GPs are an expensive resource so undertaking a review of appointments to see if any patients could have been seen by other members of the team is a useful exercise. The Primary Care Foundation has a free tool that you could use.
Alternatively asking the clinical team to review their appointments for a week using the following template should provide some useful data:
|Patient||Main reason for consultation||Anything that could have been dealt with by another person or outside of the consultation?|
Then review what appears frequently in the third column to see if there are any patients that can be re-directed to someone else in the practice, for example the nurse practitioner or practice nurse, or to outside services such as pharmacy. Alternatively patients may need access to self care resources.
Self care and services outside the practice
Patients may not know that the GP is not the most appropriate person to see and it can also be difficult for the GP to raise this with the patient in the consultation so some suggestions are:
- Patient communications, for example the practice website, patient leaflet and posters in the waiting room. Practices could also consider providing an explanation of types of consultations and the appropriate clinician to see for these conditions. The BMA has reproduced a very useful template on how to do this from practices in Devon, Cornwall & the Isles of Scilly on page 25 of the Quality First document.
- Details of other services such as pharmacy and minor ailments scheme
- Self care resources: the BMA has some useful resources here.
In addition you can train receptionists to signpost where appropriate (for example to local minor ailment scheme, to pharmacy or social services as appropriate)
Investigate voluntary services offered locally or the national charities for long-term conditions, such as Diabetes UK. Patients often present wanting help with forms or support for benefits appeals, many areas will have voluntary organisations that can help with this – find out what is available locally and signpost.
You could consider approaching a voluntary organisation to provide a benefits advice clinic if this is a particular issue at your practice. Are there health champions in your area, would they be willing to run a session for patients to promote healthy living?
NHS England and most CCGs are promoting self care. Find out what is available in your area and consider promoting it on your website and in the waiting room – or in any leaflet you produce as in the Devon, Cornwall & Isles of Scilly example above.
Other ways to introduce skill mix to the practice include:
- Ensuring all staff are operating ‘at the top of their licence’. Do all nursing and HCAs have a personal development and training plan? Are they fully trained in all the tasks you need them to carry out? Is there any scope for moving some work from nurses to HCAs as long as properly supervised?
- Consider different roles such as pharmacists to run repeat medication service and manage some of the long term conditions, or employing a physician’s associate or paramedic.
Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member
More on skill mix on Medeconomics
- How to employ a pharmacist in your practice
- Employing paramedics in general practice
- Could physician associates help your practice?
- The BMA’s Quality first: Managing workload to deliver safe patient care and its associated online resources.
- The NHS Alliance report Making Time in General Practice
- NHS England’s Releasing Capacity in general practice initiative, with its ‘10 high impact actions’