Does anyone do any reporting or reviewing of patients waiting on a waiting list? This came up in a 2ndry/1ry care interface meeting. We were challenged did we know how many of our patients were waiting for something - how long - what were they waiting for - where they were in the pathway - e.g. awaiting first OP/ awaiting diagnostics etc. Simple answer was no one in the room did this sort of analysis from our side in any depth - let alone review the list and see if there were any alternatives to shorten it.
A few years ago we did a Peer2Peer referral review service that worked (IMHO) well and offered advice to referrers as an alternative to the referral- I can explain this more if needed. However that stopped being funded and we have fallen back to everyone referring their own patients with no Peer review/support which I think is a mistake as not everyone has the same level of knowledge/confidence and some must over refer for this reason but an understandable one given the reactive nature of ‘GPland’ at the moment and there is no time for this in house work.
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If anyone has done any data visualisations of their Practice or PCN population into patient segments I’m keen to see them. Either along the NAPC model or John Hopkins or anything different? I know Sollis are in this area anyone used them? Locally we have a “if this PCN was a village of 100” but I don’t find this very useful.
I saw a demo of their AI yesterday. It looks good. It can summarise a long letter an into pertinent brief paragraph to make it easier to read. It will hopefully code the letter too and put this into my EPR neither of these seem ground-breaking any more.
It doesn’t seem to be doing all of this yet and appears to be taking quite a while to get there but perhaps the slow but steady tortoise wins the race.
However their current strategy seems to be to charge extra for this functionality. There is no money in the system so I cant see the NHS picking up this cost and practices while being sold a story of how much money it should save them in admin time will find this difficult to believe or even see so are going to be reluctant to pay and dealing with 6000 customers is never easy.
Docman is currently centrally funded which seems an enviable position. However not many people I know like it - the UI is not great and hasn’t changed/improved for years. A lot of practices are saying why do we bother with it - EMIS X or other might have just as good a system and not trap up in holding our documents in a separate system. There is also the possibility that provider IT systems get better at sending structured coded information so we don’t have to use cutting edge AI to read and interpret it (imagine that)
There is a real danger that ICBs will see dropping the costs of docman as a win for their IT budgets - I would be as quickly as possibly adding value to my core funded product to make it indispensable and wanted by the users who might fight any move to get rid of me.
Genuinely interested in feedback on RPA products in GP land. Are you using them? Are they delivering? Feel free to DM me if you want to.“
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“yesterday speaking to a colleague in another practice who has been using RPA for around a year… not exactly a resounding endorsement - lot of effort - lot of trouble - thing crashes if you even go near it - doesnt tell us when its not working, not currently convinced going to buy it year 2…… hard to justify the cost were some of the comments. “
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“is this everyone? we know all new products have teething issues and innovators and early adopters have to put in effort but this seems quite negative. to be fair - he said the company involved have been very responsive and engaged. is it just too early? or are they doing something wrong and every one else is loving it?”
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“my surgery is hoping to start using RPA more in the new year but my staff don’t want a beta product
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Attended the last Primary Care Community of Practice meeting as CRN North West Coast before the merger to become the RRDN North West this week. Good meeting and nice to meet in person rather than Teams. Some interesting conversations and good that the NHS is getting keener on commercial research (which we have been doing for 15 years). There were some strategic talks but also some conversations about operational matters. The number of websites you have to log on to often several for each study and the usual nightmare of passwords and usernames all with different requirements came up from several people.
It strikes me that given the NHS is adopting the study onto its portfolio and providing support to get it going shouldn’t we be insisting that as part of adoption their tools need to integrate/interface with ours? Why can’t they use SmartCard or NHS mail Login authentication? So, I can single sign on? A lot of websites are now using passkeys? is there some way of me being authenticated on an NHS network that would prove to one of these sites who I am?
EMIS have just upgraded their security - I know Gateway uses Smartcard authentication so it’s possible for third parties to use these - I know some have had issues with using Windows Logins. Thoughts?
In an accountable care organisation such as KP or VM they have tools to encourage / incentivise healthy behaviour. In an insurance backed health care system you can adjust the premiums based on individual risk. Have your flu/covid jabs - get your BP under control - take that Statin - prove you exercise/maintain a healthy weight etc and your premiums are lower. lower because you will ultimately cost the health care provider less over a determined time frame. The NHS lacks such levers. Arguably alcohol pricing is one but not quite. How about paying less NI if you have your flu jabs? or more if you dont? thoughts? alternatives?
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Does anyone know of a tool that would compare a practice database to a list of addresses and potentially identify homes that haven’t got any registered patients in them? We have hundreds of new builds in our area, and we theorise that quite a few patients new to the area only register with us when they want to be seen. This means we miss out on their registration fees while inactive. we are considering doing some active marketing to those areas, but it would be useful to have an idea of the size of the problem. If anyone has done anything similar - what lessons learnt?
