How often does a patient need to see a GP to review their care?

#GPFUQ 124 How often does a patient need to see a GP to review their care? It’s usually less often but sometimes it's more often. Many patients can get over serviced and are seen more often than needed whilst the ‘hard to reach patients’ remain underserviced.  There are different ways to bring about a change. Patients often know what they need, they just need to be told when they are due for something and help getting it scheduled. A simple way is to always ask the over serviced patient ‘When do you want to be seen next, and then ask gently why?’ If the reason for the next attendance can be handled just as well without a face to face consultation with the GP then the next face to face consultation can be postponed. Another way is for the GP to ask his/herself ‘What’s the longest time before the next face to face consultation is needed and why’ and stretch out the intervals between consultations. Similarly the hard to reach and under serviced patients needs to be asked what they want and give the GP permission to use more assertive outreach when needed to get them reviewed. 

#GPFUQ 125 How can GPs improve the way hospitals work?

Most hospitals are efficient and effective but some individuals and departments work less well or push parts of their work over into general practice. For example they may expect GPs to provide the following for their patients: sick notes for hospital procedures, patient transport requests, chasing up the delayed hospital appointment, to do or chase investigations ordered by secondary care, make referrals on behalf of hospital consultant teams because they think GPs can get them seen sooner, prescribe nutritional supplements advised by dieticians, re-referrals because the hospital can't police it's own ‘did not attend’ problems. If GPs do nothing then the problem just gets worse for everyone and the patients get involved in the frustrating hospital-GP game of ping-pong. 

Suggestions for action

·      Engage with hospitals so they have a simple process for feedback e.g. SMS text messaging, or email process to inform them of breaches of best conduct

·      Collect notifications of breaches and if nothing improves escalate the feedback to hospital management or the commissioner of services

·      Plan an in reach service regarding the care of patients in hospital. In many countries GPs visit patients in hospital; this is very popular with patients and we would have a lot to offer in terms of discharge planning, it is however foreign to UK hospital culture

·      Hospitals should stop seeing people after hospital outpatients to give them results. The consultant should send a copy of the letter / result directly to the patient unless there is an overwhelming reason not to.

·      Have a system for taking messages during surgeries from hospital doctors about patients if you don't know the patient then the message could be given to secretary instead.

·      Agree a process with hospital about misdirected letters - hospitals should realise the importance of writing back to the doctor who wrote to them!

·      Set up a local sponsor one consultant scheme. Improve collaborative working with hospital consultants  to provide greater collaborative working among GP and consultants, including communicating each others knowledge, skills, understanding and attitudes which may allow faster dissemination of better practices for joint working and patient care – a buddying/sponsoring system between a GP and a consultant. A GP works with one local consultant to help him/her provide the important information for GPs and patients and robust contact details.

• Have a local triage service for GP referrals before they get to secondary care. This ensure a roughly uniform criteria for referral, educates GPs and limits unnecessary referrals to secondary care

#GPFUQ 126 How do you rate yourself as a GP?  Probably incorrectly! If you think you are better than average then how many doctors do you know who are worse than you? We are always likely to rate ourselves above average. Your knowledge, skills and attitudes need constant refreshing. Your knowledge won’t keep much better than fish! Filling in knowledge gaps is not continuing professional development (CPD) or continuing medical education (CME), it’s the result of an established skill. CPD is acquiring new skills. If you were the pilot of a commercial jet you would check the weather at your destination before you tried to land; this is not discovering a new knowledge (i.e. the current weather) its an essential part of using the skill needed to land an airplane safely.  Keeping your knowledge up to date used to be like knowing the climate now it can feel like checking the weather forecast frequently

Suggestions for action

·           Have a simple system for keeping your knowledge reasonably up to date eg using memory prompts like Patients Unmet needs PUNs and Doctor Educational Needs DENS to remind yourself to check something or using the network of on line prompts and learning whilst your patient is with you.

·           Don’t pretend that poor quality sources of information are the same as useful knowledge eg Pharmaceutical representatives marketing information, Opinion based medicine.

·           Improve informed patient choice by increasing your understanding of evidence and Risk management. If patients know and understand the numbers needed to treat (NNT) and numbers needed to harm NNH they will make better choices about their care (and often decline care).