Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.
Case study summary
Bridge House Medical Centre in South Warwickshire has seven GPs and over 9,000 registered patients. The practice participated in the Learning in Action element of the Time for Care programme by NHS England’s Sustainable Improvement team, to look at reducing the amount of time its GPs spent dealing with incoming paperwork. The programme is part of the support available through the General Practice Forward View.
Bridge House Medical Centre, along with a group of 13 other practices within South Warwickshire, took part in Learning in Action, a collaborative approach to learning and improvement. Among the areas the group selected to focus on improving was document management, giving the practice an opportunity to look at how to introduce new ways of working involving training administrative staff to deal with clinical administration tasks.
Testing small cycles of change
Using the Plan, Do, Study, Act cycle, which provides a structured approach to improvement, the practice carried out a small test cycle with a Standard Operating Procedure. The procedure set out the types of correspondence the GPs received and what they did and did not need to see each day. The test involved admin staff and the practice manager working through the previous month’s letters to see what actions they would take following the Standard Operating Procedure. The results showed that 20% of the correspondence did not need to be sent to the GPs.
The second cycle was on the ability to develop a pathway for certain types of letters, ensuring there is an agreed set of principles and a standard approach for the process. The first pathway tested was on diabetic eye screening letters, where there was frustration from the CCG around the level of coding with regard to retinopathy screening. To improve this, ensure the data was visible in the patient record, and some enhanced steps to the actions taken on receipt of these results, the practice carried out a process mapping exercise during one of the workshops. One of the outputs was to develop and test a template to match the format of the hospital letter and a pathway written.
Supporting staff in change
The aims and objectives of the project were discussed with the whole practice team and role changes with individual members of staff were discussed during appraisals. The clinical team was involved in the process including a GP processing all of the documents for one week to see what was coming in, how much work it involved and how the process could be managed better.
A Standard Operating Procedure was developed with all clinicians for a consistent approach to what documents they still needed to see. One receptionist and one member of the admin team underwent the practice’s training programme, mentored by the practice manager, and also took part in training events organised by the federation.
Sharing and learning with other practices
The Learning in Action workshops enabled the practice time to think and share ideas. Breaking the process down into small steps made it easier to start the change process and identify weak spots the practice was able to adjust accordingly. For example, demonstrating ‘safety’ in the new method was worked through during shared discussions, where the practice found it could build into the audit the review of ‘safety’. Measurement was also discussed and the practice was able to break down and identify a baseline measure.
- The volume of incoming paperwork going to GPs has reduced by 83 per cent per week, for the practice this has collectively released seven hours of GP time a week.
- GPs can now spend more time on the correspondence they receive and the actions highlighted for them e.g. on reading one letter to the end a GP discovered that the list of current medications on page one had in fact been stopped and replaced with another. He felt he may not have had time to spot this had he been working through 60 or 70 letters rather than the 8 letters he had that day.
- Staff are very positive and the two team members taking on the role are very enthusiastic. The change of role offered ensured the practice was able to retain one team member who without this opportunity for development would have left the practice. Other members of the reception team who no longer have to code letters are currently undertaking training for active signposting with the time that has been released from their workload.
- Having engaged with the Patient Participation Group, it understand the pressures on GP appointments together with recruitment problems and an ageing population with more complex needs, and are supportive of the changes. The time released will subsequently mean GPs can spend more time with patients.
- Ensure everyone in your team is aware of the planned changes.
- Manage expectations in that this is not something that is quick and easy to introduce, allow yourself time to plan and test changes.
- Access the support available through the General Practice Forward View to train reception and clerical staff to manage clinical correspondence.
Marie Tew, Practice Manager, Bridge House Medical Centre