The Howbeck team grows again. Really pleased to have such an amazing person on board. Jo is working on a range of projects with us - she is an expert on call/recall and repeat prescribing optimisation and will initially be helping us expand our practice support offering with a few other interesting projects to come.
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Last night on news I saw a spanish citizen affected by the floods stating one of the big issues they have had is the mobile phone masts going down and despite everyone having on them a powerful mobile device that could be used to 1. communicate with 2. look up information 3. collect information etc its largely been reduced to a torch.“
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“I know some ?@phones/versions of OS now have satellite calling/messaging but it makes we wonder why peer to peer comms isnt a bigger thing?”
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“My understanding is you dont need a network/central network you can send messages from peer to peer - if i remember my computer science isnt that what TCP/IP and ethernet is all about - sending packets from node to node with them passing on ones that arent for them??”
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“In a disaster area - if everyone had the ability to switch to some form of peer to peer it might maintain connectivity? or am i misunderstanding the range/capabilities - im sure i once saw a walkie talkie type product on ?kickstarter that was for groups operating in remote locations that used the same idea ?perhaps on a different frequency?”
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“I guess if p2p doesnt work? what are the alternatives? use starlink? use drones flying over head as temporary networks? anyone know anything about this?
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Is it time to revisit how Problems are coded in Primary care EPRs?“
“There is currently a lot of talk of next generation EPRs and what they may look like. For me we need to revisit and upgrade/update the problem coding section.”
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“A list of codes - sometimes different one meaning the same thing - entered randomly with no information is not very helpful.”
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“We need to include meta data - like - who made the diagnosis, how certain where they of it, on what criteria was it based. Has thinking changed or evolved?”
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“Let me give some examples. I recently completed a questionnaire on patients with pericarditis which I was sent as someone is extracting data from us and had ID a patient was coded with it. Now entering the notes - it was an A&E diagnosis with no real clarification on how senior or how definite the diagnosis was. the person filling in the discharge made a big effort to record they hadn’t seen the patient. interestingly looking on ICE - that wasnt the working diagnosis - which was just chest pain - I dont have access to any other notes - so the 1 page discharge is all we have.. however I then found a cardiology follow clinic letter which stated the patient was being followed up for myocarditis not pericarditis. The letter seems to imply there was no pericarditis. It was unclear whether there was confusion - disagreement or whether the person filling in the original form didnt know the difference. Now I cant blame our read coder for coding pericarditis - it says that.. but do I take it off? do I cancel it? none of this nuance is in the coding. what’s funny is the research study clearly think this patient had it and want to know all sorts of things about them - and of course there wasnt a box on the form to say - I dont agree the pt has it please remove them from your registry.”
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“another example - a letter from the DVLA about a patient with fits. wanting information about her epilepsy.. well is it.. a&e have said fits/seizures on various discharges but not really given me any more information. when shes eventually seen consultant neurologists - one categorically has stated she doesnt have epilepsy others since then as she gets no continuity in out patients say its complex partial epilepsy and are treating her for it. one letter hints that a sleep deprived EEG confirms it but another letter than mentions the same EEG isnt clear. What code do we put in her notes? Never mind the fact the DVLA ask all sorts of questions about frequency/type/ last fit etc none of which is in any of the letters.”
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“What about something simple - diabetes? surely thats easy. well.. has someone put a code in the notes based on a slightly raised HBA1C - not quite WHO diagnostic criteria. “
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“Don’t even get me started on orthopaedics or worse psychiatry. I used to think it was vitally important to include which knee or ankle I was referring in my letters but given most of the letters back don’t mention it why should I & trying to find a definitive diagnosis on a pt with an SMI…
Great quote today from a meeting I was in - “governance is like bondage, it’s sounds exciting and you quite fancy a go until it’s actually time to do it” :-)
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EPR summaries can be a mess. we have been coding consultations for 20 years plus. Most consultations get coded often with benign useless codes. Chat to patient is a common one. Problem significance is an issue. some codes are significant some are minor - some should end - some should be in past not current. often things have multiple similar codes for the same thing.“
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“Why does this matter? well GP records form the basis of shared care.. insurance reports - patients can see them and the mess looks a mess and appears unprofessional. “
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“tidying notes is a pain - it takes ages - and you need to agree a list of standards - often individuals will differ. However RPA could sort this.”
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“RPA applies one set of rules consistently. Teach it the rules and let it code. Recode significant things as significant. end problems that are minor. group and combine codes. tidy up the problem history. perhaps point out oddities?”
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“imagine - clean - well structured problem sections that are easy to read and make sense… RPA could do this… is anyone?
Been playing with EMIS-X this week. Hadnt really done much with it previously. While I think the UI needs some work and there are so many features I hope they add to it - its so fast im stunned/impressed. “
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“Ive stopped opening documents in Emis web/docman - its really speeded things up for me. They are just there in emis-x as soon as I select the patient - really impressed. I wish i could create docs in it!
