Reducing GP pressure with less incoming correspondence – Thornbury Road Centre, London

Case study summary

Thornbury Road Centre in London has four whole time equivalent GPs and approximately 8,000 registered patients. The GPs were struggling on a daily basis to deal with the volume of incoming correspondence. To look into whether they could reduce this the practice took up the offer of support available through the Productive General Practice (PGP) Quick Start programme delivered by the Sustainable Improvement team, NHS England. The programme is part of the support available through the General Practice Forward View.


The idea

Undertake the Efficient Processes module from PGP Quick Start to develop a more efficient process for dealing with incoming correspondence that would reduce the workload pressure for GPs.

Identifying the issues

Each GP was spending approximately one to two hours a day dealing with incoming correspondence, leading them to start work early or finish late, and sometimes coming into the practice over weekends.

To grasp what was making the process so time consuming, the practice team process mapped the steps it took to deal with incoming correspondence.  This highlighted a number of issues.

  • There was a great deal of variation due to the different ways in which correspondence was received into the practice. It came in via post, fax, email or hand delivered to reception.  Each route was dealt with in a different way making the process complex and time consuming.
  • The sheer volume of correspondence was overwhelming for GPs. When the team looked into the type of correspondence the GPs were receiving it found most was for information only and did not need to go to the GP e.g. consultation letters that required no action.
  • There were a large number of steps in the process which sometimes caused correspondence to get lost in the system. This caused issues for patients if they required a copy of the correspondence the same day it arrived in the practice, as staff were not always able to locate where it was in the system.

A more efficient process

The team developed a new process that would utilise other more appropriate members of the team to manage incoming correspondence, and only forward to GPs what required their action.

All correspondence, regardless of how it was received into the practice, would be scanned and processed the same way.  This helped reduce variation, save time and minimise risk of correspondence getting lost in the system.

Two members of staff who were already involved in coding were trained to manage incoming correspondence and identify what needed to go to GPs and what could be dealt with by a more appropriate member of staff. A GP spent an hour per day over one week with both staff providing them with additional help, then on-going support when needed.

To manage some of the safety concerns raised, a risk assessment was carried out beforehand where the team went through a week’s worth of correspondence together. The admin staff were given the opportunity to state what they would have done with the letter and then the GPs would confirm if this was correct or if anything had been missed. This flagged very minor errors with coding and nothing of significance. Going forward the team agreed a monthly audit would be conducted where a sample of 20 letters would be reviewed and checked by a GP.


  • The practice has released an initial 10 per cent of GP admin time, an average of 1.3 hours per week per whole time equivalent.
  • GPs were previously receiving approximately 80 letters per day; this has now reduced to less than 10. This is a 90 per cent reduction which is helping to ease the pressure on GPs and making their working day less stressful.
  • Patients receive a more efficient and speedier service on any correspondence that requires action. For example, if a correspondence states that a patient needs a blood test staff will inform the patient on the same day and book it in rather than add to a list to do later.

Implementation tips

Committing time to the programme is important for all staff, particularly GPs.  If you are able to give your GPs protected time so they can fully participate and be focused on the work, it will be hugely beneficial and in turn deliver huge benefits.

“We have found the PGP programme to be very beneficial and would highly recommend it to other practices. It seems like a lot of time to commit before you start the programme but the outcomes are definitely worth it. We would gladly participate in this programme again.”

Maria Power, Practice Manager, Thornbury Road Centre for Health


If you would like to find out more about how you can access the Productive General Practice Quick Start programme, visit our ‘Releasing time for care’ web page.