Dr Cain Hunt explains how the practice he recently retired from found a way to improve work pressures without the expense of hiring permanent doctors
The idea of GPs having a personal assistant (PA) can seem a bit unusual although they are commonplace in other industries. Can they really help and are they worth their salary? We found that expanding the role of receptionists to carry out PA tasks for GPs was a more effective approach, saving us money and improving our work lives more than if we had bought in extra locums or hired a physician associate.
In theory, offloading straightforward clinical problems to less well-trained clinicians, such as physician associates or general practice assistants, can seem like an effective way to reduce workload. However, it only really helps if their cost and supervisory needs of the alternative clinicians are low enough, so that they see more patients than if the equivalent money was spent on a GP.
Administrators, on the other hand, are people to whom GPs can hand over non-clinical tasks while they concentrate on seeing patients . They also do not need clinical training or accreditation. Our four-GP partner practice made some changes in order to play to everyone’s strengths and allow GPs to do the thing they excel at – diagnosing and treating medical conditions.
So, what did we do?
Upgrading receptionists to administrators
We realised that our two secretaries had become the only people in the surgery who could carry out certain vital admin-related tasks or who were familiar with particular processes. For example, only they understood the complexities of the e-Referral Service. The problem was we didn’t always have a secretary available when it came to making urgent referrals.
So, we broadened our seven receptionists’ jobs out to include secretarial tasks. In effect, we amalgamated receptionists and secretaries into multifunction ‘administrators’. It seemed a logical move especially given that our receptionist jobs were becoming increasingly complex. As the work increased, we negotiated adding in 23 admin hours to the team’s work.
What administrative tasks you can offload?
Since we retain clinical responsibility for everything the team does, we needed to give staff training and support, so they could complete tasks properly. We also put in place systems to identify any problems. However, these were the sorts of tasks the admin team took on:
- Drafting replies to simple requests for information
- Drafting onward referrals to secondary care – for example from opticians or physiotherapists
- Bringing urgent items (e.g., from the CQC or Coroner) to your attention
- Coding and making diary entries
- Completing referral proformas and collecting the required path results
- Dealing with the administrative burden of referral pathways
- Communicating with patients about the referrals and handling requests to expedite
- Chasing up referrals to make sure they were correctly received
- Redirecting rejected referrals if they were sent on the incorrect pathway
- Managing diary entries and repeat test requests or referrals
- Checking for and responding to abnormal results
- Communicating simple results and management plans to patients
- Communicating with other hard to reach professionals (social workers, teachers etc)
- Filtering incoming calls to reduce interruptions but allow through important calls
Data and reports
- Running and repeating clinical searches and audits
- Drafting reports for PCN / ICS
- Tidying up summaries
- Developing templates and writing protocols
This list is not exhaustive and not everything will suit everyone. Nevertheless, these are all areas that take up clinicians’ and which do not require a medical degree to do. Time spent by GPs to develop their teams can dramatically reduce their workload while maintaining your continuity of care and availability to your patients.
What are the benefits of working this way?
- Developing the team was more cost effective than hiring a specific individual. It also strengthened our continuity planning and resilience. Since, all members of the team can now do most of the tasks, it means it is easier to cover holidays and sickness absence, or even just the ends of the days when not everyone is in the surgery.
- We retained a working knowledge of how to do tasks even when people did retire or leave, so that our organisational memory was preserved. As skills developed, we did increase pay banding, but this could be done incrementally rather than having to find resources to hire a whole new person. Some team members had a flair for some tasks and tended to specialise, but we made sure that no-one was indispensable.
- This model creates more interesting roles, which helped us retain staff. By expanding their skills and making our receptionists’ jobs bigger in scope, we retained more capable staff members. Improving retention and reducing churn produces a significant cost saving in recruitment and training. We did have one receptionist who outgrew her job, but we were able to promote her to deputy practice manager and keep her organisational knowledge within the surgery. Staff members will inevitably end up leaving to pursue other opportunities. However, being supportive of their career development while they are with you sends an important message to them that you care and value them as in individual and that you won’t hold them back just to make your life easier. This makes for a more positive and happier work culture.
- It freed up GPs time so they could focus on clinical work. After changing how we organised our admin team, it was rare for partners to be at the surgery after 7pm if working for the full day. We didn’t have to work in the evenings or weekends, which had previously been common. In all, it saved me around an hour a day. The new arrangement improved our GP work life but also made the job more appealing when recruiting future doctors, which all contributes to the long-term stability of the practice.
How much did it cost?
The admin team’s hourly rate was increased as their responsibilities expanded and we increased the number of hours the team worked. So, overall the annual cost including NI and pension contributions went up by around £17,343.
A lot of the change for reception was not getting them to work more but getting them to do different things.
Tips on how to successfully make changes to your admin team
- Keep your purpose central. The point of upgrading receptionists is not to send out a message that certain tasks are beneath GPs, but to improve team productivity and performance by allowing doctors to focus on the only they can do. Ensure your admin team is appreciated and that they know their job is an important part of keeping the surgery functioning well.
- Be available when staff need you and invest your time. Your admin team needs to know they can check queries with you and that you will invest time in them when they need it. They need to learn how you want them to do things so they can do a good job. You are working in partnership with them to get the work done and they need to know they have your backing. The effort you put into training your admin team will save you much more time in the long run.
Dr Cain Hunt was a GP partner at Milton Surgery, Cambridge and now acts as a consultant to the practice. He is also author of Guerilla GP. Read more from him here.