The Ranworth Surgery in Clacton-on-Sea, a busy town centre practice, took the innovative step of taking on a part-time remote GP after struggling to fill a traditional salaried GP post.
Last month, England CMO Professor Chris Whitty published his annual report, which focused on health in coastal communities like Clacton-on-Sea. The report acknowledged that many of these communities are facing a shortage of GPs and other healthcare workers, while also dealing with high prevalence of many long-term conditions.
The Ranworth Surgery says its decision to recruit a remote GP has been hugely successful and could provide a radical new solution to current recruitment problems facing practices not just in coastal areas but all over the UK.
Dr Kikie Gardner was hired last year by the practice as a digital GP. She works two days a week from her home in North West London around 90 miles away.
Easier to recruit
The 8,000-patient practice, located in a very deprived area with a large elderly population, previously struggled to attract GPs and designed this new role before the pandemic to offer greater flexibility and appeal to candidates.
A key advantage was also not being restricted to hiring a GP who lived in the area or who had to relocate, widening the pool of applicants, explains practice manager Jane O’Shea.
‘A traditional recruitment campaign might attract two or three candidates at best, sometimes none,’ she explains. ‘For this post, we received in excess of 40 applications and interviewed 12 GPs.'
What does the role involve?
Dr Gardner’s main responsibilities are holding telephone-based clinics as well as looking at patients’ test results or X-rays. The system put in place ensures that should Dr Gardner decide a patient needs to be seen by a GP in person, she can directly arrange an appointment herself, so they are given faster access.
‘Roughly 30% of patients are booked in for face-to-face consultations,’ says Ms O’Shea. ‘Even when that happens the GP that has to see the patient benefits because much of the background work has already been done for them.’
And patients themselves have been overall very satisfied with the new arrangement, Ms O’Shea adds.
‘COVID has, of course, been a positive influence in helping us as a practice to recognise that a large proportion of patients can be safely managed over the phone. However, patients have also embraced this way of consulting with their GP. They like it because it gives them quicker and more convenient access to a GP.’
Dr Gardner says there have been other surprising benefits too.
'I have found that not having face-to-face contact can encourage some patients to be more open when discussing personal problems. For example, I’m now seeing many more male patients than before and I suspect it’s because they feel more comfortable explaining symptoms without me being able to see them.’
As all GPs will have learned during the pandemic, dealing with patients remotely does pose some challenges and requires a different consultation style.
‘You can’t rely on visual clues or body language, so you have to be fully alert when listening to pick up subtle cues,' Dr Gardner says.
‘I’ve learned to pay close attention to tone of voice, for example, and will delve deeper if I think someone is sounding unsure about something I have said or if they clearly sound unwell. Because I really take the time to listen to what patients tell me it leads to a lot more shared decision making, which I think works better for both of us.’
How has the practice made the role work?
With this kind of role being so new the practice had to take additional steps to ensure Dr Gardner felt she was part of a team and not working in isolation. Before starting the job, the practice invited Dr Gardner to visit so she could meet all the staff in person.
‘I went up there a few times, which really helped me get to know everyone and ensured they too understood my role and the days I would be working,’ Dr Gardner explains.
‘I do feel very much a part of a practice team because I have regular patients who I have built relationships with and I’m included on all the practice screen messages so communication is regular.’
In addition, Dr Gardner is onsite at the practice for face-to face consultations with patients once a month or so and has online meetings with the other GP partners and practice manager regularly to discuss particular issues or to have a general catch up.
‘All of this is critical to making my role work and helping me feel supported,’ Dr Gardner says. ‘Particularly important is regular contact with the other partners so any problems can be sorted quickly as a team.’
Benefits for general practice
Both the practice and Dr Gardner believe remote GP roles could bring real benefits to general practice.
Ms O’Shea says it has the potential to ease recruitment difficulties, especially in areas that are seen as less attractive to live, and can offer new and innovative ways of working that benefit the patient as well doctors.
Dr Gardner points out that although working remotely was an attractive option for her because it meant she could more easily balance her family and work commitments, the flexibility of the role means it’s a great opportunity not just for parents but for anyone seeking a better work-life.
‘There’s a lot of talent that can be potentially better utilised if there are no ties with regards to having to be onsite,’ she says. ‘This type of role is revolutionary because it opens jobs up for doctors that may not be in a position to commit to being onsite full-time but can work in flexible ways, keeping them in a career in general practice and ultimately reducing pressures on the current workforce.
‘There is a demand for this kind of role from both GPs and patients as I see it.’