Lessons in correspondence; improving practice efficiency

‘Productive workflows’ is one of the 10 High Impact Actions established by the NHS; the NHS concept behind this is to, ‘Introduce new ways of working which enable staff to work smarter, not harder.’ Essentially, it seeks to release GP time and improve practice efficiency and the healthcare delivered in GP practices. We caught up with Paul Deffley, clinical director at Practice Unbound, for a best practice approach

Back in 2016 NHS England recognised that the volume and complexity of work undertaken in general practices was increasing, a pressure compounded by growing challenges in relation to the supply of GPs and nurses. At the same time, research revealed that 19% of GP workload would be better-handled by someone other than the GP; helping practices to better manage their workload became a high priority and 10 High Impact Actions were established – one of which is ‘productive workflows’.

Sustainable solutions

Of course, what this requires is perspective – the ability to take a step back, review, and make high-impact, small changes. ‘Workflow’ is a solution developed by Paul Deffley and the team at Practice Unbound – a not-for-profit social enterprise. Traditionally, clinical correspondence has been read, actioned, coded and filed by GPs; Practice Unbound’s Workflow enables clinicians to delegate this to an administrator who can assume the responsibility in a supported environment.

Improving practice workflow saves a substantial amount of time for GP practices. A trained ‘workflow administrator’ can code and action up to 80% of clinical correspondence and, cumulatively, Practice Unbound estimate that improved workflows can release 7.9 hours each week, per practice (per population of 7k).

However, to achieve this requires a GP practice culture which is open to change. There are some key elements that can help a practice implement ‘productive workflows’; Paul walks us through them:

Let go of control;

“Workflow is more than a protocol,” Paul says, adding that it requires changing how GPs approach an aspect of work which, traditionally, has been seen as a ‘clinical’ role. “GPs often need reassurance around governance, and the letting go of control, in order to successfully implement workflow,” he explains. If practices – and the GPs who lead them – underestimate this component, anything they might achieve by delegating this work will be radically reduced.

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Time to train is essential

“Administrators need training but also time in order to carry out this role successfully. We cannot displace this work without ensuring we have the administrative capacity to take it on,” Paul advises. It will be important to ensure you plan time for members of staff to engage in their training fully – after all, it benefits you to have staff who are well-trained and confident in their new skills.

Be consistent – set administrative time aside

Paul stresses that significant value is added by having dedicated administrative time for undertaking this role. “We have seen data quality improve due to consistent read code entry, and also improved pick up of QOF and other income-generating activity by having someone consistently processing correspondence with the correct, dedicated time to do it.

Selecting the right individual for the job

It may seem obvious, but ensure that the administrator you put in this role has the necessary skills. “Picking the wrong people can increase anxiety for staff members and mean that they are slow in the task,” Paul explains. “Pick someone with familiarity around reading coding – not necessarily through formal training though; choose someone who has a good understanding of the clinical system – someone who has been in post for >2 years. When we reviewed administrator efficiency in their roles, we found these to be the critical factors in success.”

The right tools for the job

Practice Unbound’s Workflow system also enables further efficiency on the job; for example, the use of dual screens mean the ‘workflower’ is more efficient. “They spend proportionally less time with every letter. Whilst the gain may be marginal, the average practice of 10,000 patients will be processing in excess of 500 letters a week, and over 30,000 a year! So this small time-saving really stacks up. Equally, such a practice stands to save 12 hours a week of GP time – over 600 hours a year!” Paul says.

So, the question is, what lessons can you apply to your own practice and, in the long term, how much time can you save?

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