Having recently become an expert on robotic mowers (thinking of adding mower guru to“
“My tag line) - mine is a Mammotion Luba 2 btw - and having a DJI drone - I’m wondering if there is a combo product? Given Hedge cutting is the bane of my life - what about an autotomonous flying hedge trimmer? Can’t see any issues with a ai powered device flying around at head height with 8 razor sharp spinning blades
Human vs Bot - John Connor vs The Terminator“
“At the BP show - I saw 2 sides of an interesting debate and wonder what you all think. I spoke to a couple of RPA companies who are doing exciting things especially around results filling. They have moved from just filing normal results to working on quite clever protocols that can do some clever things - inc messaging patients, messaging parts of the team and telling them what to do.. all looks good. still not sure how its priced.. “
“I then spoke to a range of outsourced human companies - some with GPs some with pharmacists all of whom can dial in and do work for you - again - following a protocol but with a qualified clinician with a brain at the end who could do more than the protocol… if appropriate. we can do everything the bot can but better… was their claim.. we do it faster and more to the protocol was the bots claim…”
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“which is better? what is better? cheaper? more cost effective? safer? more adaptable? who is more environmentally friendly (5 nuclear reactors!!) “
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“who wins the bot or the human? which do I suggests my surgery investigates?
Another interesting insightful post from Gus. Although I have cordial relations with our local AHSN - and I have ended up doing quite a few meetings with companies for them for free (never been offered a payment) I do wonder if their methodology works.“
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“In my experience start ups want innovators/ early adopter practices to test/help develop their product and write it up in a way that convinces the later adopters its worth buying. “
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“The problem is who is going to pay for this work? Innovator practices want the software for free - they don’t want to pay for something that doesn’t work or needs fixing/developing all the time. Startups often don’t have this money and often need the fees to keep their cashflow going.. hence a conflict..”
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“IT interested GPs like me might be happy to invest time in helping develop a product but why should we unless we are paid or are given some form of equity in return- which many companies are reluctant to do….as they have little money.. “
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“Many practices as well as wanting the software for free would like some external project management to help in its implementation. Most PMs are really busy and don’t see it as their role to manage the implementation of new experimental software - so either a payment to the practice or a support team with dedicated time is needed again most new startups don’t have this.. and while they can work with 1 might struggle at the 2-20 practice size.”
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“Interestingly NHS-e in the TIF framework phase 1 paid practices/GPs to engage in assessing new tech- and my understanding is in phase 2 they are paying practices to be early adopters of it. Surely this is a model that should be more widespread? A chain of early adopter practices - funded to support new products and help develop them & turn them into ready to scale products?”
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“Now my conflict of interest is my company Howbeck Healthcare is happy to act as a middle person between startups and practice - we have done this for funded by a couple of SBRI bids - where there has been outside money to fund us and we have worked with companies and practices to adopt/test/trial new software”
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“We work with roughly 150 practices - some are innovators who would be more than willing to take stuff on if as above -1) it was free to begin with perhaps with a discount moving forward - 2) there was some payment for time invested 3) they were supported in the hassle it can be and 4) they felt they got to input into the product.”
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“The struggle we see at Howbeck is companies asking/needing help but a struggle to come up with a model that is going to fund the above.. “
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“I tend to agree the money going to AHSNs needs to look to support this. - whether they use howbeck or not :-)
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Here is a copy of the slides from my talk at BP.“
“To be honest I didnt give the best talk - personally found the blinding light in my face - that meant I couldnt see the audience - the microphone over my ears that kept slipping off and the monitor showing my slides on the floor (weird place to put it) very distracting… “
“I was meant to be giving advice to either myself 5 years ago or to a new budding PCN CD - on how to be a successful CD and the journey its taken me on - by example of some of the books ive read over the last 5 years and how they’ve all fitted in. The slides list most of the books - there are others - some are great - some .. so so.. happy to discuss - if you are a new CD and want some support/mentoring - get in touch! Im much better on a 1:1 or in a workshop.”
“Which of these do you like? which would you recommend?
I know everyone is at Best Practice.. and do come listen to my talk tomorrow 930 in the Transformation theatre in which I might suggest some books you might want to read. “
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“One not in my talk that Ive just finished and highly recommend is The Revenge of the Tipping point by Malcom Gladwell https://amzn.to/3NixHeb”
“The book discusses big Pharma, the USA opioid epidemic and how consulting companies using big data and segmentation techniques targeted superspreaders to change prescribing behaviour and while it can be used for harm how do we use this for good? “
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“It also talks about the concept of small area variation and how it can be influenced by “overstories” - perhaps why SMASH PCN has high insulin prescribing.“
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“Totally fascinating book also available on audiobook - so you can listen while driving to and from the NEC!”
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Im speaking at Best Practice! “
“Im on at 930 in the transformation theatre on Thursday the 10th.”
“Ive changed the title a little from the published one to “
“Lessons learnt and reflections on 5 years as Clinical Director for a PCN - including some advice to those thinking of taking on the role.”
