Changes in admin team processes help reduce GP pressures – West4GPs, London

Case study summary

West4GPs in Hounslow is a family practice dating back to 1907.  With 6 GPs making up 4.75 whole time equivalents, it services a practice population of over 10,000 patients. The practice’s history and long standing in the community has created a high expectation among patients, which has stretched the GPs’ capacity to breaking point.  Keen to reduce pressure on the GPs, the practice participated in the Productive General Practice (PGP) Quick Start programme delivered by NHS England’s Sustainable Improvement team. The programme is part of the support available through the General Practice Forward View.

The idea

Use the Efficient Processes module to help reduce the pressures GPs are experiencing on a daily basis.

Reviewing admin processes

The practice team undertook a review of existing admin tasks. They established which processes were taking the most time, and identified where improvements would likely have the most positive impact for GPs. It brought to light the following.

  • Eight hours a week were being spent scanning and printing emails arriving in the practice via Outlook. These were saved onto the desktop before being transferred into the SystmOne scanning model. This was a time consuming and unnecessarily long process.
  • The prescription clerk spent over one day a week printing discharge summaries and prescriptions so they could compare the two and cross reference for any queries that were then forwarded to the GP. Not only was this delaying actions the GPs needed to take but was potentially wasting money on printing.
  • Fax machines were heavily used to send or receive external information. Staff spent one hour a day standing at the machine waiting for faxes to go through or trying to locate the correct department numbers to send faxes to.
  • Staff were spending time calling patients whose acute and repeat scripts were close to expiring, leaving messages with them, then re-calling patients to check if they had received the original message.

The review opened up the team’s eyes to the extent of inefficiencies within their admin processes. Without it they would have been unaware and carried on working the way they always had.

New admin processes that benefit GPs

Using the process mapping tool the team took each process in turn and identified which steps were creating waste and needed to be removed. Whilst discussing the changes the admin team worked with the GPs to make a number of improvements.

The NHS mail workflow system would be used more effectively. Instead of printing and saving emails to the desktop, they would be transferred straight into the workflow model. Clinicians were also encouraged to file patient results directly to their record so patients can see the comments and results online, reducing the need for them to contact the practice or GP for results.

  • Two monitors would be issued to the prescribing clerk, one to view discharge summaries and the other prescriptions, enabling them to compare the two without the need for printing.
  • Fax machines would be removed and replaced by email. Anyone asking for the practice’s fax number would be advised it is no longer active and an email address provided instead.
  • Calling and leaving messages for patients would be stopped. In its place a quick action button would be added to the toolbar on monitors. This would allow a text or email message to be sent directly from the patient record with the correct wording being chosen from pre-set scripts.
  • As the changes were implemented the team reviewed and monitored how effectively they were being embedded and the impact they were having.

Impact

  • Transferring emails straight to the NHS mail workflow system has released over 57* days a year of the admin team’s time. In addition to the time saving GPs now have quicker access to information and fewer delays to progressing actions for patients.
  • The removal of fax machines has made all staff communicate more via email. An unexpected benefit for GPs is that requests to consultants are now receiving a quicker response e.g. one GP received a response within 30 minutes of sending an email whereas in the past it could have taken up to 3 weeks. This is helping GPs get on with what they need to do next for the patient rather than having to wait, be chased by the patient, and in some cases hold avoidable appointments.
  • A new staff member now reads all the post before it goes to the GP, this has enabled all actions to be completed before the GP gets the letter so that they only need to read letters for information. Time freed up due to the letter reader is allowing GPs to deal better with the daily tasks that are generated when seeing patients.
  • Collectively the changes have helped GPs manage patient needs better without increasing their workload. GPs have commented how the changes have made a difference to their working day and helped alleviate some of the daily pressures they were experiencing. They are extremely positive and supportive of the changes that have been made.

* Time based on approximately 8 hours per week collectively released for 9.5 whole time equivalent members of the admin team.

“We were aware that we needed to make changes but like everyone, we never really had the time to stop and actually think about the things that needed doing. Working through PGP Quick Start has made us commit to putting aside the time, and the benefits have been many. Staff across the board seem more passionate for change, they want to put forward ideas and are coming up with their own. Communication has improved and the atmosphere seems more relaxed but with an element of excitement for what lies in front of us.”
Cindy Heslington, Practice Manager, West4GPs