Sorting out GP workload 3 – Patients on the team

There is a lot of talk about promoting self care. But much of this seems to be telling patients off for seeking help with genuine problems. Or else giving them lots of bewildering choices and telling them it is up to them to decide. If we treat patients as overly demanding customers then that is how they will behave.

But they are our registered patients, we know them, and they know us. Would it be crazy to enlist the help of our patients as members of our team rather than just consumers?

We all want the same thing
We exist to help the people in our community to live longer and enjoy better health. And that is what our patients want too. We all want to maximise the benefit to patients that we can get from the resources available. Chasing waiting times or satisfaction scores can sometimes lead to worse outcomes in the things we care about.

How can patients reduce our workload?

  • Having patients do what they can do themselves will leave more resources to help with what they can’t do.
  • Some degree of waiting by patients stops scarce clinician time being wasted being idle waiting for patients so it enables more care to be done.
  • If clinicians are less able to work at antisocial times, then more care will be available if non-urgent care is done during office hours.

Treatment not triage
Spending doctor time triaging requests for appointments is tragically inefficient because it means that some treatment time is lost forever. Trust patients to work out when they need appointments. By all means educate them when they get it wrong but include their ability to think as a resource you can use to help look after them. People behave how they are treated, if you want them to be thoughtful collaborators then treat them as such.

Flexibility and feedback
Patients need a variety of appointments – on the day, this week, this month. If their only choice is a contest to secure one of today’s appointments by phoning at 8 am sharp, you may actually increase demand. You need to keep some slots for urgent extras, so your surgeries don’t overrun, but despite the luxury of unbooked slots, you are wasting treatment time if you don’t fill them. Reviewing the demand for urgent extras and adjusting the proportion of these slots during the year can help you get through the work when it is quiet to free up time when it’s busy. Don’t be afraid of seeking feedback from patients about what is working and what isn’t. They may spot “easy wins” that solve problems without much effort.

Trust and fairness
It is not very fashionable these days, but you need to trust your patients to be fair and reasonable about how they use your time. Like new staff members they may ask for things which can’t be done in the time or aren’t in your power to do and you need to educate them when this happens. But avoid doing things which are easy now but make more work in the long run. Sometimes you have no choice but to put off work and get patients to come back. But remember that if you are able to sort things out at the time it will usually be quicker.

Give them the tools to do the job
If patients are to be your partners in improving health, then they will need access to information and services. Look for things you could trust them with which will save them time and save you work. Certain patients have recurring problems and learn what they need. Having systems to allow them to request a re-referral or test or non-repeat medication without needing an appointment can save significant time although you will of course need to approve the request. This works hand in hand with continuity because when you know the patient you can agree together how best to organise their care.

One of the most important things in building a team is creating a sense of belonging. Explaining to new patients how your surgery works and what they can do will help them feel part of the team. The message about collaborative care will need to be repeated regularly to keep it the expected way of working together. You also need to reinforce this teamwork spirit with your staff – particularly receptionists – so they look for ways to work with patients, rather than just defensively coping with their demands.

Focus on the long term
Developing collaborative relationships with your patients is one of the most powerful ways to reduce your workload in the long term. Because you have a registered list of people you look after, you can focus on them and their needs. Although patients move, the majority stay with you a considerable time and you can use this to give you a competitive advantage and give them better care for given resources than another provider. Although there will always be some unfairness in the allocation of funding, the most certain way to ensure your long-term future is to out-compete the alternatives.