“The talk is aimed at anyone that wants an inside track on what PCNs do and how they work. “
“If you are thinking of coming - and have questions you would like answered - please post them in the comments. “
“https://lnkd.in/ebrNDXZR
The Howbeck healthcare bid writing team has a successful track record of winning SBRI bids and partnering with the aplicants to help deliver the project in practices we work with. If you are looking for bid writing support or a delivery partner get in touch!
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Thanks for your contribution to our conference - we are hoping to put on another one next year - later this year we are running a conference more aimed at PCN CDs and Mgrs and practice management on ideas around using any arrs underspend esp slippage monies“
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“https://lnkd.in/dkn4NYue
In a previous post I whinged about EMIS in terms of worsening reliability and performance - what I didnt say is I think the whole way we do EPRs needs to change. GP records have historically followed a SOAP system. Subjective, Objective, Assessment and Plan. I guess analogous to history examination differential diagnosis and management plan. However in reality they are a series of text entries which are a mess. The consultation screen if filled with rubbish. hundreds of admin messages, Accurx/Paco other messages, blood tests, attachments its sometimes difficult to work out where the patient was actually seen and while there are filters they are a pain and dont work well. so Requirement number 1 is - a better way of logging what is a consultation what is communication, what is admin, what is plan. “
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“The way we work has changed and practices are no longer in isolation. some staff work at multiple practices - some only need access to some not all patients. some things e.g. admin tasks like prescriptions/incoming workflows etc need to be able to be seamlessly done at scale with perhaps different practices engaged in sharing different tasks. so requirement 2 is dynamic scalability and loss of the thinking of a practice as the only unit.”
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“LEAN - TPS etc.. I can track a parcel from Vietnam I ordered to my door and know where it is every step of the way inc when the driver is 2 stops away so I can meet him at the gate yet I messaged the practice I’m registered with the other day about a form I need filling in and ive literally no idea where they are up to with it Our IT systems have no inbuilt process mapping - I cant track anything, I cant really count anything - managers find it difficult to manage as there are no easy metrics or performance figures - yes there are some bolt on products that add features but requirement 3 should be built in process mapping and tracking.”
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“clinically I kind of want the same. when a do a referral I never get told how long it has taken to type or send - has it been send - has it arrived. how many referrals do I have active our there how many of the pts ive referred have been seen what are they waiting for. I can probably pull some of this from e-rs but its not by default - if we want to move to an active case management approach I need a better understanding of what is happening to my pts - similarly a local renal conslutant writes amazing letters. they list all the pts problems - where he is up to with them - what hes tried what hes not - what’s next - their last results etc… id love GP records to be like this - most as stated are encounter entries. some very brief some pages long - often poorly coded - often with no discernible plan no allocation or timescales - my computer friends tell me things like ?Jira do this well. Scrum masters know what is being done by whom and what is on time and what isnt. Given these type of project management software exist lets build that into the software.
I try not to whinge on here - but EMIS just gets worse and worse. First the panic button didnt work, then screen messaging didnt work, now the task counter is failing to update automatically - causing people to miss messages and results and prescription requests. Almost all other tech gets better with more features - EMIS gets more buggy and less useful. I cant believe we are paying them for this - desperately seeking a new EPR
Read an interesting book the other day that told a story about how a American university significantly increased its uptake of students attending for tetanus vaccine by playing with the message they sent out. Little tweaks to the message improved turnout. We have noticed that by sending email as well as SMS has improved uptake of certain services but we haven’t really played with the message in what I believe is known as A/B split testing. Has anyone done this? Has anyone learnt any lessons? I got an SMS from the surgery I am registered with the other day - to be honest - it was a little ambiguous and seemed to assume I knew how their systems worked. Perhaps it was because they wanted to keep it short to save fragments but I wondered if anyone has done any research/evaluation of how well we communicate with patients?
Still a lot of talk about the Streeting GPs - newly qualified GPs funded from a new ARRS pot of money. Calc have been done and people reckon its about 0.8 WTE per PCN, which isn’t a lot.
Also, if you have 7 practices, how do you share this person out?
Employ them centrally and have them provide holiday /sickness cover for different practices?
Provide backfill for GPs doing GP management work?
Have them do a project?
Perhaps do cross practice visits or nursing home reviews?
Look at what targets they could work on?
LD checks
DM 8 care processes?
Could they do minor surgery?
Perhaps a cross practice coils/gynae service?
However most will be fresh from training - little other experience - need supervision and presumably don’t want to get button holed in to a niche. Will they want such a job, perhaps its not quite the panacea we hoped?
The other big worry is if they set a pay scale this could disrupt all the existing salaried GPs!
Letter just out. Interesting - contract uplift and expansion of ARRS scheme to allow newly qualified GPs - who are presumably currently unemployed to be funded from ARRS monies.
My comment would be while Ai interpretation may speed some aspects up don’t assume that is the only hold up - many times I’ve seen in ICE a scan has been reported but not viewed and I suspect in some cases (not all) the consultant does not look at it until the patients next out patient appointment which might be some time away. It can then take“
“Weeks for that letter to arrive….
