Clinician, confidant, administrator, accountant, lawyer, human encyclopedia and IT specialist. This list of vocations paints a picture of an interesting and varied job specification. Yet for the GP concentrating on presentation through to appropriate referral, these are functions that may need to be performed in a single sitting. In the 10-minute surgery the majority of the time is taken by history and examination, leaving less and less time to make the right referral, at the right time through an increasingly complex referral process.
Clinician and confidant
First and foremost, the GP is a clinician. This is a given. Secondly, the GP is a confidant. As well as dispensing medical advice, the GP must play the role of the compassionate advocate. By listening to patients, the GP helps patients explore and understand the options that are appropriate for them. Patients who are engaged with their treatment fare better than those who are not.
Businessman and lawyer
Thirdly, the GP is an accountant and businessman. Invariably encouraged by CCGs and practice managers to keep costs down, the GP has to bear in mind QIPP (quality, innovation, productivity and prevention) and QOF targets throughout each consultation. The GP lawyer must be sensitive to risk. Per consultation risks are low, but with time pressures, rising expectation and increasing litigation, it can be tricky to balance the best interest of patients with the burden of responsibility.
IT specialist and administrator
Next, the GP is an IT specialist. GP practices rely on technological software programmes, such as scoring systems, which allow for data collection contributing to decision support. This does not alleviate the administrative burden, as the technology is frequently not integrated. While the scoring system is on one programme, guidance documents are on another, and personal health records are elsewhere altogether. This means the GP ends up printing out the various reports and filling them out by hand just to get information ‘on the same page’.
Finally, the referral heptathlon demands exceptional powers of memory, the ideal GP needs to have encyclopaedic knowledge of service conventions and pathways. It is essential that they know the detailed criteria of each referral made, since forgetting excluding factors will result in an inappropriate referral. For example, a GP using the choose and book system to refer an obese patient for gastric bypass surgery must remember that the patient needs to exceed a certain BMI in order to be included. Failure to do so will lead to a rejected referral, disadvantaging the patient and wasting administrative time.
Raising your game and making good time
But we know GPs are stretched when making a referral, this is nothing new. What’s the solution? GPs are increasingly using technological systems; they serve both to top-up our collective knowledge, to save time and improve the experience.
Using decision support during the referral processes changes it from an isolated act to a team function. We can embrace the opportunity for best practice and peer learning by monitoring referral patterns (amongst individual GPs, CCGs and nationally) in order to identify the potential for improvement. We have to think about improving efficiency in the referral process.
Decision support and automated processes have the potential to deliver, without devaluing clinical judgment. Whether we want a quick confirmation of something that we already know, or want to know more detail, we need a system that understands and addresses the opportunity costs, and that is integrated, quick, and clinically assured. Integrated assistive technology can be the making of Team GP. It has the potential to reduce costs, administration, risk and omission, and it would allow us to concentrate on the clinical, advocacy and support roles that we were trained to fulfill.
* Dr Peter Short is a GP in Buxton, Derbyshire and national clinical lead GP, Health and Social Care Information Centre.