Improving efficiency through personal lists

First part of the series discussed the advantages of personal lists, make sure to come back next week to read a view of a Locum advocate.

Why I would never work anywhere without them.

The image of the local GP who has their own list of patients and looks after them from the cradle to the grave seems to be old fashioned and, in the government’s eyes, inefficient. The current drive is for diversity of healthcare workforce, bringing in highly trained nurse practitioners, pharmacists and physicians assistants. It is hoped that these professionals can take the burden from GPs and see the less complex patients.

In most practices, doctors will see any patient and do duty days, which consist of seeing all acute patients from the whole list. The effect of this is that a GP can be faced with anyone from a list of several thousands. So why is it so difficult for patients to get appointments if this system is so efficient? At the practice where I am registered there is a 3 week wait for a routine appointment.

How personal lists work in my practice

We run a strict personal list system. I am a 4 session partner working Monday, Wednesday and Friday. I have a list of 950 patients and if any of my patients ring for an appointment they will see me unless the problem truly cannot wait 1 day. They will almost always get an appointment that week for routine problems and often on the day they ring.

“When they walk in I generally know their past history from my previous dealings with them and I have an established relationship. The consultation is therefore highly efficient. I usually deal with all of their problems during the appointment. Otherwise I know they’ll be back to see me again, although if the list is too long I can prioritise.

When I see a patient for a minor illness I can also do other things if I want to, like QOF, or remind them that they need x y and z doing. A nurse practitioner will not have the same holistic overview and so will probably not be addressing these issues as they are not all in the QOF box.

Establishing relationships, improved safety and learning

I see all my own blood results and letters. And when I look at these I know exactly who the patient is and I feel more able to judge if it is significant or not. This is efficient because I’m not trawling through the notes trying to work out why the test was done etc. It is also safer.

I build strong relationships with patients, which means if something does go wrong they are less likely to escalate a complaint. I am able to do a lot of my consultations over the phone as I know who I am talking to and what their issues are, which is again safer. I know who it is safe to treat over the phone and who tends to downplay their symptoms and should be seen.

Another advantage is job satisfaction for the GPs and also learning as we see the clinical journey of the patient with their symptoms from the beginning to the end and we see the outcomes of our decisions. The patient has to come back to us rather than going off to a different GP if they don’t like what we have done. When things go well – there is satisfaction, and when they don’t – there is learning.

“So I believe that bringing in more and more professionals to service the same patient is inherently inefficient and more expensive. We have a very low staff bill because we don’t have nurse practitioners or others. Unfortunately, it looks like the only way to get extra money from the government in the future is to go along with their model of care, which we fundamentally disagree with. So whilst we provide an excellent service to our patients we will not be rewarded for it.

 

Pauline GrantPauline Grant is a 4 session partner in Southampton in a practice of 15,000 patients over 2 sites.

6 Comments
  • Harry Longman
    Posted at 13:37h, 28 November Reply

    We are very much in favour of relationship continuity. Personal lists can help, although we don’t find they are necessary as long as the patient has the choice of a named GP every time. It’s about how the system is designed rather than simply “personal lists”. Somewhat over half patient demand is from those who say “don’t mind” and this gives flexibility to the practice which is also important. Lots of evidence in this area, do get in touch

  • Mark Newbold
    Posted at 09:44h, 29 November Reply

    Hi Harry Thanks for commenting. I know you have done a lot of work on managing demand in general practice efficiently. Would you agree that personal lists and/or relationship continuity is an efficient approach, as well as one that many patients prefer?

    • Harry Longman
      Posted at 10:18h, 29 November Reply

      Most certainly. Relationship continuity should not be seen as a luxury we can no longer afford. We need it more than ever and it is more efficient because problems are dealt with once rather than being passed around.

      More efficient, better quality and patient satisfaction .. It is worth very careful design to build continuity.

  • Mark Newbold
    Posted at 10:23h, 29 November Reply

    Very interesting, thanks Harry. Given the acute workforce crisis in general practice it is imperative that we look closely at how GP’s work and if continuity provides greater job satisfaction then we might need to plan for this? Next week we will hear from a doctor who likes the freedom of working as a locum. It will be fascinating to debate how we weave this into the planning too!

    • Harry Longman
      Posted at 10:31h, 29 November Reply

      Clearly there is a place for locums but I think its crucial that we tilt the system so that long term relationships, and the accountability of partnerships, are the best career choices for GPs.

  • Mark Newbold
    Posted at 11:32h, 29 November Reply

    Yes I agree, though I wonder whether we could do more to configure these ‘permanent’ jobs to include the sort of flexibility that working as a locum provides? Perhaps a discussion to follow up on after the next article?

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