The role of UK general practitioners (GPs) is critical in maintaining public health, but are they spending their time in the most beneficial way? Should GPs focus more on proactive population screening, chronic disease management, and complex care to improve the overall health system?
Proactive screening by GPs offers substantial benefits. Early detection of conditions like diabetes, hypertension, and cancer allows for timely interventions, significantly improving patient outcomes and reducing long-term healthcare costs. By identifying and treating these conditions early, GPs can prevent complications, decrease hospital admissions, and enhance patients’ quality of life.
Chronic disease management also benefits from GP holistic expertise many clinics are quite tick box. Regular monitoring and patient education on managing chronic conditions can prevent exacerbations and the need for emergency care. This focus can alleviate pressure on the broader healthcare system.
Currently, the emphasis on providing instant access to GPs for all minor ailments diverts valuable time and resources from these critical tasks. Many minor issues could be effectively managed by other healthcare professionals or other services.
By delegating the care of minor ailments GPs can dedicate more time to proactive management and treatment of chronic diseases.
Shifting GPs’ focus to screening and chronic disease management supports better health economics. Reducing the obsession with immediate GP access for minor issues can streamline healthcare delivery, making resource allocation more efficient. This ensures that GPs’ expertise is directed where it has the most significant impact—on preventive care and chronic disease management, ultimately reducing the overall cost burden on the healthcare system.
*Thoughts on the above?* Is the obsession with GP access misplaced? Do we need to be asking what the best use of their time is rather than using them as a backstop to other services? Is it time to take away the Gatekeeper role?
The current guidance on gender reassignment is as follows: https://lnkd.in/e83uZMJS.“
“This is relatively straight forward but while the guidance talks about the cervical screening team contacting the practice re smears - there is no discussion about normal results ranges and physiological measurements that might affect algorithms such as Qrisk or ECG interpretation or Spirometry?”
“There is a worry that pop up warning boxes - searches based on risk factors - prevalence of some chromosomal diseases might be missed unless “sex at birth” is recorded and I can’t see any evidence or standard way this is being recorded? This could lead to patient harm both in terms of under and over diagnosis.“
“Does anyone have any more details on this?
Over the last couple of months we have been taking part in a trial doing Viral swabs on patients presenting with viral type infections. The kit tests for about 10 common viruses So far our results are: “
“217 Results returned”
“39 Positive Results”
“2 x Adenovirus”
“8 x HMPV”
“2 x Human Seasonal Coronavirus HKU1”
“2 x Human Seasonal Coronavirus NL63”
“3 x Human Seasonal Coronovirus OC43”
“13 x Influenza A”
“3 x Influenza B”
“5 x Sars Cov -2”
“1 x RSV B”
“which i find fascinating.”
“We are now trialling a POCT viral machine that gives results in 30 mins. Love the idea we might know for sure its just a virus! How might this change care? what if its available OTC or for home delivery?
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I recently saw an article predicting the death of GP federations. Having reflected I have to say I disagree. It’s worth defining that I think there are 2 types of federation one is a for profit outward looking federation that was originally setup to bid for AQPs - I don’t have any problem with these but I think most have struggled. The other type was setup more to help practices where the federation usually spends its time trying to help practices deliver their GMS contract better. This might be advice, setting up at scale back office or patient facing services. This is the type of federation I helped setup and still exists. Most were setup at whole CCG level with participation voluntary but often due to FOMO most practices joined.
As PCNS came along federations almost died. Everything was suddenly 3-5-10 practices covering 20-80K. Patients. CDs like me were appointed and apart from vaccine centres delivering IIF and the DES took priority. Size was about right for this. A CD doing a couple of sessions a week can get round 5 or so practices know them well. Help them, cajole them. ARRS funding was generous and some PCNS built a central team and infrastructure while some devolved the money to practices and ran lean only spending the bare minimum.
However smallish size has issues.
Governance can be an issue - a lot of money goes through the PCN books.
Power can be odd despite network agreements and voting schedules in a small group often 1 practice can dominate or can veto things.
Many PCNs are made up of not natural bedfellows and PCNs have perhaps stopped some practices that aren’t geographically coterminous but who have similar ethos from working together. Headspace is a problem. The management team at a PCN are often running to deliver and don’t have time to develop services. Now some of this is generalisation some are developing amazing stuff and some are huge - I know one of over 50 practices.
My PCN and all the local PCNS use our existing GP federation for governance. They have a team of people who watch the money - track it and make sure it’s not being misappropriated. The federation team help provide project management for local PCNs. Some of our most successful schemes locally have happened at federation level.
Our original federation was setup with a director being from each Area - each area turned out to be a PCN in the end. Some PCNs have looked at incorporating. Personally I think this is a mistake - often driven by accountants and lawyers who stand to charge large fees. It works for some but adds complications. Some have merged into one, which can work, though often these are at the low 10s of thousands.
It strikes me as we move forward as money gets tighter - as perhaps more roles need to be shared as management resource is squeezed - that working at scale is the way. That PCNs should be thinking about how they join together to deliver scale but retain their local focus and identity and projects. Keen to hear your thoughts!
