Dr Peter Cairns contrasts operating models

Dr Peter Cairns

Lead GP at Wester Hailes Medical Centre, a “Deep End” practice in Edinburgh, Dr Cairns has run the Dot Community Health model since July 2012. He writes:

“We innovate partly because we have no choice. GP Access would work very well for both staff and patients in an area where there is no fundamental access problem, indeed there is plenty of evidence in England of it working well in the leafy suburbs to the point where these practices have been able to reduce their GP outlay…

Some of the opposition to Dot Community Health systems is irrational – perhaps driven by a workforce who are saturated with unnecessary work – who are therefore unable to take a balanced view of the pros and cons.

I am always scratching my head when traditionally minded GPs ask me to ‘justify’ our system. Bearing in mind where I work, it looks something like this:

Traditional model
Dot Community Health model
Main offering10 min appt, in person, no matter what problem is…Timely GP callback, quick chat, arrange further appropriate care as needed.
ConvenienceTime off work no matter what is neededCan chat to you at time/place of your convenience
AvailabilityAppointments gone by 8.30, appoitments clogged up for weeks in advance.Worst case scenario: appointments available until early afternoon; no clogging up of system.
Unmet demandHigh level unmet demand, excluded from systemLow level unmet demand, excluded from system
Effect on OOHOver-uses OOH services‘Under-uses’ OOH services
ContinuityPoor continuityBetter continuity
Provision of careNo idea of patient need until they are in the roomGood idea of patient need before I speak to/or see them

The last one is such a no-brainer I felt the need to put it in italics. I cannot imagine going back to the days when most of the time I had little idea of what most people were wanting from me, until they asked for it – seems crazy in retrospect…! Even practices who run a lot of telephone consulting, may not necessarily be taking the information from the patients in advance.

Why it is still seen as acceptable, let alone ‘traditional’,  for some practices to exclude 30-40% of their patients on a daily basis, with no understanding of the problems they are not seeing, and putting a good 1/3 of that unmet need onto the OOH service?!

I don’t think Dot Community Health is perfect – far from it – nor is it a panacea for health inequalities or lack of clinical and political leadership to make sense of a primary care system that will probably collapse in parts of the country in the next 3-7 years – but its certainly a more efficient and sensible way to start engaging with a patient population.”

Wester Hailes Healthy Living Centre opened August 2013

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