Delivering workload transformation in primary care

Making radical changes in the way we plan and deliver services at all levels of the NHS is vital if it is to remain sustainable. Alison Powell, Wales Development Lead for Workflow by Practice Unbound, discusses how their social enterprise is seeking to revolutionise the way that GP practices administer clinical correspondence.

You’ve got mail. Lots of it. In fact, GP surgeries are awash with correspondence that needs to be read, actioned, coded and filed. This presents a huge workload challenge, especially as GPs traditionally deal with clinical correspondence themselves – alongside many other competing demands on their time.

Primary care as a sector is under huge strain, and the increasing pressure shows no sign of slowing. My organisation works with practices who are struggling to recruit and retain GPs and who have trialled a variety of measures to ensure their own sustainability. We also work with practices who have a stable team in place, and just want to work more effectively and enable a better work / life balance.

One of the core principles of prudent healthcare, pioneered by the Bevan Commission, is to “care for those with the greatest health need first, making most effective use of all skills and resources”. Our initiative is focused on using our skills and resources as effectively as possible.

We work with GP surgeries that have tried upskilling their staff in various ways - Practice Nurses to Nurse Practitioners, Phlebotomists to Healthcare Assistants – but found that although it helped a subset of their patients, it did not have a significant impact on workload. Instead, in reviewing their processes, many found that mounting paperwork was the main cause of fire-fighting.

Is dealing with correspondence the most useful way for GPs to spend their time? We don’t think so, and our social enterprise therefore aims to enable administrators and practice managers to safely take on this responsibility in a supported environment.

The benefits of the Workflow initiative are two-fold: to free up the time of GPs, who can now focus on treating patients and addressing the few remaining letters which require their specialist input; and to build the confidence of administrators who are developing new skills and feeling like they are making a real difference to the running of their practices. A trained Workflow administrator can code and action up to 80% of clinical correspondence, and in an average sized practice of 7,000 can expect to release 8 hours of GP time a week. There are robust governance procedures and the quality of the patient record can be improved.

Establishing this initiative in GP practices of course takes time, effort and trust. It requires the sort of cultural sea-change that the Bevan Commission advocates and the NHS needs to bring about if we are to move beyond incremental improvements and into the realm of transformation. GPs and Administrators have had to adjust their expectations of traditional workforce roles and processes, familiarise themselves with what for some is an entirely new way of working and trust each other to commit fully to this. This echoes a recent Bevan Commission publication which recommended that we look beyond traditional workforce roles and think about how we develop a flexible healthcare workforce fit for the future.

As a not-for-profit social enterprise, we reinvest all of our resources back into primary care development, and are always on the lookout for ideas that similarly have the potential to transform service delivery and patient experiences. With this in mind, we have watched the Bevan Commission’s Exemplar programme with interest, and were delighted to attend a networking session to hear first-hand about innovative initiatives in NHS Wales.

It is clear from this scheme, and our experience, that we can no longer cling onto old certainties, processes or roles if we are to truly transform the way we deliver primary care. Change is no longer optional: we must all work together to identify and implement tomorrow’s revolutionary ideas.

Alison Powell is Wales Development Lead for Workflow by Practice Unbound, a service created by Here, a not-for-profit based in Brighton, and 2017 “UK Social Enterprise of the Year”.

The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.

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