Interesting morning welcoming and meeting Graham Urwin Cheshire & Mersey ICB Chief Exec and Amanda Doyle Head of Primary care at NHS England to my practice @SandbachGPs and discussing working at scale issues/PCNs/IT issues.
At the Howbeck DTL conference tomorrow due to a last minute scheduling change - I’m now running a workshop on The Business of General Practice - Everything you wanted to know and more! What makes GPs tick? How decisions are made. Im keen to keep it informal and interactive. I’d love to know what questions you would want to know the answer to? comments please
Only a couple of weeks ago I posted about the need for more intelligence and automation on assigning usual gp - and gosh someone’s only gone and done it!
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Why aren’t we seeing major insights from big data? Im constantly hearing stories from other industries where they make amazing leaps in customer service from looking at big data - I was listening to a podcast about American Airlines who got all sorts of insights in customer behaviour and wants from their ticket booking system. What do we really learn from our appointment system other than people want appointments? Has anyone done any work on this?
Potentially have another use case for the RPA companies out there. Apparently the registration system in EMIS is clunky. Practice managers tell me that if one GP leaves and is replaced by another - it’s fairly easy to bulk switch the usual GP fields of the patients to the new doctor. However if more than one doctor is leaving or moving and or changing sessions and you want to be more bespoke in how you reregister people - including trying to match the number of people registered to the number of sessions a GP does (to balance out the workload re results/etc) there are no easy ways of doing this. The tool will allow chunks of pts to be moved but not in any clever way.
It has been suggested this might be a useful thing for RPA bots to do - go down a list of pts and switch their usual GP to the appropriate one - also on the list perhaps. This would be run at times of change - or every so often after a search looking at say who is seeing whom. As well as getting the right results to the right GP - we try to promote continuity of care and that’s hard to do when the record has the wrong name on it.
I’ve probably not explained it well - any PMs may be able to explain it better.
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My surgery has switched to using Paco from Blinx Solutions. We have just setup our call/recall system using their software to automate and streamline the process. As an end to end tool unlike some other systems - we have built all the searches (in PACO) identifying appropriate patients to call in and then message them allowing them to book their appointment online. Patients can also use the link to change or cancel if needed and where appropriate are sent a health form to fill in prior to the appointment collecting useful data. The process just runs in the background automatically.
We think it’s saving our admin team a load of time - they certainly seem to be happy they are now only having to do blood forms! Now if only ICE had a good API that would allow us to automate the test ordering we could make it a human free process. If anyone has worked out how to drive ICE - please let us know - seems silly that that needs a human to go into each record, We have a list of pts, we know which bloods they need - why can’t it just create the orders?
Just been having a play with AnalyseRx on my EMIS system.. nice UI - some useful features. Need to attend the training to get most out of it but I can see a real use case for it.
We have some excellent talks at the conference this year including a keynote from Tim Caroe the new new NHS E lead for Digital and Data. We also have a great talk from the folks at UCL Partners on their new CVD action toolkit and we have the great Dr Clare Sieber from the Well-led practice talking about managing conflict in PCNs (something a lot of us CDs have had to deal with!)“
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“Although aimed at DTLs - any CD or primary care interested manager or GP/clinician are welcome - this year places are free!
My new favourite primary care review podcast https://lnkd.in/ee95VhCc“
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“Seriously some impressive AI tools”
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“Love the double act Amar Ahmed and Fari Ahmad
The East sussex assistant coroner has written to TPP and EMIS complaining that their record sharing/transfer isnt good enough and may have contributed to a prisoner’s death because of the delays it created. https://lnkd.in/eEVWurqP“
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“As a GP who most Mondays for the last 25 years has done a clinic at a local probation service approved premises where vulnerable prisoners post release (I almost said discharge) are housed temporarily - I can categorically state its even worse the other way. “
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“Every week I get a new patients from a range of prisons with almost no information on the resident. We are sometimes lucky to have their currently prescribed drugs and often that isn’t correct. Medical records from in prison stay and pre-prison should be automatically sent as part of their release. “
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“Whilst I get that punishing them for their crimes is the intention denying them adequate health care is IMHO wrong. I was some years ago involved in a coroners inquest over a gentleman who committed suicide whilst on license and the first we found out that he was known to mental health services prior to his incarceration was at the inquest. He had for what ever reason not disclosed this and there was no record in his non existent prison records. Some things get better - some clearly stay the same.
Dr Murray Ellender any comments? IMHO Seems a bit unfair to tarnish an entire triage system that a lot of GPs see as a solution to coping with the relentless demand based on one case that went wrong.
With regard to Cloud based telephony and call recording - can I ask what people do about recording out going calls? on our inbound calls - they get a message saying “all calls may be recorded” however when ringing out - we are being told we have to say this every call out anyone makes else we cant record it? Is this what others do?
