MedEconomics: Why a personal list works better for me

Only seeing the patients who choose him as their usual GP eases the pressure for Dr Tim Kimber.

If you want an easier life as a GP, think about running a more personal service.

Politicians often tell us that we live in a 24/7, convenience society. Our patients apparently want their supermarkets and banks open all the time, so it should be the same with their health services.

My view is that healthcare is less about convenience and more about a quality personal service, although the two are not mutually exclusive. In my experience, what patients seem to value most in their healthcare is an enduring relationship with someone whom they trust with their life.

Until April 2004, UK patients were registered with a specific, named GP. At a few practices, mine included, the GPs ran personal lists, but at the majority there was a free-for-all where patients could and would consult whichever GP they chose.

Those of us running personal lists tried to do the opposite. We told patients at the time of registration that the doctor with whom they were registered was their personal doctor, and would coordinate all their care.

Under the new GMS contract, patients now register with a practice. They do not have a named doctor - although there can be a 'usual' doctor.

Keep it personal

However, my practice is trying to keep the personal list system alive. Patients can develop a relationship with and trust in one person. Their GP has a vested interest in working in a problem-solving way. That GP is responsible for overseeing their repeat prescribing, chronic disease management, investigation requests and results interpretation, and hospital referral.

If the patient's family also consults the same doctor, having a clear overview of the family's psycho-social circumstances is helpful. At my practice, there are four partners with widely differing personalities and consulting styles so patients have a good choice of GP.

Personal lists help us manage our time effectively. For instance, I am a full-time GP, a trainer, a director of a company set up by local practices, an appraiser, a locality commissioning board member and LMC deputy chairman.

How do I find time to do all these things? My personal list is how. Every weekday morning, I am responsible for all the patients who have named me as their usual doctor.

All prescription queries, investigation result queries, home visit requests, and urgent appointment requests for my patients come to me. If I have 10 home visits and my partners have none, I do 10 home visits.

Because I know my patients well, I can deal with more work by telephone. From noon, we run a duty doctor system. I have an incentive to do today's work today, because if I do not, it will still be there tomorrow. The buck stops with me.

As a result, we have a low consulting rate, and little trouble reaching access targets. For practice staff there are clear lines of accountability. They always know which GP to ask about any problem concerning a patient. As partners, we have few arguments about workload.

- Dr Kimber is a GP in West Sussex.

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