Case study summary
Parkview Surgery in Cleckheaton has three GPs and one nurse practitioner, serving over 7000 registered patients. Document management was taking up a huge amount of clinicians’ time at the surgery. Struggling to recruit new GPs and relying on locums who were reluctant to deal with post, the practice team recognised it had to change the way it was working.
The practice manager attended a ‘Learning in action’ workshop, part of the Time for Care programme delivered by the Sustainable Improvement team, NHS England, and part of the support available through the General Practice Forward View. Here they heard about a protocol developed by another practice that had significantly reduced the time clinical staff spent on document management, and felt a similar protocol could be implemented at Parkview Surgery.
Getting buy-in – the first step was to get buy-in from two clinicians who split the post between them, without this the project was a non-starter. The practice manager shared a copy of the protocol, discussed how it had been tried and tested with success at another practice and the benefits it could have for all clinicians, and not just GPs, at Parkview. This secured buy-in.
Adapting for local needs – the protocol was adapted and tweaked so it aligned with the surgery’s way of working, and was shared with all clinical staff for review and feedback. The managing partner spent time with the staff members who scanned and audited the post to ensure they got the pre-planning phase right before testing. Conversations were had with admin staff to draw up a process for the admin team to follow, to ensure a robust process was in place which is operationally efficient. The default situation for all admin staff was that if they are unsure whether a piece of post needs action, they should send it to a clinician. This acted as a support and safeguard for the admin team.
Implementing the new protocol – the new protocol involved three steps.
- When post arrives in the surgery an experienced staff member reviews to identify what needs to be actioned e.g. blood tests, scan results that are abnormal etc., and what needs filing (two staff members were trained and made available to do this work for continuity).
- Post gets scanned onto the clinical system and a second person (with a fresh pair of eyes), will review and match it to the patient record and the relevant read codes recorded. All post with actions are sent to clinicians; either nurse practitioner or GP, depending on who last saw the patient. If it is medicine related it will go to the practice pharmacist.
- During the test phase all filed post was reviewed by the practice manager for any inaccuracies, now only random spot checks take place to make sure everything is running correctly.
- Out of 1,687 pieces of post only 329 (21%) needed clinicians action, the remaining 1,358 (79%) required filing*. Previously all post would have gone to clinicians so approximately one hour of clinical time has been freed a day.
- Though the surgery uses more of the admin team’s time this is easier to source than a clinician.
- Following the success at Parkview Surgery the new protocol has been rolled out to the practices second surgery, Dr Mahmood & Partners, with similar success.
- The protocol has been shared with other practice managers and at least three other practices in the local area have now adopted and given good feedback.
* Audit took place from 18 April to 31 May 2017.
- To make it work you need some experienced admin staff, if you do not have these you can train existing staff – you will just need to support them over a longer period of time.
- Access the support available through the General Practice Forward View to train reception and clerical staff to manage clinical correspondence (see links below).
- Someone good at read-coding will be beneficial.
- Getting buy-in from clinicians and the admin team is key.
- Regular audits/spot checks are needed on an ongoing basis to minimise inaccuracies.
I’d previously been to a national event where there was a presentation about improving document management but it was high level and didn’t go into detail. The Time for Care workshops were the opposite, they were on a smaller scale and local, which made it easier to have in-depth discussions. Change can sometimes be that simple, finding out what’s worked well elsewhere and adapting it for your own practice.
Rachael Kilburn, Managing Partner, Parkview Surgery, Cleckheaton Health Centre