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Today at 10 o’clock is our next DTL online forum/webinar. We have an update on the GP contract and demos of 2 interesting products that might help general practice. If you are a DTL or PCN manager or indeed a Practice manager interested in digital transformation and dont have the link - message me - it’s free to join. could be a useful 90 mins!
My PCN Manager Luisa Garlick and I were asked to take part in a Pulse Roundtable including other luminaries like Dan Bunstone and Matthew Prendergast the article is out now: Digital transformation: PCN progress so far - Pulse Today : https://lnkd.in/e4Uw4njc“
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“A quote from me at the end: “I could probably double or triple my DTL workforce and still have more work for them to do.”
My co-director Michael Pyrah usually produces a summary document of any relevant publications for our clients - here is a copy of his document about last weeks GP contract letter. “
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“If you are a practice/PCN/federation or provider of services to one and are looking for some consultancy/support esp bid writing - get in touch with lisa@howbeckhealthcare.co.uk
It’s the end of the 5 year deal - no more increases in ARRS funding. I would suggest to fellow PCN CDs and Managers and Practices, now is the time to review what you are spending your ARRS funding on.
Are you getting value for money? - is it delivering what you wanted it to? You aren’t going to get anymore and you are likely to have wage issues with wages going up higher than funding so you need to be sure you are getting the bang for buck.
MSK FCPS, Pharmacists Pharm Techs and Care Coordinators appear to be the favourites. PAs are controversial and marmite :-) - from a recent poll I did - hardly anyone has gone in for GPAs - despite me thinking they are a good thing. I know one PCN that loves their OT but you don’t hear a lot.. some of the other roles are barely talked about. What are your thoughts? Are you happy with what you have? Are you changing your plans? How are you measuring the impact?
If you are thinking of changing your team around how about a DTL per practice? So much of what we do is IT/data/coding - having dedicated people in a practice to do this could benefit all and with the removal of restriction everyone could have one. It could even be a career progression for some CCs?
For me - part of ARRS was to introduce the concept of non GPs / nurses working in primary care - Id like to think I was a forerunner having had a couple of Pharmacists for years before hand. Some practices have I suspect got around the additionally rules and made some savings but on the whole its delivered new roles in primary care..
Where next? hopefully it continues? One of the conversations we have had with our practices is you can have these people and fund them yourself - if you think it’s worth it. For example the GPA role - I think most receptionists could become GPAs and upskill themselves and perhaps get pay rises. Many practices love CCs and why not have more of them? More MSK?
Having had a few days to digest the new GP contract letter, one of the potentially interesting ideas is the one where non-GPs will be allowed to work in general practice. While some of my profession will see this as a threat to the status of a GP and some will see it as a way of NHS trusts running GP surgeries to fill gaps with existing staff - there are interesting possibilities both that might help practices and perhaps the system at large.
We have embraced the MSK first contract practitioner without feeling threatened - Could we employ a surgeon to do more complicated operations in primary care (need to think through the estates issues here).
I could easily see roles for gynae, urology, cardiology, care of the elderly perhaps even neurology non-consultant grades doing clinics in primary care.
Trying to reduce referrals, and drive the left shift.
Should ICBs actually encourage this with funding to trusts to send out these staff to work with PCNs/Places? Should the royal colleges plan to have some of their juniors training be in primary care to get a feel of disease at an earlier stage. A long time ago a medical consultant I worked for - had done a year as a GP during his training and he always claimed it was a great learning experience.
We may need to redefine the role of GPs - Leave GPs to see the undifferentiated and lead the management of care perhaps in a more direct way than losing patients into the abyss that is a hospital?
I’m a couple of weeks into our new CBT phone system at the surgery and I guess I’m a little underwhelmed. The patient call back facility works. The callboard is useful and has my Practice Manager watching who is logged in like a hawk but as with all software there are quite a few areas where we are finding it odd.
It’s too tied to our clinical system EMIS - I’m currently sat at my PC on a teams call and because EMIS isn’t open I cant use the phone and no one can ring me (may be this is a good thing, but it’s not really).
The toolbar doesn’t show my status when in small form.
When someone rings me it gives me their number not their name - despite the fact it knows that and so I’ve no idea who is ringing me (internal calls).
The report engine - while good needs loads more functionality to help you find historic calls.
We have staff who log into different EMIS systems for cross org working and it disconnects them.
The rise of private equity - this article is mainly day case type hospital work but you wonder about primary care - it’s happened in many industries esp in USA vets dentists etc
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There are some cool medical gadgets around at the moment. I’ve just bought and been using the new Electronic 3M Littmann Stethoscopes Digital Cardiology Stethoscope and its loads better than the old version and much easier to use. I’ve also been playing with a Welch Allyn Digital Macroview Otoscope which puts a video image on your PC which is really cool. Patients love being able to see their own ears and you can record images or video to save in the record if you want. I love my Alivecor 6L - for single or 6 lead ECGS (though the app is rubbish).
Have you used any cool gadgets recently that I should try? (I would love a really good ophthalmoscope but the ones I’ve tried so far haven’t been great).
