Quality improvement techniques can help GPs take control of workload

GPs can harness quality improvement techniques to avoid being helpless 'innocent bystanders' as the environment they work in becomes more and more challenging, a senior GP has told the RCGP conference.

Dr Simon Stockill (Photo: Pete Hill)

Speaking at the RCGP annual conference 2018 in Glasgow, Leeds CCG director of primary care Dr Simon Stockill acknowledged factors driving up GP workload and the impact on GP's working lives.

'General practice is still going - it’s lacking some investment, needs a sense of renewal, but it is still there,' he said. 'Is it safe, is it efficient, is it the best use of resources and is it enjoyable? Maybe not all of the time. For me, quality improvement is about trying to address this.'

The reasons for rising workload were clear, he told the conference. 'Demand is going up, complexity is going up, expectation is going up. In the next 20 years across  all four UK nations, the number of people aged over 85 will double, the number of people aged over 65 with two or more long-term conditions will double, and the number living with or beyond cancer will double.'

Rising demand

Many GPs - particularly in parts of the country with large elderly populations - are already experiencing the impact of growing demand from these groups, he said.

But Dr Stockill said that he - like the RCGP - was both optimistic and realistic, highlighting the college's first position statement on quality improvement in general practice, published last year.

He said the document made clear that GPs should take responsibility for the context they work in. 'It recognises the context we work in, but suggests to us as professionals within general practice that we shouldn’t be innocent bystanders in that context, we should take an active lead in creating the conditions and changing that context.'

He urged practices to avoid the 'wonderfully anachronistic business model that applied only in general practice and possibly the Catholic church', in which the oldest person in the room was sometimes in charge by virtue of having been there longest.

Quality improvement

Practices should ensure people 'who have the right skills and enthusiasm are taking the lead'.

He cited an example of quality improvement driven by secretarial staff at his own practice in North Yorkshire, who realised that GPs did not need to be reading all the letters that came to the practice.

Following a mistake by a GP working on letters late at night, a review by the practice led to a new approach. Secretaries now forward only around 10% of letters to GPs to handle, with the rest filed. Periodic reviews and analysis are carried out to ensure the process remains safe - and GPs now routinely go home half an hour earlier than they used to.

Consistent reviews by practices of what they do well and what they could improve were always likely to drive down workload, he argued. 'Good medicine is usually cheaper medicine, because you are not treating "failure demand" - having to put right mistakes that shouldn’t have happened.'

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