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Becoming a paper-light practice

Dr Peter Crouch describes how his practice tackled its rising paperwork mountain by digitising its document management system

GP practices have dealt with clinical documents successfully for many decades, but the volume and variety entering our surgeries has been increasing year on year.

In our practice, the staggering volume of documents we had to process – we estimate around 2,000 each week – presented a real challenge to delivering the seamless healthcare that patients demand. So we decided to tackle it head on.

We have revolutionised how we manage our documents, and have a developed system that is modern, efficient and intelligent. We are not a paperless practice yet, but we are closer to it. Here is how we did it.

Defining our needs

We are a busy training practice serving a young, rapidly expanding population in Wiltshire and we have a fully digitised medical record, but our paper-based document management system left a lot to be desired.

Bottlenecks frequently formed, with some individuals’ in-trays overflowing, delaying results reaching the record. It was often difficult to see who – if anyone – had seen the documents before they arrived with you and a lot of effort was expended to ensure that the system remained safe.

In order to improve this situation, our practice team sat down and tried to define our needs. We decided that we needed a digital system that stored, displayed and transmitted incoming clinical correspondence efficiently and instantly. It should be accessible from multiple locations and should allow simultaneous access to the same document.

The system should record when a letter required a GP or nurse appointment or other actions to be taken routinely, soon or urgently. It should also allow certain colleagues to be copied in for their information and keep all comments made by users.

Finally, it should be auditable and efficient, and work well with our current clinical software system, EMIS. In other words, it should support – not dictate – how we wished to work.

Implementing the new system

After defining our needs, our managing partner set about looking for a system that could meet them – and soon realised there were few IT systems specifically designed to assist GPs delivering UK healthcare.

Most business-document workflow systems were born of the simple need to process decisions and authorise them. Often this takes the form of ‘approving’ or ‘rejecting’ documents and moving them onto the next department – unfortunately, general practice is not this simple.

Our ideal workflow system was a more intelligent system. Documents should not be required to follow the same route and could be re-routed if needed. For instance, letters with no action required might be filed with a note saying: ‘Please let the patient know that no further action is required if they ask.’ Or, if I received a document without a NHS number, I click: ‘No NHS number, please inform PCT’ – and the letter would go to my reception team to action. Suppliers include CADmeleon, Kainos and UK Document Management, but in the end we went with PCTI’s Docman.

Effects of the change

The new system has made a huge difference to the way we handle documents in our practice. The time we spend processing documents has reduced, saving our staff hours each week.

What used to take seven to eight mouse clicks to process one document is reduced to just one or two clicks, documents are easily traced and we can then run reports to audit our data effectively. As a result, we have been able to redeploy staff more towards providing patient services.

If we receive a patient letter electronically, we can file the document quickly and accurately and it can be with a patient’s GP instantly to comment. We can determine the route of the document in the system, clicking ‘Read code highlighted’ for it to be forwarded to my coding team, or ‘appointment request with GP’ for my admin team to call the patient.

We can therefore act on information more quickly, delivering a faster service to our patients. If a patient attends the surgery, I can easily search through clinical letters filtered by specialty, knowing I have access to an up-to-date patient record.

As well as linking in with our clinical system, our electronic document management system can also act as an intranet or storage of non-clinical documents, such as newsletters, meeting minutes, holiday forms, price lists, training guides or financial statements.

This means anyone in the practice team can view non-patient documents instantly and workflow them if required.


The company claims we should receive a measurable return on investment within nine months, with an average return on investment per practice of £6,560 per year.

We are very happy in our practice with the cost of the solution, given the benefits of knowing that documents were being routed in a way that we thought was efficient, secure, safe and methodical.

The system is managed and hosted within the practice and access to information is managed through role-based access. Physical document data is encrypted to a standard designed to exceed Connecting for Health’s Good Practice Guidelines.

Our future plans are to encourage our local hospital to transfer its correspondence to us electronically, to provide an even faster and more informed service to our patients.

Dr Peter Crouch is a GP in Wiltshire and chair of the Transitional Leadership Group (NHS Consortium for Swindon)

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