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
