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‘Opaque’ practice systems lead to workload duplication and delays, study suggests

by Jess Hacker
6 December 2021

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Practice staff’s ability to work efficiently is sometimes compromised by ‘opaque’ processes and ill-designed ways of working, a study has suggested.

Published in the BJGP, the research set out to characterise the number of operational barriers facing GPs and other practice staff, in order to identify targets for improvement.

Following interviews with 61 GPs in 28 NHS surgeries, researchers found that important internal processes such as medication management, allocation of incoming patient information or patient queries, and phlebotomy ‘often lacked agreed protocols’ or standard operating procedures which could in turn increase workload in the practice.

It said: ‘Opaque processes led to duplication of work for practice staff, delays in task completion, and discrepancies between staff in the advice given to patients.’

It added that there was some indication that these issues were exacerbated in practices with more complex set ups, such as larger practices or those with multiple part-time GPs.

Similarly, the findings indicated that the ‘formal schedule’ in place for clinical sessions ‘did not accommodate the realities’ of how GPs spent their time. The researchers said this led to staff multitasking, rushing tasks, and adding to existing stress.

It said: ‘At practice level, these findings indicate that investing time into the identification of operational failures experienced by individual GPs may lead to improvements in the safety, quality, and efficiency of patient care.’

Additionally, the NHS should improve mechanisms at a system level for coordinating care between practices and services.

The authors added that as integrated care systems (ICSs) develop, the systems should be ‘sensitive to the challenges and vulnerabilities’ associated with coordination and should focus improvement efforts ‘directly’ on this.

Throughout the pandemic, concerns about the workload of practice staff have increased, with the latest NHS workforce data indicating that England has lost the equivalent of 1,700 full-time, fully qualified GPs since 2015.

Last month MPs voted against an amendment to the Health and Care Bill which would grant greater transparency around workforce numbers in the NHS.

Meanwhile, the General Medical Council in July found that as many as a third of trainee doctors felt burnt out to a high or very high degree, with stakeholders warning this could undermine recruitment and retention schemes.