GPs can improve care by 'playing the ball where the monkey drops it'

GPs and the wider health service can improve quality of care by focusing on simple, small-scale achievable goals, a senior Scottish doctor has told the RCGP conference.

Professor Jason Leitch, clinical director of healthcare quality and strategy, Scotland (Photo: Pete Hill)

Speaking at the RCGP annual conference 2018 in Glasgow, clinical director for healthcare quality and strategy for Scotland Professor Jason Leitch said that the healthcare system often aimed for complex solutions to problems that could be addressed simply - and highlighted the importance of integrated care for patients.

He pointed to the example of aspirin use to prevent strokes in patients who have had a previous stroke or TIA - pointing out that stroke risk could be reduced by 23% in these patients.

But although only 58% of eligible patients receive aspirin in these cases, he said the health service and the wider healthcare industry spend more time looking for better versions of aspirin rather than on making sure that everyone who could benefit from the simple, cheap medication received it.

He pointed to the case of a heart attack survivor patient called Maureen - who said she had been 'given her life back' by the care of an integrated team spanning primary and secondary care following her cardiac arrest.

Her primary care journey, he said, was not a seven-minute GP consultation - it was a journey that took in up to 15 healthcare staff, including physio, nurses, and doctors that had enabled her ultimately to acheive a small personal goal - to be able to go shopping for a birthday present for her daughter.

Professor Leitch pointed to a piece of 2005 research that showed 'huge investment in technology that only marginally improved efficiency' and pointed to the fact that this was 'consuming resources needed for better delivery of care and may cost more lives than it saves’.

He hit out at clinical guidelines imposed from on high, and warned that the best way for doctors to learn was to 'go and do the work', to 'learn how to do that change inside the work'.

Asking where doctors should start to try to improve patient care, he said: 'It is tricky. You see these big scale decisions, big policy decisions. Many of you are involved in them, many are not.'

But he pointed to the world of golf, and said that a local club in Bombay where monkeys often stole balls from the course had a unique rule: 'Rule number 8 - play the ball where the monkey drops it.

'I think it's good advice,' he said. 'You can't fix those above you, you often can’t fix those below you. You can go in when you next see a patient and spend a bit of time asking them about their family.

'Ask them what matters to them. Try spend a bit of time asking patients Try and fix that circle of influence around you. Play the ball where the monkey drops it.'

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