Group Exercise 35 – 45 minutes

Background - There are not enough appointments left to see the doctor on the day. The surgery only books 2 weeks in advance and there are usually very few appointments available after the morning rush.

GP is trying to attend the CCG meeting at 1.30 pm on managing workload

You are short staffed at reception

Examples of Visit requests

  1. Housebound MrsX with Stage 4 COPD and bad arthritis , needing frame to mobilise few steps, has a painful red swollen leg
  2. Housebound Mr Y needs a medication review and care plan review (CVA with left hemiparesis, COPD, depression and early dementia. Wife died and no children. Has a carer twice / day)

Examples of other phone calls

  1. My 12 year old has a high fever and I’m worried. She needs to be seen today
  2. My mother (89) went funny this morning , seemed confused and for a while was drooling from the side of her mouth and dropped her spoon. She’s not so bad now but doesn’t look right to me
  3. I’ve just come out of hospital after an amputation and the discharge letter says that my GP needs to check my blood pressure after they stopped my tablets. I can come in my wheelchair if you want.
  4. I was told I needed to make appointment because the GP started Ramipril 4 weeks ago and told me I must have a check. I’ve been trying to get an appointment for 2 weeks and cannot get through
  5. You referred me for my hearing aid 4 weeks ago and I haven’t heard anything. Can you chase the referral?
  6. I was told my vitamin d levels are low
  7. What are the results of my ECHO? – Overweight patient with breathlessness, COPD, swollen legs and ex smoker and hypertension (mild diastolic impairment and trivial mitral and tricuspid regurgitation.)
  8. Can you write me a letter urgently? They have stopped my Employment support allowance and they said to bring a supporting letter from the GP to the Assessment Centre.
  9. My asthma is getting worse and I have taken photos of the mould in my bedroom. I need to see GP.
  10. I’m calling from Newcastle. My mother is your patient, she is feeling low and has lots of medical problems. Could you pop in to see her once a month? She only trusts Dr Goody. I know how busy you are. It can wait a week or two.
  11. I’m a busy important person and have a nasty rash. I need a late appointment today.
  12. Can you send my blood test results? I’m seeing a private doctor in 10 minutes.
  13. I have terrible arthritis in my knees and think it is due to my weight. Can anything be done?
  14. I think I have a urine infection.

GP also has to sign the repeat scripts on paper and electronically

GP has 15 prescription queries (requesting drugs previously prescribed, patient has not attended their medication review, request for Methotrexate, Hospital have prescribed, but patient didn’t wait for hospital pharmacy to dispense)

GP has 35 letters to read, some of which involve asking GP to make onward referral or action .eg:

  • Optometry: needs referral to eye clinic
  • Serum rhubarb is borderline low - please monitor,
  • I’ve excluded anything to do with my specialty - please send to pain clinic,
  • You haven’t sent enough information for the RMS to process this referral,
  • This child did not attend their hearing appt at UCL – we are informing you as a safeguarding measure,
  • 10 pages of results from R Free for patient who has mixed connective tissue disease and scleroderma,
  • Patient attended AE with superficial injuries – AUDIT C suggests unhealthy alcohol intake – GP informed,
  • We are discharging this patient. They declined a care package. Can you ensure the appropriate community arrangements are in place?

TASK

Bearing in mind the evolving models, what alternatives are there to manage the above?

  • Brainstorm ideas of how multidisciplinary working, networks or the use of technology could manage some of these problems.
  • Think about who is the most appropriate person to help the patient and what tools / resources they require?
  • What mode of contact - face to face, telephone, e mail, web based

Which areas of the workforce do we need to develop/recruit?

What technology do we need?

How can we feed this into the CCG and Education and training bodies?

Record ideas proposed