29.12.15
Freeing GP capacity by reducing bureaucracy
Source: NHE Nov/Dec 15
David Stevenson reports on the hard-hitting ‘Making Time In General Practice’ report.
Reducing unnecessary bureaucracy in general practice must be a “national priority”, with NHS England taking a lead on the work, according to a new study by NHS Alliance and the Primary Care Foundation.
Commissioned by NHS England as part of its wider work to deliver the New Deal, the ‘Making Time In General Practice’ study revealed that more than a quarter of GP appointments could be avoided if there was more co-ordinated working between GPs and hospitals, wider use of other primary care staff and better use of technology to streamline processes.
An online questionnaire of 267 practice managers revealed the main sources of bureaucracy: getting paid; processing information from hospitals and other providers; keeping up to date with changes; reporting other information; and supporting patients to navigate the NHS.
It was noted that ‘getting paid’ has become a much “bigger burden” since CCGs and local authorities have been commissioning services from practices, and that the use of different systems for reporting, claiming and reconciliation has exacerbated this.
Respondents’ central plea was for less complexity, more transparency, and a single IT system that works.
GPES (the General Practice Extraction System) and CQRS (Calculating Quality Reporting Service) make up the system through which data is collected from practices for payment and monitoring purposes. The aim was that it would be more versatile than its predecessor, QMAS, and reduce the bureaucratic burden on general practice. However, after the system went live at the beginning of 2013-14, instead of making life easier for practices, it’s made it more difficult, they say.
The report recommended that NHS England must ensure it rapidly sorts out the way practices are paid, working with its new provider of primary care support services – Capita – and with HSCIC (responsible for GPES and CQRS), with regular feedback from practices to monitor progress.
Rick Stern, the chief executive of NHS Alliance and a director of the Primary Care Foundation, said: “This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden.
“We want to ensure that GPs and their colleagues in general practice are freed up to deliver the job they were trained to do and care so passionately about.”
The study suggested that a significant amount of GP time could be freed up if family doctors were not having to spend time rearranging hospital appointments, and chasing up test results from local hospitals. This accounted for 4.5% of appointments in the report – an estimated 15 million appointments if repeated across England.
One of the strongest themes coming out of the research was the unnecessary extra workload created by the lack of clear systems and processes for practices and their local hospitals to communicate with each other and their shared patients.
The report authors added that some of this can be addressed through consistent national rules and guidelines, but probably even more important is a shared local commitment and creating opportunities for clinicians to cut through “unnecessary rules” that get in the way of treatment and lead to many repeat consultations to chase up basic administrative tasks. For instance, it was suggested that patients who are unable to attend a hospital appointment should be able to re-book within two weeks without going back to the GP.
It is no surprise that IT and systems were identified as an enabler and a way to share information across boundaries and reduce bureaucracy. However, the study identified that there is “no easy and quick fix”.
It suggests immediate practical steps to cut down on bureaucracy, such as practices freeing up time for GPs and other leaders to think through how they can work differently, learning the lessons from the PM’s Challenge Fund sites and the vanguard sites as they become available. And GP federations should be funded to work across their practices to build practical social prescribing projects that offer real alternatives to taking up GP time with patients.
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