Shredding the administrative paper trail

In all the doom and gloom of our chaotic NHS, it really is good once in a while to be able to report progress.

Our practice has been cleaning out its archives to make more space. Naturally, we kept all the clinical information but a large amount of administrative material ended up in the shredder.

It's been very instructive. Firstly it provided a graphic demonstration of just how much paperwork was involved in running the practice during the decade leading up to the millennium: petty cash receipts by the box-load, plans for long-completed administrative projects, detailed staff appraisals, and reams of minutes of practice meetings. Did we really spend our time on these minutiae? Was there really no way to run a practice efficiently without creating such a paper trail?

The next shock was a reminder of how constrained we were prior to the new contract. We couldn't just take on an extra partner: we had to get permission from the Medical Practices Committee. Practices had to apply to the health authority for funding for specific projects such as summarising records, converting Lloyd George envelopes into A4 files, or transferring data between computer systems. We even had to apply for reimbursement for each member of staff. Then there were claim forms by the thousand - for new patient checks, health promotion clinics, minor surgery and obstetrics.

Thankfully, this was all swept away with the new contract. Gone was the need to let health authorities have the final word on how we organise ourselves: now practices can act autonomously in deciding levels of personal workload and whether they want to take on further partners or staff. With a known yearly budget we can spend our time concentrating on the quality of medical care.

Ask most GPs about the new contract and they will think first about the money. Certainly the pay rise was well-deserved, and giving up out-of-hours a welcome relief, but these undoubted benefits have overshadowed the changed contractual arrangements which gave practices a managerial simplicity they never previously possessed. As our archives demonstrated, the new contract - while not perfect - has benefited practices in more ways than one.

Dr Lancelot is a GP from Lancashire. Email him at

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