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Training administrative staff to deal with clinical letters

A new clinical assistant role has helped dramatically cut GP paperwork and shows how GP Forward View funding for training reception and administrative staff will be spent. By Rima Evans.

Dr Jonathan Serjeant
Dr Jonathan Serjeant

The GP Forward View published earlier this year promised £45m over the next five years for training receptionist and administrative staff. This funding will be made available to practices via their CCGs and can be used for training receptionists to actively signpost appropriate help to patients or to train clerical staff to manage clinical correspondence (see box below for full details).

The idea behind training administrative staff has come from an initiative in Brighton, which has developed a new clinical assistant role, that is now being used in 51 practices across England.

The role has helped eliminate GP input in up to 80% of patient correspondence, freeing up around 40 minutes of GP time every day enabling them to focus on patient care, data has shown.

The training programme for the initiative was developed by a not-for-profit social enterprise called Here (formerly the Brighton and Hove Integrated Care Service [BICS]), to train practice administration staff in dealing with clinical correspondence and reduce GPs’ workload.

Dr Jonathan Serjeant, GP partner at Benfield Valley Healthcare Hub in East Sussex  and an executive director at Here, helped to pioneer the clinical assistant post as part of a project called ‘Workflow Optimisation’.

He explains that under its remit to improve healthcare, Here, was looking for ways to widen patient access beyond merely extending opening hours.

‘We wanted to look at how systems could support that too,’ he says.

Administrative burden

Dr Serjeant identified that the administrative burden patient letters put on GPs is considerable.

‘On average, for a patient list size of around 2,000, doctors receive about 40 to 60 letters a day. If one doctor is away that can rise to about 100 per doctor,’ he says.

‘Traditionally, the GP is thought to be the repository of information so every letter is  read by them. Most doctors also carry out this task in the evening after a long day so inaccuracies can occur.’

Dr Serjeant decided to see if the system could be improved – with less reliance on GPs - by reworking processes on a small scale at first.

This involved training an administrator from his practice whose main job would be to deal with correspondence.

There were two agreed main outcomes which the role covered: collecting the right information from the letter, coding it and picking up metrics to make patient records more accurate; and taking action to ‘move the patient on in their journey’.

Crucially, the administrator also had to learn and understand which letters still required GP attention. This would include, for example, any issues in connection with the safeguarding of adults or children, new cancer diagnoses and a list of other categories.

On-the-job training

On-the-job training was carried out by Dr Serjeant and fellow GPs last year for a period of three weeks.

He explains: ‘We put in safety systems to ensure the administrator was working effectively and safely. But after that time she was able to complete 70 to 75 per cent of all paperwork coming to GPs.

‘So we discovered that doctors didn’t need to see certain information at all if it was well recorded on the system. As a result we were able to focus more time and attention on the letters that did come to us because the load was much less overwhelming. We quickly realised this was going to have a major impact.’

Training was offered to other practices in the Brighton and Hove area using monies secured from the Prime Minister’s Challenge Fund and 10 practices took up the offer.

‘After the three-to-four week training the impact was the same,’ Dr Serjeant says. ‘Some GPs reported it was the highest impact change they had made in the last 10 years and that it really made a difference to their working lives.’

National roll-out

Last December, NHS England asked the organisation to train a further 40 practices, this time nationally, as well put robust protocols, templates and procedures behind the programme.

Lessons learned from previous training sessions and refining of processes meant the programme was distilled into four days with the provision of ongoing support.

Data from the new practices was verified and confirmed the initial positive results.

Lewis Smith, business manager at Workflow Optimisation explains that in addition to reduced paperwork the clinical assistant brings wider benefits. This includes improved ease of QOF data collection and accuracy of submission through the consistent application of Read codes and collection of numerical values, for example, blood pressures.

‘Practices have also reported greater job satisfaction for GPs and administration staff,’ he adds.  

Practices that implement the role will need to inform their medical indemnity organisation. But Mr Smith says that so far there has been no increase in indemnity costs for practices that fully implement the training programme.

Support of the practice

However, intrinsic to the success of both the programme and the new role is the support of all the GPs and practice.

‘We have found that working with the wider practice team aids a smoother implementation,’ says Mr Smith. ‘By working with a GP champion in each practice and outlining their key responsibilities it ensures the practice achieves safe, sustainable and full implementation of Workflow Optimisation.’

Dr Serjeant adds: ‘We teach GPs about change management and how to have governance over a particular new way of working which isn’t always understood.

‘It’s a commitment for the GPs and the practice. And they have to be prepared to feedback when it’s not right so they can deal with any problems.’

Post-accreditation, Dr Serjeant says, GPs or staff are encouraged to spend at least a half day every two months with the clinical assistant to help grow and develop their role.

‘We also teach the practice to carry out audits so they can pick up errors.’

Cost of the role and experience required

So, how can this new be funded given the pressures facing general practice?

‘It is a slight cost pressure,’ Dr Serjeant admits, ‘but we have found practices have been more than happy to take it on because it’s made such a difference to GPs’ work lives.’

The clinical assistant sits in between a basic administrator and medical secretary post. For a practice with a 10,000 patient list size for example, Dr Serjeant says, the role would be full-time.

‘It may also be a good fit for someone who wants to become a healthcare assistant because there’s the opportunity to learn the language of medicine. The role creates a bit more career development and helps staff feel better connected to the people they serve because they are dealing directly with them.’

Across general practice, the role helps channel work to the right people given that primary care now incorporates many other skilled professionals such as pharmacists Dr Serjeant says.

‘For example, medication queries can go directly from the clinical assistant to the pharmacist, bypassing the GP.’

Accessing GP Forward View funding

The first tranche of funding for training for receptionist and administrative staff will be available from CCGs this autumn. In liaison with their practices and the LMC, CCGs will agree how best to distribute money for practices. A new directory of training providers, that will be available on the NHS England website, will signpost CCGs and practices to relevant training courses.

See here for more information on Workflow Optimisation

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