

So, after much soul-searching, we decided to give all our patients a ‘named GP’.

 

Getting started

At first, the main difficulty was identifying our ‘own’ patients from the list. Our practice had historically not ‘registered’ people under specific GPs, and therefore the ‘registered GP’ recorded in the patient record was meaningless for this process.

Similarly the ‘usual GP’ listed in patients records appeared to be randomly distributed because we had not used these fields previously and had been relying on our admin teams to direct post appropriately.

We had learnt that a neighbouring practice recently launched full personal lists after GPs and practice staff matched every patient by hand, but it took significant time and effort. We decided this would be too much work, and decided to find an automated solution.

 

What we did

From the clinical system we exported all face-to-face and telephone contacts with GPs over a three-year period. These were then cross-tabbed in a database to find consultation frequency for each patient with each GP.

One of the partners then wrote a piece of software which picked out where a patient had consulted with one GP more than any other. This allowed us to allocate two thirds of our patients at the press of a button. With the information we had collected, it was then possible to generate lists of the unallocated patients the GP had seen the most, for each GP, to allow them to find their remaining patients.

We then had the dilemma of how to inform patients of the change. This has been a gradual process, advertising through newsletters, patient screens, and through the telephonist’s appointment scripts.

 

Challenges

With the first two-thirds of patients allocated electronically and the remainder placed with decision aids, the main challenges were logistically of how to import this information back into the clinical system, which proved to be quite painstaking, although with some support from our clinical system supplier, semi-automatic.

We also borrowed an IT tool from a neighbouring practice that risk-stratified every patient by a variety of criteria and used this to ensure our lists were balanced in terms of need and attendance. This ensured that GPs were not unfairly burdened with high-intensity patients, flagging those that were ‘overloaded’, to allow some swapping.

Electronic allocation of around 17,000 patients (the first two thirds of our list) saved a lot of time. The actual allocation took approximately a day of one partner’s time (although this could be done by any IT-savvy member of staff). The intensity tiering process was much more time-consuming, taking two or three days and some admin support time.

 

Results

The move to allocate named GPs has meant that we can operate a ‘nominal list’ system. Most appointments are offered as in a shared list surgery, with some priority appointments (coded differently) for seeing your ‘named GP’. Priority appointments are available only to patients with named GPs until the day of the appointment, at which point they are opened to all patients. This keeps the flexibility of the shared list system that we valued, while regaining the continuity in non-face-to-face work we had lost.

Documents arriving in surgery can now be automatically directed to the correct clinician, as can results, using Docman and iWorkflow. Our local acute trust is now sending many documents electronically and results can also be automatically distributed. Our system, Vision, allows these to be directed to the ‘usual GP’ where the requestor is not a partner or unspecified, and any queries arising in the office are easily directed, as staff can readily identify the responsible partner.

All of our proformata and letters can be populated with the now easily accessible Vision’s ‘usual GP’, meaning patients receive letters from, and hospitals are correctly informed of, the right clinician.

There have been time - and therefore cost - savings due to reduced paperwork, which has helped us to trim costs. Lines of responsibility are clearer and our processes are much less stressful now they are streamlined. GPs appreciate receiving documents and results for a consistent group of patients, as we can coordinate care more effectively.

 

The future

We intend to gradually adjust our clinics to find the optimal balance of ‘named GP’ vs ‘any GP’ appointments for our patient group, and have started to be able to split our QOF work (QOF clinics, coding, co-ordination, recall) down to the responsible GP much more easily than before.

We have already been approached by others practice interested in our process for allocation, and looking to replicate it.

Dr Iain Redmill is a GP in Blackfield, Southampton. He is also the founder of www.RevalidationTools.co.uk. Practices interested in the process can download the script for free here: www.revalidationtools.co.uk/usualgp

Related images

  • Online Help Computer Screen

Readers' comments (6)

  • It is very interesting that it has been recognised that the traditional way of every patient having a named doctor is helpful in delivering best care and is welcomed by most patients. Once more we are reinventing the wheel! It is a shame that the incentive to do this has to be financial

    Unsuitable or offensive? Report this comment

  • This works until you have a patient with a long term condition, with a fairly high level of need/complexity, who appreciates continuity with the doctor they normally see, who also happens to be the most popular doctor with most other patients! I'd be interested to know how Dr Redmill would handle that one...

    Unsuitable or offensive? Report this comment

  • This is so far removed from most practices that I know it's like going back to the stone age .
    Where are your salaried GP s in this cosy set up ?Or your nurse practitioners ,or your female clinicians going off on maternity leave on a regular basis, or your younger newer doctors ringing in sick with 'flu' on a Monday morning or your GPs in their 50s retiring with stress and the only people answering the advert are totally unsuitable but you are so desperate you take them anyway.
    As for your practice of 25 k on top over this named GP requirement which you have obviously sorted so efficiently may I wish you good luck in setting up care plans for 500 patients to prevent admissions as part of the new DES , then do monthly reviews of all of those ie 6000 reviews and then 3 monthly reviews of those 500 care plans ie 2000 reviews of care plans, and all this for about 30 k in your collective pockets after tax and other stoppages. I'm sure you will find some computer programme to make this easier too but more likely within 12 months your 16 or so 'Partners' will be down to 12 or 13 ,

    Unsuitable or offensive? Report this comment

  • Sorry but this is a nonsense. Most patients with long term conditions in my experience will organise their follow up and routine care with a favourite or named doctor and are used to seeing any doctor if an acute problem arises. Patients do this automatically it doesn't need a government intervention. The care plan is key not the named doctor I'm spread so thinly these days I'm in danger of disappearing and fed up of jumping through new hoops. Roll on retirement .

    Unsuitable or offensive? Report this comment

  • completely idiotic misguided bureaucratic nonsense beyond parody reinventing a much more efficient common sense wheel.idiocy.

    Unsuitable or offensive? Report this comment

  • The timing of this article perhaps misleads, but actually this process was undertaken 18m ago with the intention of improving our non-face-to-face continuity (long before the incentive was announced)- I agree pt's with LTCs generally try to book with same gp if can, but that doesn't stop their paperwork milling about the practice less efficiently. (which this system has helped significantly with)

    All our regular GP's take a sessional share of 'usual' patient list, and therefore non-face-to-face work.

    This system was not intended to 'solve' the unplanned admissions headache we all face (and it won't), but was presented in the hope it might help some with the smaller UGP headache, so they can concentrate on the other stuff out there.

    Unsuitable or offensive? Report this comment

Have your say