Doing what, officially, cannot be done

A couple of things this week have given us great joy at Dot Community Health, and I make no apology for talking about them because we need to turn around the prevailing wind of moans.

The first was talking to Rupert Bankart about his practice in Peterborough.  For all the reasons which bedevil general practice at present (demand, recruitment, contracts etc) life has not been at all easy.  But he told me how in the last month he has become so much more productive, financially better off too, as he has switched his patients to seeking help online.

I really can’t do better than invite you to listen to the interview.

Dr Rupert Bankart talks about askmyGP.

The second was experiencing (remotely I’m afraid) a Somerset practice launching their GP telephone led service.  No one would claim it’s all settled after one week, but it was promising to find the GPs had gone home an hour early on day one, all work done.  Steve Edgar told me on Friday how much their safety and quality had improved, giving appropriate time to each patient.  One had a cyst removed, the whole episode start to finish completed in 45 minutes.  Of course, it costs far less like that than the palaver of arranging multiple appointments over several weeks, and the patient is delighted.

Ironic then to see the BJGP publish a rehash of the Lancet August 2024 ESTEEM data, “proving” that telephone consulting doesn’t save time.  Tedious to have to go over it again:  the point is that this did not test systems, but a technique in isolation.  The resolve rate achieved was 25%, by GPs in 13 practices who were paid extra to do the telephone sessions.

We, along with others, and right back to the pioneers 16 years ago, have shown that 60 - 70% can be resolved remotely.  One GP friend told me last week she was measuring 72% resolution now, consistently.  These simple facts completely upend the findings of a four year, £2m RCT.

I’m reminded of G B Shaw’s saying, “People who say it cannot be done should not interrupt those who are doing it.”

Best regards,

Dr Sara Cowell

PS Anything I write on this, the BJGP will say I have an interest.  Indeed, an interest in what works, declared with pride.  But I know many of you already run super efficient GP telephone led systems and would never turn back.  Could you please drop me a line and we’ll find someone to co-ordinate a response?  Do hurry, they will want it for the April issue.

One response to “Doing what, officially, cannot be done”

  1. Dr Sara Cowell says:

    From Dr Simon Coupe:
    Back in 2002 we were struggling with access and demand, life was becoming stressful for patients, reception staff and GPs. I decided something had to change. After considerable deliberation I decided to telephone this patients who had booked an appointment. I was amazed to find that after telephoning these patients I reduced the face to face appointments by 30 %. The others were further divided into 2 groups- telephone advice and an appointment with another health professional- nurse or HCA. The Stour Access System was borne.
    Since the early days for us we have seen a steady reduction in the conversion rate.I’ve not measured the conversion rate recently but expect it to be over 50%. Initially some patients were sceptical and some objected to being telephoned before being given an appointment. It took a few months for patients to get used to telephone triage.
    We soon however saw an improvement in satisfaction rates and as the system bedded in we soon realised that we could never go back to the old system. It has reduced the stress, reception staff no longer have to triage patients themselves trying to make the call as to how urgent the request is.
    The system allowed us to concentrate our resources on cases that actually need us and we for the first time started to manage demand and our day.
    We have seen an increase in telephone demand as patients reduce their threshold for calling. The system does not save us time as has been reported. It does however make us far more efficient, enabling us to manage higher patient lists than average. We are able to offer same day / next day appointments and maintain high continuity rates for patients seeing their own GP.
    The system has been a win win for patients , staff and GPs.
    Our model of care also includes a walk in nurse run open surgery every morning. This takes out many self limiting conditions which would otherwise just be added to GP telephone lists. This whole system approach has transformed the way we deliver care and the 2 -3 week wait to see a named GP is certainly a thing of the past.
    I have no financial interest in this system, indeed have not generated any income from the Stour Access System bar a couple of lecture fees several years ago.

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