Why don’t GPs know and do everything?

#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