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I was having a look at www.how2.training earlier - It is the not for profit free to use training platform for primary care IT that I helped setup with Howbeck Healthcare Limited“
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“To be frank even I was surprised at how much useful content we have on there! I remember watching the first video we did - check it out!”
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Just been having a look at my practice website stats, we are getting 200-300 unique viewers a day which is interesting. What is more so is they only tend to look at about 4 pages - hence why we have culled a lot of extra gubbins recently. What I hadn’t realised is 70% of our visitors are on mobile safari on an iOS device of some sort another significant number are on android mobile.
Of course our website does scale to mobile - but I tend to view it on a full wide screen. Is a lesson here to keep making sure it looks good on mobile?
Great progress with implementing PACO from Blinx Solutions at my surgery it can do so much it’s difficult to know where to start but the Self Book feature blows the socks off the main opposition.
Similarly we’ve just installed Gateway from Accenda and that does the things PACO doesn’t!
Great meeting with Dan Worman from Cinos about some next gen things they are hoping to do that hopefully Howbeck Healthcare Limited can get involved in and Mind blowing meeting with Chris Crockford about his drone adventures in Morecambe Bay flying blood samples around but some interesting conversations about new products on the horizon possibly including Mark Hashemi that Steve Roest from PocDoc might need to join in with!
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Very impressed with Gateway from Accenda which my practice and PCN are trialing.
Went to a LMC talk yesterday on the new Medical Examiners system that is coming in this April. They want a form filling in for each death by the Attending Doctor with information on it from the records to support the diagnosis. Of course they have created a paper form to fill in.
Well - Gateway has already automated it - they build the form automatically - including any associated data/attachments there pathway function asks all the relevant questions and then when complete it can send it over.
Should reduce the admin burden for this unfunded work.
A few years ago I went on a course at The Success Factory run by the amazing Graham Wilson - one of the many things I learnt was his 6Ps approach to projects. I’ve recently introduced this to my PCN management team as a way of framing all the projects we are working on. Highly recommend it and him!“
“Purpose”
“Principles”
“People”
“Process”
“Performance”
“Pride”
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This has been recommended to me: Im certainly going to buy it - maybe you should too? (Im not on any kickbacks/commission.) “
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“https://lnkd.in/ee6TxvuA
This last week has been crazy - loads of Docs off sick - an explosion of minor illness - so bad a local primary school sent an email to its parents saying on friday they had 84 children off sick a record for them! (most seemed to want an appointment with us)“
“Had a Quick Look on Edenbridge APEX and our Minor ailments activity is peaking and running at twice the rate it was over summer. At a time when we have a load of staff off - and demand for “normal” appointments is high partly because of the backlog from hospitals. This is really hard to deal with. Personally while ive always believed in the cradle to grave do everything for your population approach of general practice - I think its time the system delivered “Fuller Centres” mopping up this work and leaving us to do the chronic care. Expand OOH, expand walk in centres.. a lot of this is under 5s. we need more paediatric trained AHPs.. a lot in my experience say they wont deal with children.“
“(graph is count of consultations with any code related to minor ailment of a URTI/cold/flu like nature)
In a previous post I talked about general practice not doing “performance reviews” well enough. Not having enough time seemed to be the main obstacle. Many people thought being able to slow down reflect/ review what they were doing with a senior or peer would be really valuable.
Part of the problem is making the business case that investing the money/time would reap rewards in terms of productivity - perhaps we need a trial/pilot of this. I know HEE and or others have put money into careers coaching and mentoring but perhaps clinincal review could be an area worth testing.
A few years ago my local GP federation ran a project we called Peer2Peer referrals. Every practice uploaded in redacted form a proportion of its referrals. Some months it was X% of all - some months it was all Cardiology or all paediatrics. The referrer was anonymised. Each referral was reviewed by 2 reviewers who were experienced GPs but not GPSIs who has some training on feedback. The practice was encouraged to have meetings where the practices referrals comments were reviewed to stimulate learning.
The idea was partially to induce the Hawthorne effect. This whole process was along side the referral - we were clear it wasn’t a vetting or triage. The reviewers all met monthly to feed back to the project lead who collated key themes - often systemic issues and pathway design problems.
We think it worked well. Some GPs felt that it was just a way of getting people to think twice about referrals and hey it was! some felt that because we were grading the quality of the referral - it encouraged people to write more and more and there was no real benefit to the hospital for this extra info. However we were clear there was a line - satisfactory was fine.
What was interesting was some of the reviewers started giving loads of feedback - links to articles - suggesting alternatives - all in a nice way but perhaps providing a learning resource that was more useful that a consultant letter saying - referral rejected.
The reviewers were paid a small amount - but the work could be done evenings/weekends and we never had any issues getting it done. Which tends to make me think that there is a large workforce out there that might work extra is that extra work isnt just doing more of the same - endless surgeries.
How do we tap into this capacity? could we use it for quality improvement? education? would it help retain? motivate? and deliver productivity.