Three GPs give their tips on how to organise your practice to free up more of your time for the tasks that really matter
‘Computer request forms for lab tests have brought real joy’
Sometimes you wonder why you chose to be a GP, when you find yourself bombarded with so much information that you have such little time to spend with patients. To combat this, I have come up with a number of ways to release my time, some more practical – saving vital minutes – and others more strategic, to save hours.
Firstly, buying in a small piece of hardware can make all the difference. In my practice, the introduction of computer request forms for lab tests has brought real joy. Those old enough to remember the nightmare of attempting to fit a triple-barrelled name onto a minuscule blood tube will understand the pleasure of applying that wonderful sticky label, complete with all required information, and not having to scribble on the form itself. Our system is T Quest1 and saves about five minutes for every blood test done.
Several years ago, we started using a screen system to call patients from the waiting room. After the usual barrage of complaints from patients, this device has become a great bonus. It is amazing what you can do in that vital 30 seconds while the patient is en route. I can have a quick look at the notes, check the last results, read a hospital letter, or wash my hands. The sport comes in estimating how long an elderly patient will take and whether I can really eat a whole biscuit.
Dealing with repeat prescriptions is not number one on my list of favourite activities, and I suspect I am not alone. It is the ones with the harmless looking annotations that turn out to be unbelievably time consuming. ‘Could these 19 items be converted to weekly boxes, dispensed every seven days?’ or ‘This drug is now withdrawn, please provide an alternative.’ We have recently tried to make this process more efficient by having one duty doctor each day doing all the repeat prescriptions, freeing the others from this task. The idea is that by focusing on the task properly and altering the drugs so the review dates are correct, we can discourage patients from booking appointments just to collect a prescription and start batch prescriptions where appropriate.
My final tip is to make friends with your staff. Then they will help you out in those vital moments when it all goes pear-shaped and you have double booked a whole surgery, or you need to be protected from the frequent caller heartsink. Without their help you will be spending many unnecessary hours on the telephone trying to wriggle out of a mess.
Dr Fiona Cornish is a GP in Cambridge and president-elect of the Medical Women’s Federation
‘I ask if any visits could be done by a community matron’
As a single-handed GP, I am heavily reliant on my practice team taking the burden off me, allowing me to focus on patients and the business more closely. We often audit our surgery appointments to find out what sort of patients are coming to see us, and identify whether they could be seen effectively by other members of my team or other allied health professionals – I estimate a third can.
For instance, I delegate all chronic disease management and baby and travel immunisation to my practice nurse, a dedicated family planning nurse looks after contraception and cytology, and all new patient health checks and health promotion are handled by our very capable healthcare assistant.
I have developed protocols for how to conduct some pathology reports – for example cholesterol, triglyceride and eGFR checks – allowing a practice nurse to order the tests, follow up on the results, and refer back to me if they are unsure. All bloods are taken by a trained healthcare assistant.
One excellent way to free up my time was to employ a healthcare assistant who is computer-skilled. He is able to help with Read coding and carrying out simple prescribing audits, enabling me to more accurately record QOF activity and reach my prescribing goals set by the PCT.
A trained receptionist helps patients book outpatient appointments using Choose and Book (except for two-week cancer referrals, of course) and I also have a healthcare assistant who has been on a summarising teaching day and does all this work for me. I have to check their work, but gain some valuable time by not doing this myself.
Before setting out to do a visit, I make sure I think whether this could this be done by a community matron, practice nurse or a district nurse. An acute exacerbation of COPD can be managed effectively by a trained community matron if you have one, and she can make a rational and competent decision on whether an admission is needed. A blocked catheter and setting up a syringe driver can both be done competently by a district nurse.
One last tip – telephone triaging is not new, but in most cases the triage is done by a nurse, sometimes helped by computer-based protocols. I feel very strongly that triaging by the GP frees up more time, reduces the DNA rate and manages your workload effectively.
Dr Anita Sharma is a GP in Chadderton, Greater Manchester
‘Having one single pathway has made interventions interchangeable to a degree’
One of the most productive ways we have found to manage the number of consultations GPs have in our practice is to agree a single pathway for patients with certain conditions.
We base these on templates from respected sources, such as NICE2 or Map of Medicine,3 but adapt them for our use, so everyone in our practice feels like they have ownership of them. This means all the GPs and nurses in our practice are clear on which therapeutic option is first line for long-term diseases such as asthma, which is second line and so on, and patients receive care that is consistent.
This takes a bit of work initially, but the gains in efficiency have been considerable. Having one single pathway rather than subtly different ones has made interventions interchangeable to a degree and enables us to easily audit our practice achievement and review adherence to treatment. It has also aided productivity within the wider practice team, with our administrative team now only needing to cope with one of everything rather than two or three.
We have a common and shared understanding of what we do and what we prescribe. This makes our interactions with patients much easier, as there is a culture of supporting each other among the clinicians as well as our nurses and healthcare assistants.
It also has the unexpected benefit of helping prevent patients ‘shopping around’ for a clinician who will give them what they want. Once they understand the practice has a policy where a treatment will not be prescribed by any doctor or nurse, the merry-go-round of appointments will stop – also freeing up GP time.
The other benefits are less tangible, but in many respects more important, as we have started to embed a culture of trust, interdependency and mutual support. This inevitably leads to having easier and more inclusive discussions around time management as well as the importance of managing the challenges of the new commissioning workload collegiately. It will not take too long before this is taken for granted and then much more will be achievable.
Dr Charles Alessi is a GP in Kingston and an executive member of the National Association of Primary Care
Dr Anita Sharma Dr Fiona Cornish Dr Charles Alessi