Thinking outside the box …


There’s a bit of chatter on Twitter today about the results of a Pulse survey showing that more than 50% of Gp’s would charge fees for routine appointments. The article mentions that patient demand is only going to go up and of course there is the lingering issue of OOH of course 

Declaration of interest – I am a GP’s wife and a friend of many Gps. I don’t think many Gps would vote for this charge (which will be doubtless spun as ‘greedy’ GPs wanting to make even more money off the backs of the public) without feeling some sort of desperation about their future workload.

How can GPs work smarter and manage workload?

There are some very good ideas floating around – Patient First, for example- an extension of the ‘traditional’ model of GP practice.

There is always going to be a place for the face-face appointment at Primary Care level especially for those who are acutely ill but surely the time has come to think outside the box instead and look to ways to integrate technology properly into care, especially chronic care?

  • What about thinking about ways to ‘stream’ data from chronic patients eg: blood sugars from diabetics, daily / monthly blood pressures, even peak flows from asthmatics. Constant streaming will mean that clinicians would have access to real time information highlighting problems as they happen. Patients wouldn’t have to come in for routine checks, checking the data wouldn’t be time specific
  • Using wifi pedometers / wifi scales that link to the web that can be accessed remotely by lifestyle trainers to monitor / encourage / set targets for. This approach could potentially have more capacity than any gym program.
  • Better signposting to support groups on and offline
  • Improved Communication between Pharmacists and GPs – if pharmacists begin to see more patients then records need to be shared.

Most of this technology is already here, the vision and the will to use it has to be here too. The NHS should be free at the point of use service but if that principle is to be kept, Primary Care has to have the will to change the model of delivery.

Just my two pence worth!



2 responses »

  1. Good points but its also worth considering unintended consequences of a system where lots if data is continuously streamed to GP records. Who would monitor it all ?

    Yes we need better systems for sharing the info & knowledge that we already have wrt to promoting self management of long term conditions. A Citizen doesn’t “need” tech before they can selfcare – but it can help. Plus having the tech doesn’t mean the person suddenly becomes great at self management.

    We are encouraging patients to use the self check bp machine that we have in our waiting room. It prints off the BP – patients show it to the GP & they code it to the record. It’s not high tech bit it helps…

    Weight is probably the easiest condition to self manage – but clearly many people struggle with this for a multitude of reasons. Wearable tech that acts as a pedometer or wifi scales that track weight progress can make it easier for the citizen to be aware of what’s going on with their weight – but they still have to do the difficult work of 1- exercising more and 2- avoiding the cakes (especially hard at work )

    • Stuart,

      Thanks for the reply, yes there will be a lot of unintended consequences – change always brings those! Even change to consultation patterns will bring that!

      I’m sure it would be easy enough to make sure that there are alarms set into the system to alert HCP’s to any inconsistencies or change in patterns. It wouldn’t need continuous monitoring. Surely real time data is better than a six month old diary – what’s the point of asking for a six month old diary. I think (as a pt that could do better on self care / monitoring) if I knew the data would make a real time impact with my HCP. Be a better opportunity to teach self care than a 3 monthly / six monthly appointment where you are essentially reviewing historical data – who can remember what they were doing at a specific point 3 months ago?

      Exercise and weight issues – I’m pleased that docs are prescribing gym courses etc but what about the ones who don’t like gyms? I hate going to the gym for exercise *sessions* – doesn’t capture my interest, wearing a pedometer though has helped me tremendously. Made me more aware of my baseline of activity and with the gaming inherent in the system really helps me think about my choice of activities – get an extra walk in, park at the furthest end of the car park, park in a car park further away. I feel good about the fact that I can look on my dashboard and see the fact that for several days on the trot I walked 2K steps over the target 10k and can begin to plan how I can make that 15k.

      I envy those who can run / cycle long distances – weight and build kind of make that a bit daunting for me at the moment.

      What I am saying though is that the tech can help capacity issues – gym capacity is limited and I don’t suggest that people would be given wearable tech without telephone / personal support – that goes hand in hand – but it doesn’t have to be a GP that does this bit of it.

      Making 10k+ steps / day means that the individual is walking around 6 miles / day – certainly a relatively high level of activity and more consistent than 2 or so gym sessions / week.

      As I say – I have a friend who has to visit her GP 2x month to get weighed – why does she have to have her schedule disrupted to make that appointment and a GP appointment essentially wasted when she could do it at home and a notification appears in the GP’s email inbox (or wherever).

      Just trying to think outside the box. Working smarter does mean changing the way Gp’s work. GPs are notoriously conservative in how they work (I should know) because they care and worry about delivering the care their patients need.

      Someone needs to take the first baby steps – who will it be?

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