We have been complaining to the Government about GP workload for over a decade and nothing has changed. Maybe it’s about time we sorted it out ourselves.
Yes, they brought in PCNs with much fanfare and the additional roles had quite a lot of funding. But they wouldn’t let us spend the money on what we actually need. And so GP workload spiraled upwards and morale has plummeted. And ICSs seem like more of the same – except now we will be lumped together with social services and there is still no more funding for GPs or practice nurses.
We could just let things continue and watch the whole thing sink. That will give us the satisfaction of saying “I told you so”, but in the end General Practice will be wrecked and in any case the politicians will have moved on and won’t care anyway. It will leave doctors with the options of leaving General Practice or not going into it in the first place.
But what could we do if we are committed to General Practice and want to see it thrive? First we need to stop worrying about what we can’t control and concentrate on the things we have power over. Then we need to look at things we can do which might help the problem. And systematically try them and keep the ones that help.
Workload, Income and Patient Health
These three are in balance and we need to look at how to improve one without harming the others. It is essential that we don’t confuse patient health with patient satisfaction or access or convenience. What we want is for people to live longer and enjoy better health – and sometimes asking them to wait so they see the right person gets better outcomes.
Culture
We’ve all come across teams where everyone is working well and doing really great things together. The atmosphere is electric and you really want to be around these people. And here’s the important bit: in repeated studies(1), these teams achieve way better results than teams that are just working together normally. This is the single most powerful thing that you can use to improve the performance of your team without extra resources and it is called Culture.
Personal Assistant support
Delegating tasks can free up an enormous amount of time. But how do you do this effectively? You need to spend time with the people who are going to help you so they grow into the role feel supported. This is not just a work dump. If they do more of what they can do it enables you to do more of what they can’t do. They need to know that they are making a difference for patients and have recognition of their new skills.
Getting patients to do more
There is much talk about promoting self care but most of this seems like telling people off for asking for help with genuine problems. Creating barriers does not promote cooperation. They are much more likely to listen if you get to know them and show you really care. Treat your patients as part of your team. Give them training, a voice, empathy and honesty and they will reward you with support and understanding. Reducing patients’ need to see you will do far more for your workload than triage or pharmacy referrals.
Stop doing stuff
But don’t stop doing the stuff that takes you nearer your goal or makes the job worth doing. Don’t stop seeing patients – it’s actually your core job. Don’t stop hanging out with your team – nurturing each other is essential. Be like a football team – everything is focused on the match. Your kick off is morning surgery.
Get rid of stuff that doesn’t work for you
- Answering emails
- Going to meetings
- Writing reports
- Returning phone calls
Unless they actually help you core priorities they are window dressing and should be cut.
Collaboration
Sometimes joining up saves you time. But there has to be a reason why doing things together is more effective. Simply mumbling about joined up working or doing things at scale is not enough. Every change takes time and effort and you need to show that the change achieves more than simply putting the same time and effort into the current system. Working outside your sector – for example with social services, education or housing – may seem more spectacular, but often you get the best results by seeing how you can work more closely with your current colleagues. Local practices and consultants share your goals and often you can save time simply by fostering closer relationships.
Continuity
Patients seeing the same doctor for follow up of the same condition improves outcomes (2). As well as quality of care there is a significant time saving since the doctor already knows the patient and can pick up where they left off. The benefits of continuity extend beyond long term planned care. Acute GP care from someone who knows them gives patients better faster care. And the benefits of continuity are cumulative – the better you know the patient, the more time you save.
These are all things that surgeries can get started with right now. Over the next few weeks we will take a practical look at how to do them.
(1) https://hbr.org/2015/12/proof-that-positive-work-cultures-are-more-productive
(2) https://bmjopen.bmj.com/content/bmjopen/8/6/e021161.full.pdf