What’s the trilemma or impossible trinity in health care?

#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