Northern Ireland GPs show us how

Unusual, but I was rendered pretty nearly speechless this week when a blog appeared on the BMA Northern Ireland Community page.

They lead with an outcome which is vital for patients.

They present the context, tougher in NI than other parts of the UK because of fewer GPs per patient.

They talk about method, rather than lengthy, complicated and evidence-free jiggling with structure as we saw from NHS England last week.

They end with an outcome which is vital for GPs, easing workload.

Struggling back onto my perch, I have nothing to add but will quote this unknown Irish patient, a female of 47 with a sore nose.  It’s typical of much feedback we receive, showing that when we stop thinking of patients as the hordes to be diverted at all costs, we find they actually want to help ease the workload:

“Great service. I have had a call back from the GP almost immediately and saved my own time and taking up an appointment slot.”

The link again:  BMA Northern Ireland GPs show us how.

Happy weekend and slàinte.

Harry Longman

4 responses to “Northern Ireland GPs show us how”

  1. mark goodwin says:

    there is no doubt some patients ( maybe many) can be dealt with this way. But at the risk of new systems that make it harder for many to being seen. They accept a well meaning call back when really they want a face to face but dont feel able to demand this, new barriers to effective compassionate care, eagerness to reduce face to face consults, undermining the GP’s pivotal role, removing the eyeball to eyeball contact that tells us so much more that a phone. what about opportunistic care being missed and long term dr patient rapport sinking. Why text when you can chat, why chat when you can see, There is a danger of taking things too far the other way. Yes improve efficiency but not at all costs. The time to ring back negates efficiencies unles you are Gps short.

  2. Harry Longman says:

    We are concerned with the safety, quality and efficiency of general practice as a whole. The patient may always say “Doctor I really need to see you” and they should agree to that. The point is to give appropriate attention to each patient, and it’s striking how GPs tell us that the system overall is safer. That is not to do simply with the technology of telephone or online, but because it saves time overall, GPs have the freedom to see patients they need to for as long as they need to.
    The biggest danger is having no GP help available for a needy patient, because the GPs are busy seeing the wrong ones. For GPs, the biggest danger is burnout from overwork, when much of the work is unnecessary. So it’s about the system, and making it flexible for all the infinite variety of patient demands.

  3. Allen Wenner says:

    It is worth noting that BMA Northern Ireland is supporting a disruptive technology. AskMyGP’s informed triage certainly alters the GP workflow. GP business as usual is, “Patient calls, comes, and waits.” The patient is seen on the doctor’s schedule. The unsaid message is, “maybe your illness will go away before we have to see you.” This is a provider-centric health care. The doctor is the center of everything.

    The radical change of AskMyGP is to make the patient’s needs first. The patient contacts the office and something happens quickly. Either the patient gets an e-mail with a plan of treatment with medication prescribed, or is telephoned by the medical staff about how the problem can be solved. This is patient-centric health care. All the patients are cared for on the day they are sick.

    The differences in the workflow are subtle, but explain the dramatic success being realized in Northern Ireland. In the doctor-centric workflow, the doctor does everything (determines the complaint, asks appropriate questions, decides on a diagnosis, plans the treatment and finally explains the problem to the patient). Medical diagnosis and treatment is a lot of work for the doctor. S/he dutifully repeats all the steps over and over again with every patient every day exactly as taught in medical training. This is tiring and exhausting work.

    In the patient-centric AskMyGP workflow, the patient does some of the work and relieves the doctor. Since the patient wants to help get well, s/he gladly enters the history of the present illness into the computer, to a staff member, or the doctor. Through a series of branching questions that mimic what a doctor might ask a patient with a specific complaint, information is gathered and then synthesized into a report that looks like a medical record. That’s actually 70% of the work if you count the words in a medical record that are patient generated. Sir William Osler said if you talk to the patient long enough, s/he will tell you what’s wrong…and software can do that. In this new workflow the GP has only to read the summary and make a simple determination:

    • Does this patient need to come to my surgery today because a delay could place this patient at risk of getting worse?
    • Can I do something to safely affect clinical improvement using non-visit care and re-evaluate this patient in a day or two?

    So why would an organization like BMA Northern Ireland be a leader in encouraging disruptive technology in health care? Northern Ireland is far from the central hub of traditional medicine in SE UK where ideas have always originated. Obviously, not much centralized attention has been given to the abysmal one doctor per 1700 patient ratio when it comes to providing service. Northern Ireland is a self-contained community isolated from external pressures to conform. Northern Ireland is free to think about how to solve its problem of GP access. They are not impeded by those who benefit from the status-quo of provider-centric health care.

    Disruptive technology often begins in such areas that have been abandoned by the establishment. It would appear that patient empowerment is taking off in Northern Ireland.

  4. mark goodwin says:

    I like the reply..maybe i can be convinced, just not so sure of the triage processes I hear from disgruntled nearbye practice patients ( some of them unwell) . I suppose I am a rare breed where mostly Dr centric but same day appointments with avrage 12 consults per surgery and still enjoying General Practice. Rural dispensing small weighted list of 3700 for 2 Gp’s Wales

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