How often will GPs see a condition that statistically they will never see?

#GPFUQ 181 How often will GPs see a condition that statistically they will never see?  About once every ten years.

#GPFUQ 182 Can GPs increase patients self treatment and reduce the need for medical involvement?

If GPs don’t do the work – will GPs lose their special relationship with their patients? General Practice can be like being a good parent it involves not just quality time but also routine stuff so being a good GP means being available for the minor worries, coughs and travellers' diarrhoea as well as for major physical and psychological pathology. By dealing with the former GPs can build the relationships they need to be able to help with the latter. However many minor ailments could be self managed. IMS Health survey Dec 2007 shows 57m GP consultations annually involve minor ailments, (51.4m involve minor ailments alone), 18% GP workload is for minor ailements, 50% Minor ailment consultations are for 16-59yr olds, costs to NHS £2b pa (80% are for GP time), averages 1hour/day for every GP http://www.pagb.co.uk/information/research.html#tns

Suggestions for action

·               GPs should develop a strategy for promotion of self-treatment of minor ailments, and a triage process. Setting up self-treatment facilities and advice.

·               RCGP should script Video and podcasts for use on the practice website and in the waiting room that tell patients how to look after minor ailments. Use the same RCGP script in different practices but with the local GPs as the ‘actors’ to promote local interest and validity. The video and podcast are accompanied by a printed handout on the management of minor ailments. You can have video added to video broadcasts in waiting room

·               Set up an ‘Avoid the queue, self manage your illness’ area in the practice to advise on initial best management for the following conditions which are the commonest minor ailments back pain, dermatitis, heartburn and indigestion, nasal congestion, constipation, migraine, cough, acne, sprains and strains, headache, earache, psoriasis, conjunctivitis, sore throat, diarrhoea, haemorrhoids, cystitis, hay fever, warts, nail infections, colds.

·               Produce an evidence-based handout on How to manage your minor ailment for each of the common minor ailment conditions.

·               Identify patients who have presented with minor ailments from the consultation records of the electronic health record and after the consultation mail the patient the information sheet How to manage your minor ailment for the relevant conditions- invite patients to return feedback sheet to enter into a prize draw

·               Gain greater value from previously under-utilised sources. This may include: enabling patients, carers and communities to manage and improve their own health and/or contribute to the process of healthcare; empowering members of the healthcare team whose contribution is at present limited owing to lack of training for example; and/or removing barriers that are standing in the way of obtaining full value from all members of the healthcare team eg ‘practice to the limit of the licence’

·               Triaging, consulting and prescribing for common benign conditions without red flags e.g cold, sore throat, UTIs in women, acne minor skin problems etc. Transfer most care of minor illnesses to triage by others and taught self care

·               Getting experienced staff to deliver some of doctors duties, i.e writing prescription for minor illness

·               Use local newspaper adverts about management of minor ailments

·               Provide more information for patients to record and track their symptoms and signs eg A one page leaflet to record and track symptoms of pain

·               The RCGP should publish a template for best practice

#GPFUQ 183 How should GPs assess their professional networks? Ask can you find and spread best practice any faster? The success of social networking websites shows how quickly networking tools spread. A ‘spread strategy’ is being part of an effective network of knowledge that works for you. Networking in one shape of form seems the most usual way that GPs already spread ideas. Formats include any professional meeting, peer group discussion and social events in practices and other group meetings and discussion in the wider world  (e.g. focus groups, internet groups, site visits, conferences, educational meetings, email communications, the media medical press, networks like CHAIN, doc2doc, Resilient GPs on Facebook, other social networking, chiefs meetings, champions, GP cooperatives, practice visits, annual appraisal, study groups, and on-line discussion groups). Most of these meetings are part of the professional and social fabric of the world we live in, and the networking is mostly unstructured and informal. However although it is clear that this networking connects almost everyone,  it may need improvement to make it more efficient and effective e.g. keeping up to date knowledge on any clinical topic like diabetes will be more robust if you can link with more than one network source about diabetes. Many of these networks have become prescribed with the formative processes involved in annual appraisals, and the various practice inspections (e.g. trainers reaccreditation) and provide a regular process of checking that every GP is part of a functioning professional network. Modern general practice where we work in groups and often have special responsibilities for certain clinical areas in the practice favour a networked approach to learning and being clear how each of us is connected to these networks for updating our knowledge and skills.

Suggestions for action

·           Map out your main networks and document them (who they are and what they link you to) for your next NHS appraisal. At your appraisal discuss whether there are any important clinical or business gaps in your links. What can you do to improve the efficiency and effectiveness of your networks? Circuit testing your learning networks at an annual appraisal process is a simple way to check up on the networks that each GP relates to. Whilst its too difficult to document all the networks, its is reasonable to test and trace the networks with hypothetical questions like how would you be confident that you would learn about and discuss a new innovation in practice management or new evidence in a treatment

·               Meet regularly with local colleagues to discuss difficult cases or to reflect on where they are and what can/must be improved

·               Buddy up with another practice to share expertise and resources

·               Look outside medicine and learn from business colleagues and friends

·               Have a relationship with secondary care colleagues- so that you can resolve local problems easily

·               Meet with wider social care/community nurses regularly to discuss patient referrals

·               Visit neighbouring practices to see what works well then discussing it at practice meetings to see whether the practice could learn from this

·               Continue any regular meetings with other GPs that has an agreed task of say support and sharing good ideas – and clear achievable and measurable aims eg Balint groups / Learning groups / Co mentoring

·               Undertake an evidence-based journal club weekly for 1 hour

·               Encourage all staff to attend practice meetings, not just partners. Involving them means they're more engaged with the practice.

·               RCGP should promote network groups- Unofficial groups abound, particularly among recent CCT holders. Make a census so they're known about.

·               The RCGP should publish a template for best practice

#GPFUQ 184 How do you improve GP? You need the feedback you can get either from a mirror or from a village