Northgate Medical Centre in Chester is made up of four whole time equivalent GPs serving a practice population of over 7,500. The large volume of correspondence being sent to GPs everyday was difficult to manage and increasing their workload. The practice participated in the Learning in Action programme to help it do something about this issue. The programme is delivered by NHS England and NHS Improvement and part of the support available through the General Practice Forward View.
Change the protocol for document workflow management to reduce unnecessary admin work for GPs to free up time for other tasks.
Up to 13 hours of GP time spent each week reading correspondence
The GPs were receiving large volumes of correspondence every day ranging from routine clinic to normal result letters, through to third party referrals. The admin team would scan the letters then forward them straight on to the GP for reading. Every day the GPs could spend up to 40 minutes just reading the letters, collectively across the practice that could be up to 13 hours of GP time per week spent reading correspondence.
Analysing the correspondence type – does it need to go to a GP?
Over two weeks the practice recorded what correspondence GPs were receiving. It found that whilst some needed the GPs’ attention the majority could have been better dealt with by another member of the team or filed straight away e.g. completely normal results letters, post-op discharge letters that required no GP action.
The practice looked at other members in the team who could better deal with the correspondence that did not need to go to a GP. For example, medicine change letters going straight to the medicines manager, third party referrals where GPs were copied in for information only could be picked up by the admin team and filed.
Making changes to the protocol
Equipped with a better knowledge of where there were flaws in the current protocol, a GP worked with a lead admin member of staff, and made changes to the protocol which they consulted with the rest of their colleagues and got support for the changes made.
- The protocol now lists all correspondence that GPs do not need to see e.g. routine clinic letters with no action, DNA letters, normal test results.
- All correspondence GPs did need to see e.g. child or adult safeguarding, hospital discharge letters following emergency admissions.
- Any medication changes on clinic letters are sent to the medicines manager directly, who will action then forward to a GP for sign off.
The revised protocol required a greater role from the admin team to ensure that the GPs received only the correspondence that required their attention, and that the rest were directed appropriately to other members of the team. To support them they were given training and time to test and embed the revised protocol. Whilst testing the protocol admin staff looked out for potential pitfalls and picked up a couple of letters for new diagnoses that would be useful to send to GPs, as a result the protocol was slightly adapted.
- Changes to the protocol have reduced the volume of correspondence sent to GPs by 78%. GPs now only receive 22% of the total correspondence coming into the practice.
- The correspondence now received tends to be more complex but because there is far less of it GPs across the practice have been able to release a significant amount of time. This has enabled them to spend more time on the correspondence that needs it most and deal more effectively with complex patient care, so these patients get more timelier support for their care needs.
- GPs agree that the changes have made a huge difference to their working day, some of the feedback includes they no longer dread opening their document inbox and feel more energised to do other work! It also means that they are not spending time at the end of the day trying to clear their inbox.
- The improvements made have encouraged the practice to look at other areas that need looking at such as protocols for managing test results and medication reviews for chronic disease patients.
- The work the practice has done has been tried and tested, proven to have worked. As part of a Primary Care Network it can share what it has done with the wider network and if adopted and rolled out, help achieve similar improvements at greater scale across the network.
We knew we were receiving far too much correspondence but it was only when we took part in Learning in Action that we did something about it. Previously we were spending up to 40 minutes a day just reading correspondence, now we usually only need 10 minutes. Stewart Leitch, GP, Northgate Medical Centre