Improving capacity in general practice

Dr Arfon Williams, Ty Doctor, Nefyn, Pwllheli, Wales 

The problem

Following the loss of one of their GPs, a practice in Nefyn, Wales experienced considerable difficulty recruiting a replacement. To compensate for the loss, members of the practice took on additional work to ensure their ability to see patients was not impacted. Following the retirement and medical leave of two additional GPs within the practice, the recruitment issues became critical and potentially detrimental to patient care. This left one WTE GP to care for 4500 patients from two rural sites. The practice was eventually told by the Health Board that if they were unable to recruit, they should consider returning their GMS contract and closing the practice. 

The Bright Idea 

The Bright Idea was a combination of several modest modifications which together became bigger than the sum of their parts: 

  1. A modification of skill mix, replacing 1.5 outgoing GPs with one WTE advanced nurse practitioner. 
  2. All members of staff were offered training to upskill to the best of their ability. This resulted in all staff being able to perform each other’s duties (e.g. all reception staff can use CRP machine, apply ecg/ BP machines, etc) .All reception staff attended training programmes on signposting and triage. About half are now qualified dispensers. 
  3. Two reception staff were transferred to helping the manager with admin work. This working ideal ensured cross cover at times of sickness and leave. 
  4. All requests for appointments with the Dr were triaged to signpost the patient to the most appropriate clinician, (not necessarily the GP) 
  5. Online booking of appointments was suspended as such appointments could not be triaged as above. 
  6. The practice worked to embrace technology, as well as every pilot scheme offered. This led to the ability to offer audiology, MSK physio in house, counselling, MHT and others, who see patients directly without need to be seen by a GP first. 
  7. We encourage a strong work ethic in our staff where we don't leave tasks for others wherever possible.

The practice communicated all changes with their patients, informing both what they were doing and why. This emphasis on good communication led to overwhelming support from the practice population, resulting in a 10 percent rise in the past year. 

The impact 

  • The patient: Just want to be seen and have their problem dealt with promptly by a competent individual .Once their initial anxieties were allayed they were happy to be seen by a non GP. The GP is now able to see more complex, specialised cases that better reflect the needs of the patient. We are now able to offer patients on the day access, as well as booking in advance. 
  • The Practice is very highly regarded with colleagues travelling from far and wide to see how we work. We are now regularly consulted, and have been integral in further service development in North Wales. On any given day we have ~ 15% spare capacity to see a GP/ANP or other allied healthcare professional.

  • Staff: Sustainable workload, increased morale  and satisfaction

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