Eliminating paper processes at your surgery may feel like a formidable task. Managing partner Pete Woodward advises how to tackle it bit-by bit and explains why it’s worth the effort
Until very recently, the practice manager’s role has traditionally involved a lot of paper. The main reason being that our job spans every aspect of running an organisation – strategy, finance, operations, facilities, services and more. In trying to go paperless, the advent of new technologies in the NHS is now so fast that it can be difficult to know where to start.
Here’s how reducing the amount of paper in practices puts us in the driving seat to embrace new technologies and support our team and patients.
What does it actually mean to go paperless?
When I started as a practice manager in 2021, I inherited filing cabinets full of paper, including (among other things) staff files, invoices, even accounts going back to 1973. And that’s before I found the private diaries of long-left partners! I was crammed into a tiny office and when an upset staff member wanted to talk to me, they sat on a seat wedged between two gigantic floor-to-ceiling filing cabinets. It’s no wonder they felt like the walls were closing in!
I felt it was time to say goodbye to this way of working. I wanted to get as many of these records digitised as possible, and as quickly as possible. Some of it was just about finding quick wins. Anything that didn’t seem to serve a purpose was shredded. Anything we weren’t sure about was scanned, categorised and stored digitally. A secure, unused attic space was utilised to store papers unsuitable for scanning (usually because there simply wasn’t enough time to sort through it all).
Once we had cleared the office, we could see it was a much bigger space than we had realised, with enough space for a meeting table and chairs, and that felt much less intimidating.
What are the benefits?
Reclaiming surgery space is a major advantage, but the biggest benefit of going paperless for us was better utilisation of our accounting software.
By moving invoices from paper to digital, we could automate the importing of invoices into our accounting software, enable ‘rules’ to make suggestions for categorising income and expenditure within the system, and critically, better use the in-built ‘Profit and Loss’ reporting feature to support real-time assessments of our financial performance.
Relying less on paper helps other colleagues too. For example, it forced us to make sure all relevant documentation and processes are in one place. In fact, it’s become a running joke in our practice that the answer to many questions is, ‘Pete’s put it on the intranet!’ (And here’s hoping they all remember that when the CQC turns up)!
It means that access to information is made simpler and more efficient as it doesn’t take as long to find where something is or what to do, ultimately improving colleagues’ understanding of processes and procedures and helping them to do their job more easily.
Added to that is the fact that information stored in most digital systems automatically has an audit trail, which helps with investigation of any issues and providing evidence to CQC at an inspection.
Can going paperless save money?
Going paperless directly saves money in several ways. First, it cuts out the cost of buying printer paper, toner, repairs to printers and so on.
However, the indirect savings are even more substantial. We were fortunate enough to be part of a pilot scheme to digitise paper notes, which decreased the administration needed when registering new patients, or when patients transferred from us to other practices.
Paperless has also enabled us to maintain a detailed financial plan quickly and easily, by using our accounting software’s profit and loss reporting to access analysis of our income and expenditure in specific areas almost instantly, freeing up the time to look for cost savings.
Even reducing the number of interruptions to my day because a printer isn’t working has had a positive impact. So, it may be difficult to put a specific amount of money on potential indirect savings, going paperless can be considered an investment into protecting your time and headspace.
So, how can practices approach going paperless?
1. Recognise it’s a step-by-step process, not an overnight change
Everyone is busy, so it’s important to make gradual changes. A big concern is there is little capacity to scan things onto electronic systems, so why bother at all? However, sometimes you’ve got to set down a date to let the paper systems come to their natural end and make the switch while accepting that the full benefit may not be felt immediately. For example, once we decided to create processes to scan invoices into accounting software, we soon recognised it would be too time consuming to digitise invoices from earlier in the current financial year too. It ended with us having two systems on the go!
Nevertheless, we knew that the following financial year we would be fully digitised, allowing us to fully realise the benefits of being paperless.
When utilising new technology, such as accounting software or an intranet, it can be helpful to approach it in stages too. For instance, we completed a project to digitise the reception staffing rota, and only when that was established, we moved on to digitising room planning too, using technology to automatically flag any duplications or potential errors, saving our team time and unnecessary stress.
2. Training and support for staff is vital
How did we overcome resistance from staff? Some staff felt that if the old system wasn’t broke, we shouldn’t try to fix it. But in truth, this ignored the weaknesses and inefficiency of a paper-based approach – things going missing, retention of records, no audit trails and potential for human error when updating spreadsheets, and so on.
However, for us one of the main issues was training rather than resistance. And this can’t be ignored – you have to factor in time and costs for this. I found many staff members were not as confident using software such as Office365, including features such as online forms and shared documents. It therefore took time for people to get used to submitting holiday requests through the system, rather than on paper forms. You might also encounter the occasional frustration from a team member at having to sit down and learn about another digital system.
Being patient and being positive about the benefits all helps. And as with most change, as soon as people get used to it, it’s like it’s never been any other way. I know trying to revert back to paper holiday forms now would cause a riot!
The trick is focus ruthlessly on the things that you can control, approach things one at a time, bring your team with you on the journey, and demonstrate quick wins that make everyone’s lives easier.
3. Consider where paper processes may still be required
Sometimes it’s not desirable to eliminate paper entirely – for example, we wanted to keep paper Friends and Family Test forms for those patients who don’t use the internet, but there were relatively few exceptions like this.
4. Where required, engage with patients
Similar to going paperless, the practice also went cashless. This created lots of benefits for the practice, in terms of administrative time saved going to pay in cash and cheques, having to hold a petty cash account (with all the opportunities for misuse and accounting difficulty that creates), as well as the risks of the team incorrectly charging or giving incorrect change. While this was an area that initially had resistance from patients, it has vastly simplified the job for our team on the front desk. To engage with patients, we ran drop-in sessions at the local library, and made us of our GP federation’s fantastic digital facilitators to support us and resolve any patient concerns.
In conclusion, going paperless step-by-step is an effective way to create a series of small wins for the practice. Over time, these small wins accumulate into real efficiency for you and your team, and that’s something we can all use more of!
Pete Woodward is managing partner at Cheadle Medical Practice and Alvanley Family Practice in Stockport, as well as running Woodley Village Surgery on a consultancy basis. He won the Practice Manager of the Year award 2024
