PRACTICE MATTERS WORKFLOW
Workflow optimisation has been shown to ease GP workloads but concerns have been raised that it may put patient safety at risk
TIME SAVING OR A
LL across the UK practice managers are feeling the pinch with growing patient lists, reduced resources and staff shortages – this is not exactly news. Neither is the increasing
administrative burden faced by GPs. One practice in Brighton and Hove piloting a scheme to improve the
way they process their administrative work found that a “significant number” of letters required no clinical input. Dr Paul Deffley told Pulse Online that he spends approximately 40 minutes each day processing mail, of which 80 per cent could have been dealt with administratively. New frameworks to help ease GP workloads are being developed
at various sites and many include a process known as workflow optimisation or correspondence management. NHS England has identified this as a priority and within the GP Forward View looks to overcome the administrative burden. Correspondence management strategies are intended to encourage practices to train non-clinical staff to process and action practice mail, freeing up GP time to spend on more complex patient issues. Workflow optimisation has been shown to work but concerns have
been raised that the process may in some circumstances be putting patient safety at risk.
NO ACTION REQUIRED A large proportion of mail received by practices can be identified as ‘low risk’, with GPs happy for staff to send straight to file with no action required. An example of correspondence requiring no clinical input would be a discharge letter from an accident and emergency department where the patient has attended for a minor injury, such as a sprain or strain, or an acute medical condition such as sore throat. Usually the patient receives sufficient treatment and/or advice that requires no further action for the GP and therefore the letter can be sent straight to the patient’s notes with no further action.
08 Another potential “low risk” example could be a letter from
secondary care informing a GP that a patient did not attend an appointment. This can be frustrating for hospitals with buckling waiting lists but there are many reasons why a patient might fail to attend an appointment. From a risk perspective, it is important to consider the patient as an individual and, in particular, whether they have capacity and fully understand the reason for the referral along with the consequences of not attending – or if they are vulnerable in some way. A recent call to one of our advisers from a concerned practice manager highlights this issue well. A patient diagnosed with dementia had been referred by a GP for a secondary care opinion, but after the hospital had sent her three offers of appointments with no attendance or response she was discharged back to the GP. A letter detailing the patient’s failure to attend was sent to the GP and this was filed straight into the notes without being highlighted to the doctor. The patient’s condition deteriorated and it was some months later,
when a related acute problem arose, that the GP became aware she had not been reviewed at hospital and had likely disposed of the letters without carers or family being aware. Had the ‘DNA’ letter been actioned or recorded in a way that highlighted this to the GP, it is likely the patient would have been followed up, preventing a worsening of her condition.
CLEAR GUIDELINES Workflow optimisation can help provide GPs the time to focus on work that only they can do. But to ensure that new ways of working are safe, it is imperative that practices agree and provide clear guidelines to staff on which patients fall under the umbrella of vulnerability. Indeed, many practices have created ways of flagging these patients so that non-clinical staff can direct mail to the referring GP in order
AUTUMN 2019 ISSUE 21
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