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Reducing the Limitation of Time on the GP Workload – Part One

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One of my favourite quotes goes something like “time is a precious commodity that weighs most on those who have least of it”. (Apologies if I’ve told you this before.) There are few places that have less time available to them than the GP practice. I’ve tackled the subject of saving time and costs on several occasions, for example when I discussed:

Red tape and The Practice Manager’s Five Minute Guide to Making Time in General Practice

GP Practices: Maintaining a Sustainable Business

NHS England are certainly aware of the time constraints inherent in the GP practice, as well as the escalating running costs of maintaining a viable service. In a post on its message board dated 24th February 2016, Introducing the Ten High Impact Actions, while discussing General Practice, NHS England admitted that “workforce and investment have not kept pace with other parts of the NHS”.

Building on previous studies, most notably the 2015 ‘Making Time’ study, NHS England has produced a list of ten areas in which action can be taken to reduce time impact and increase capacity. In each of these areas it believes there are specific changes that GP practices could implement, and each would make a difference: releasing time to serve patients better and implementing innovations to offer direct improvements to patients.

Sharing best practices to release the power of the ten high impact actions

In developing its ten high impact areas, NHS England has examined what is working well in reducing time burdens on practices across the country. It has also considered what actions and innovations have been taken that improve care given, and is currently collecting collecting case studies, resources, and activities to support local implementation.

5 best practices to increase time in the GP practice’s day

In this first part of two posts on the subject, I want to look at the first five areas of high impact and the best practices that GP practices could onboard as they strive to positively impact the commodity of time.

1. Active signposting

Helping patients identify the most appropriate self-help and self-management resources, before requiring appropriate professional consultation.

Online portals can provide ways for the patient to directly book appointments, manage repeat prescriptions, obtain test results, etc.

Reception staff can be better trained to provide access to information and direct patients appropriately (including to services in the community).


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2. New methods of consultation

Some consultations may be conducted with greater convenience and offer better continuity of care if undertaken using modern technology – skype, text messaging, and e-consultations are viable alternatives to traditional face-to-face consultation.

People are more adept with using mobile communications, and the use of phone consultations, for example, is proven to reduce consultation time by around half with consultations completed on the phone.

Group consultations can be used to build knowledge of and increase competency in the management of long-term conditions, as well as providing a natural support group function.

3. Reduce the occurrence of DNAs

Provide methods for patients to more easily cancel appointments, sending appointment reminders by text and creating an easy booking system online. By providing a user friendly booking system, the practice will reduce the occurrence of the ‘just-in-case’ booking.

4.Team development

Workforces could be broadened, connecting patients with the appropriate professional. This embeds with active signposting, and will reduce the demand on GP time. Possible workforce additions might include:

Minor illness nurse, capable of diagnosing, managing and prescribing. Patients are directed to the minor illness nurse by reception or online portal.

A practice based pharmacist could undertake a range of duties, such as audit, medications management, medicine use reviews, etc. If trained appropriately, he or she could also undertake the duties of the minor ailments nurse.

Trained clerical employees might perform medical assistant duties such as processing correspondence, and administration of the flow of clinical information such as test results, referrals, and explanation of care procedures to patients.

Other opportunities for staff expansion include direct access physiotherapists, physician associates, and practice based paramedics.

5. Social prescribing

Referral and signposting to wellbeing services, sports and leisure activities, carer respite, dementia support, housing and debt management services, etc. This would include referrals to one-to-one specialists, and a keener regard for mental health. Some of these specialists may be integrated into the GP practice either fully or partially by participation in team meetings, for example.

In my next post, I’ll explore how processes of working differently and further outward development of responsibilities could reduce the time burden on GPs.

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