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21 December 2018
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Dr Farzana Hussain, GP partner at The Project Surgery in Plaistow, east London, suddenly found herself with sole responsibility for over 4,700 patients when her GP partner and friend took his own life in 2013.
A difficult time for Dr Hussain and the practice, she was left as the only GP partner, creating a necessity for everyone to work more efficiently together. However, despite concerted efforts to improve processes at the practice, Dr Hussain’s ideas simply weren’t bearing fruits.
In 2016, she joined her local GP federation, Newham Health Collaborative. As one of the board directors, she was encouraged to apply for a place on NHS England’s General Practice Improvement Leaders programme, which teaches clinicians and practice managers quality improvement skills to help them work more effectively.
As a result of the skills she learned on the six-day programme, Dr Hussain managed to improve efficiency at her practice. She freed up GP time (the practice now employs three salaried GPs), as well as time for her practice nurse and receptionists and saved around £15,000 a year.
Dr Hussain tells Management in Practice how she managed to turn her practice around.
We were a two-partner practice looking after around 4,700 patients when my partner sadly passed away in November 2013. He died by suicide, so I was left as the sole GP over the winter period, as my salaried GP was on maternity leave.
There was a growing need to work more efficiently and serve our patients with fewer resources, particularly much less GP time than we ideally would have liked.
I applied for the General Practice Improvement Leaders programme because my GP federation thought I could benefit from it.
What was really different and enjoyable about it was that we were given a lot of time to work out what the problems were for each of us.
We all had a chance to say what our issues were and what we wanted to gain. The themes were quite similar: a lack of resources, a willingness to work more effectively, and thoughts about how to change our way of working.
One of the first tools we learned was process mapping, to help us understand what was going in our practice and where we were heading. We also learned about the Plan, Do, Study, Act cycle tool, which allows you to plan for chance, measure improvements, adapt to change and act on it.
We had an issue with message taking. It sounds so simple and straightforward: a phone call comes into the practice through reception, a message is taken and either goes to a doctor or the nurse. It sounds like we wouldn’t have a problem with such a simple process, but we did.
We discussed the problems during a practice meeting. The receptionists said they expected GPs to call healthcare professionals, such as pharmacists, back within 30 minutes of receiving the message.
However, the GPs could take up to two hours to call them back, which sometimes resulted in the receptionists being shouted at by the pharmacist, for example.
Once we realised this, the GPs said they would prioritise the calls. The receptionists were also asked to inform the healthcare professionals calling that the callback would not be immediate.
Travel vaccination clinic
We serve an ethnically diverse population and in July and December, we usually see spikes in the number of requests for travel vaccinations, as some patients go back to visit their home countries in Africa or Asia.
We used to offer face-to-face travel clinic appointments with a nurse, lasting 10 minutes per person. Often we would have families of five booking appointments for all of them, so that would take 50 minutes of our nurse’s time.
However, a lot of patients would forget about their appointments and not show up, leading to up to two hours of nurse time being wasted each week.
By changing the appointment to a telephone consultation, we managed to save those two hours a week, as patients do answer their phones. We now do our travel clinic consultations over the phone and invite the patients in for five-minute appointment to administer the vaccination.
In the summer months, the practice would see a lot of patients with hay fever who came to us instead of going to the pharmacy. So we started using active signposting.
Receptionists would often get calls from patients saying they would prefer to be seen by a GP, rather than a pharmacist. We asked them to tell the patients to see a pharmacist first, and that if the pharmacist had any further concern, they would get in touch with the GP who would then see them.
A year ago, we were dealing with many hay fever patients but this summer we saved six hours of GP time a week – is one and a half session of GP time – after we started signposting patients to the pharmacy.
It means I am saving £15,000 a year – money I am looking into investing into a part-time receptionist who could work as a care navigator.
Everybody used to telephone the practice to get an appointment. The lines were very busy between 8am and 9am, and 3pm and 4pm.
In January, we went live with an online appointment booking system but, at first, we noted that only 5-10% of our appointments were being booked online.
We thought we maybe needed to give an incentive to book online, so we started releasing our appointments at 7pm the night before, so patients were given all night to book.
As a result of that, the number of appointments booked online suddenly increased. At present, 70% of appointments are booked online, which has helped us save at least one hour of reception time a day.
We saved GP time, nurse time, and reception time and also made financial savings.
The greatest challenge I experienced was being patient. I like to see quick change, but change usually takes time.
I would encourage anyone trying something new to not just think that because you’ve done it once the job is done; things change. Life changes, patients change, and new systems are introduced.
Dr Farzana Hussain is a GP partner at The Project Surgery in Plaistow, East London
Additional reporting by Valeria Fiore