Case study summary
Fulwell Cross Medical Centre has five GPs and over 13,000 registered patients. The practice felt the volume of letters being sent to their GPs was unmanageable. In the past the practice had made efforts to address the issue but with limited success. By using the Productive General Practice (PGP) Quick Start programme from NHS England’s Sustainable Improvement team, which is part of the support available through the General Practice Forward View, it was able to redesign a new process that was more efficient.
Using PGP Quick Start methods, the practice team decided to tackle how it managed patient correspondence in order to reduce the administrative workload on GPs.
- Identifying the issues – A representative working team was formed, made up of all partners, practice manager, assistant practice manager and the majority of the administrative team. Using process mapping the team mapped out the different steps they currently took in managing correspondence, from when it first arrived in the building to when it was seen by a GP and actioned. This identified bottlenecks; the length of time correspondence was waiting in the system to be actioned, duplication of effort and where waste was occurring. For example, out-of-hours letters were coming in to the practice and they were being forwarded to a GP who read the report, which invariably required ‘no action’. The GP would then send the letter back to the original administrative team member for coding, whereas the administrative team could just code the letter when it arrived and forward only those letters that require action to the GP.
- Changing the focus from volume to process – The team moved away from seeing the issue as a volume problem that needed an additional full-time healthcare assistant post to manage, to one focused on developing an effective and consistent process and identifying what should happen to correspondence when it arrived. The team found 42% of the letters that arrived in the practice did not need to be seen by the GP (this included Did Not Attends (DNAs), follow-ups, cc’s, physio and optician letters). These could instead be managed by the administration team.
- Redesigning the process – The team redesigned the process, removing four process steps which included checking who referred the patient. Previously this involved having to open up a patient’s electronic medical record to determine who referred the patient. As a team they agreed how the different letter types should be routed. The new process was implemented after a practice meeting and re-audited on a weekly basis by using a random sample of letters. This showed the practice had a robust process. One of the GPs along with the assistant practice manager checked how the new process worked to make sure risk was managed.
- GPs have noticed a significant reduction in the volume of correspondence they receive, “I used to get 70 plus letters a day now I only see around four”.
- This has had a positive and important impact on the morale of the clinical team.
- There has been a significant time saving of around 1.5 hours per day of GP time which equates to releasing one day a week.
- The admin team now have time to code more accurately and lift better information from the letters; this has also increased staff morale within the administrative team.
- £20,000 cost has been avoided as the practice no longer need to recruit an additional full-time healthcare assistant as previously planned.
GP involvement is crucial to ensure that administrators are given appropriate training in what to look for in a clinical letter. Start with one type of correspondence and then slowly add in more.