#GPFUQ 112 What’s the
trilemma or impossible trinity in health care? Good health care should be easy
access to high quality at low cost. The reality seems to be that that we can
only achieve two of these three at any one time
#GPFUQ 113 How do
you ration primary care? Make people wait or make people pay.
#GPFUQ 114 Are most problems in primary care trivial or self-limiting? Yes they are. Good GPs know that patients may present with a simple illness but often have an underlying worry about their health that needs to be identified and addressed. You can use the opportunity that trivial and self-limiting illnesses give you to build your relationship and advising patients on healthy lifestyles and opportunistic health screening opportunities
#GPFUQ 115 Why do patients
present their bruises to GPs? Are many patients just bruised? Yes, the
equivalent of mental or physical bruising are common in general practice (see
#GPFUQ
114). Patients need to share their worries. Inevitably in a risk averse society
greater specialists are called upon to relieve smaller worries.
#GPFUQ 116 Is it difficult to manage self limiting illnesses? Trivial and self-limiting illnesses are not difficult problems to manage. But it can be difficult to manage the patients that have the illnesses.
#GPFUQ
117 How accessible should a GP be? Should GPs
provide their routine service ‘everywhere
all the time?’ The gap between medical professional working hours and other
services working hours seems to be widening. While shops and other services
have extended their hours, doctors moved from their traditional very long hours
of work (e.g. junior doctors hours, and GP on call hours) to reduced but more
concentrated hours of work. It seems that the trend is for longer opening hours
and it’s probably a ‘when’ rather than an ‘if’ as to whether GP surgeries are
open 7 days a week at least for routine care problems. Suggestions for action
·
Offer greater access to services (with both shorter
waiting times for urgent needs and better continuity of care for non-urgent
needs)
by redesigning the working week to provide longer opening hours including evening
and weekends, with easier phone and personal access etc
·
Collaborate with OOH providers and/or other practices to run
appointments for routine care OOH
·
Organize changes that are likely meet the needs of the practice
population
·
Work shifts so that opening hours can be extended
·
Coordinate the care better among healthcare system
(specialty care, hospitals, home health care, and community services and
support).
·
Start up multidisciplinary consultations (in GP offices)
·
Do more adult prevention out of the office by using tools like Interactive
Voice Response notification
·
Document handovers from acute sector e.g. adding discharge summary
information including prescriptions to the electronic health record, and/or
contacting the patient at home to ensure that ‘all is well and they know what
to do next’.
·
Work together with other practices to have a bigger and more robust
chronic disease service.
·
Commit to quality care and quality improvement using
evidence-based medicine to guide shared decision-making with patients and
families
·
Ensure all patients with a long term condition have some kind of self
management plan
·
Focus on designing systems of care that reliably get all aspects of care
done for all patients (e.g. all or none bundles of care)
·
Have an efficient and successful chronic condition management programme
where each member of the team plays their part and IT helps to ensure that
patients do not have to make unnecessary visits for check ups.
·
Provide patient held records e.g. asthma self management plans
·
Give screening questionnaires to relatives or carers to complete at
their leisure at home e.g. Dementia screening MMSE
·
Employ a 'doctors assistant' - to act as receptionist and be clinically
trained to triage
·
Employ a prescription clerk who not only issues prescriptions, but
monitors diary entries and actions them (e.g. blood forms, arranging chronic
disease appointments etc)
·
Develop secondary care services e.g. dermatology and rheumatology to
reduce waiting times and improve local care for these conditions
·
Allowing patients to read their notes before coming into surgery, so
they can ask better questions about their treatment
