The Pandemic has been a rough time for all practices, and the biggest problem we have had has been the crushing workload. Some have turned to Doctor First, Total Triage or AskMyGP but many surgeries still report out-of-control demand and difficulties coping. We had strong long-term relationships with our patients, and they tended not to bother us unless they had to. So we decided to use that trusting relationship to help us provide more and better care, and the result has been that our workload has been controlled even during the Pandemic.
So what is our workload?
A doctor does 28 consultations (9 face to face, 19 remote) in a full day. These were average consultation numbers in 2021and include urgents / extras. A full time GP works 7 clinical and one admin session per week and gets 110 path results and 110 letters per week and writes 8 referral letters per week. Although at the height of the pandemic we had been consulting remotely by default, even after patients were free to book face to face consultations many chose a remote consultation.
What was our strategy?
Our goal is to help people in our community to live longer and enjoy better health. So our basic strategy is to maximise the amount of actual treating / prevention of illness done and use this as the touchstone to decide which actions to take. As a starting point we were aware that we had the trust and co-operation of our patients and we wanted to see how we could leverage this to provide more care. This approach generated an interlocking set of actions including Continuity Focussed Care, Patients as Part of The Team, Reception Plus, Servant Leadership, Viral Recruitment and Team and Culture Building. None of these are particularly ground-breaking but done together they amplify each other’s effects.
One of the things that was relaxed during the Pandemic was the monitoring and target driven culture of primary care. It was a relief to focus on the patients and their needs, rather than QOF targets or enhanced service claims. As we went back to “business as usual” we have tried to identify what is helpful and what is a waste of time. Some things we will need to do to get paid, but we have tried to avoid blindly carrying out tasks unless they actually free up more time than they use. The important thing is that we are optimising to maximise long term health of our community – and that includes keeping our clinicians and staff healthy and happy.
What happened to workload during the Pandemic?
During the start of the first lockdown a lot of patients stayed away from surgeries, partly to spare us while we reorganised, and partly so they didn’t catch COVID. But after a couple of months, consultations bounced back to normal. However, there was extra work when seeing patients, since we had to use PPE and other precautions to make sure the surgery was a safe as possible. We seem to have been successful because, as far as we know, no one was infected with COVID while visiting or working at the surgery.
There was a dramatic fall in face-to-face consultations initially when we changed to consulting remotely by default. As we learned more about the pandemic, in the latter part of 2020, we started booking more face-to-face consultations. Once most people had had their second COVID vaccine dose, we trusted patients to choose if they needed a face-to-face or remote consultation. We found that remote consultations were less efficient than face-to-face because you cannot examine the patient.
Despite government rhetoric, our administration workload has continued to rise. This has been primarily an increase in path results and clinical letters – which we do need to read to look after patients properly. Sickness and death certification are a tiny proportion of our work and the widely publicised moves to streamline these will do little to help us. We have found that the way to cope with the increased admin has been to upgrade our Reception / Admin team so we can delegate more tasks to them.
The point of reducing workload is to help us recruit and retain clinicians to look after our patients in the long term. Although we are an unremarkable 5,200 patient surgery we have built an enjoyable and fulfilling place for GPs to work. Over 2019-2021 we have been able to recruit two additional partners (bringing us up to four partners in total) and have been able to stop using locums almost completely.