#GPFUQ 121 Why don’t GPs know and do everything? Every
week there is a media report that complains ‘GPs need to be better trained at
what they need to do’. GP knowledge about specific but different conditions is
deemed inadequate and an extra training programme recommended as the answer to
most problems. This is the ‘why can’t a generalist be more like a specialist’
story. The story fails to accept that it’s impossible to train all GPs in
everything or ever have enough specialists to see everyone, and it ignores the benefits
of a duel system of primary care generalists and secondary care specialists
(see #GPFUQ 98). General Practice can either be considered very easy
because GPs don’t need to have a depth of knowledge about anything or very difficult
because GPs need to know something about everything. A patient kept agitating to be referred to a
specific super specialist. On arrival at the super specialist clinic the
specialist said to the patient ‘I just hope you’ve got what I treat! Each
specialist deals just with only a very narrow area. Someone (usually the GP) needs to have an broad
overview and co-ordinate the care of the patient. There
can never be a defence for bad general practice but good general practice is not
about knowing everything its about providing easy access to good quality advice
and treatments at lower costs than all the alternatives.
#GPFUQ 122 If GPs don’t do the work – how will it get done? Nothing is
impossible as long as you don’t have to do everything yourself. Delegation is
not abdication. Many simple tasks can safely be done by others.
Practices are different in their organisation and how and to whom jobs
will be delegated will vary according to circumstances.
Suggestions for action
Restructure the primary care team to enable patients first point of
contact with practitioners to be the most appropriately trained to provide care.
For example with minor musculoskeletal problems – get patients to book in to
see a physiotherapist directly for anything that could be handled by physical
therapy first.
Use administrative staff to sweat the interface
with hospitals. For example arranging admissions to hospital ‘trying to admit someone
to hospital’, chasing up hospital regarding appointments, results, clinic
letters etc, Phone call tag – ‘repeated phone calls to get hold of people who
can’t get hold of you’. Get your staff to arrange telephone appointments at
specific times through direct phone lines
Stop doing things individually. Stop treating patients individually if
its not needed. Consider more group sessions for education of new
hypertensives, musculoskeletal problems, contraceptives.
Review and notify patients of routine investigation results automatically
via online access to their records or email.
Stop routine follow ups, especially monitoring of stable patients
#GPFUQ 123 How can GPs cope with the
overload of information? The information
highway is too busy. There are too many unsorted, unsolicited and uninformative
emails, guidelines and protocols that arrive each week. Too much information
leads to fatigue and the emails being ignored.
Suggestions
·
Practices should return unsolicited or unstructured
medical email to the sender and ask for improvements (see below)
·
Non-urgent information should be sent ‘batched’ in a
weekly or monthly email. The email should be structured with an informative
title about its purpose, the intended audience followed by a one-line summary
of each item with a hyperlink to more detailed information. The author of the
document should be contactable, there should be an ability to give feedback
about the information and to subscribe and unsubscribe from circulation lists
·
Practices have these
waves of guidelines and protocols coming from different local and national NHS
organisations and each practice needs to keep up to date by loading on its intranet.
Instead a local centre (eg a CCG based webpage) could keep all these up to date
and reduce the work for practices. All the healthcare and other
organisations should load important information on their own websites so that
GPs can link to relevant information rather than have to load a complete set of
document on a practices intranet
·
Stop the
constant changing of NHS websites addresses so that the weblinks get out of
date.
·
Stop the invention of the wheel in each practice. For
example if the Chief Medical officer writes a letter describing who should be
offered a flu jab - they should include the appropriate READ or SNOWMED CT codes
searchers for each GP clinical system
·
The RCGP should publish a template for best practice
for the dissemination of information to practices
