Why must GPs reduce the paperwork?

#GPFUQ 70 Why must GPs reduce the burden of paperwork? It increases the barriers to good care.

The paperwork in paperless offices is worse than ever. The burden of administrative tasks keeps increasing. This can make life harder for patients by erecting barriers to protect GPs from this increasing administration work. If GPs don’t do the work – will patients have to work harder or make more or different appointments with many different staff for different services? It won’t be a good service for patients (or a good marketing strategy for GPs) if a GP who has traditionally provided an accessible  ‘one stop shop’, increases the barriers to care, reduces accessibility to or reduces range of services on offer for patient.

Some suggestions for action

• Keep a clean / clear desk policy. If you can’t do this then get advise on what you have to do to achieve this.
• Reduce the time spent on practice management as much as possible - recruit a well-qualified manager as employee or business partner to manage the partnership and practice business
• Don’t write a letter to a patient if a phone call or text would be quicker
• Delegate all administration (see FUQ 60-62) to your staff
• Appoint a clerk to run processes like the Choose and book appointment system
• Use wholly computerised records – don’t run duplicate systems on paper and computer
• Use  forms in ‘Word’ and present in a way that allows merging with GP clinical systems
• Reduce your paid and unpaid subscriptions to societies, magazines and mailings to a minimum
• Throw away most journals, unfocussed reading, etc
• Unsubscribe from unwanted / less important e-mail systems
• Don’t respond to unsolicited questionnaires
• Use READ codes more to record clinical information
• Pick the important information and actions required from incoming letters, and routine investigations results to alert you if need to do something
• Don’t attend administrative or representative meetings unless your presence will directly contribute to the outcome of the meeting.
• Don’t attend unnecessary training e.g. how to give a flu vaccine when you are giving injections all the time
• Don’t do any low-end clinical work (vaccinations etc.) that could be transferred to other staff.
• Ensure office staff have month by month tickler files that remind them to routinely repeat searches, e.g. patients on warfarin without an INR for 3 months
• Designate a Duty administrator i.e. someone each half day that can do all those jobs like... chasing appointments, finding consultants secretaries, relaying messages etc
• Use the administrative team to prepare medical certificates, insurance reports etc
• Use the administrative team to contact patients (a medical assistant can do this)
• Use the administrative team to chase hospital system
• Use the administrative team to chase social care support (social services and community matron can lead this)
• Use the administrative team to monitor chronic disease and make adjustments to standard drug regimes
• Don’t participate in any process work and planning meetings without specific goals
• Don’t participate in any audits for their own sake, only those to improve patient care
• Use annual or birthday based medical reviews of all chronic diseases at one visit per year
• Have Practice protocols for consistency of approach - e.g. patients arriving late, dealing with housing letter requests, etc
• Use internal electronic messaging or have a paper system on trolley outside consulting room (in a practice where patients are waiting away from this corridor). Sort into different shelves - routine hospital letters/ probable junk and magazines/ urgent requests inc urgent prescriptions and messages from consultants, etc. This can be helpful for reception team who  would know that the urgent basket would be looked at as morning went on and didn't therefore disturb the doctor,
• Use the administrative team to provide up to date database of contact telephone numbers, service provisions et- kept up to date and accessible to locums as well as regular doctors.
• Use the administrative team to provide up to date standard locum packs such as that provided by National Association of sessional GPs (NASGPs)
• Use the administrative team to facilitate Patient Participation Groups
• Use the administrative team to facilitate Patient Therapy Groups
• Have excellent full team away days. There should be funding and support for one every year.
• Lobby RCGP and GPC to help end unnecessary structures and processes in general practice faster – there is a legacy of unnecessary chores that GPs do that we need to collaborate about to change e.g. many sick notes for patients add nothing to the care or management of the patient. RCGP or similar needs to take a lead in ‘best practice’.
• Maintain up to date disease registers in the practice
• Share work with multidisciplinary teams when appropriate
• Concentrate on the  complex medical decision-making that is often done face to face.
• Don’t collude by allowing reception staff to triage patients, due to a lack of clinical staff time.
• Have ring-fenced time for vital non-consultation tasks.
• Protect learning time for leaders in practice

Please send me your suggestions to add to this list