Prediction and Plausibility

The tints of autumn are no less uplifting for not being a complete surprise this October.  Even less “surprising” but much rarer was the lunar eclipse last Monday morning, a glowing orange moon at 03.47am, and yes, reader, I was there, awed.

The level of precision and maths required differ, but these are predictable events in the natural world.  In management, prediction is the science which gives the greatest opportunity to create value for money.

Plausibility is quite different.  All it takes is the Prime Minister’s notion that patients might want to see a GP at the weekend.  I was at two events last week where speakers described their experiences of 7 day GP services, ie weekend shifts.  Some are proud to have their “utilisation” up to 50% (ie half the slots are empty), others haven’t managed this much yet but are advertising heavily to persuade patients to come.

These are the same patients who struggle daily at 8am or wait weeks to see their own GP, and the same GPs who complain they are drowning in workload.

But in these schemes GPs are paid at twice the average rate to see half the volume of patients.  Pulse reports that nearly half of them have cut hours due to lack of demand.  Never mind the positive patient feedback, no sane, disinterested observer could call this a success.

It would be churlish of me to point to the lack of evidence for 7 day opening, which I highlighted two years ago.  It would be silly of me to suggest that stuffing £10 notes down drain holes would be a less bureaucratic way to get rid of the money.  Churlish and silly me.

We take the science of understanding and predicting demand very seriously, and for that reason it’s the top theme in our poster presented at last week’s RCGP conference.  It shows that when patients can seek help from their own GP 24/7, online, the pattern is very close both to the days and hours they are normally open.  Aha.

Based on evidence, now easier than ever to collect with online access, demand is predictable by week, by day, even by hour.  Good for patients, good for GPs, and good for taxpayers.

And the rugby?  I confidently predict  that someone will win.

Dr Sara Cowell

Founder, Chief Executive
Dot Community Health Ltd

Comment on this blog

PS Next week, our second poster at RCGP with more on the clinical benefits of online history taking.

2 responses to “Prediction and Plausibility”

  1. Avril Glencross says:

    How will this affect recruitment and retention?
    How many more will retire early?
    How much will it cost to keep premises open and pay all the other staff?

  2. Allen Wenner says:

    The Prime Minister is correct to imply illness is not correlated to GP operating hours. Perhaps there is another way to consider 7 day GP services using technology.

    Suppose the GP surgery were open 9:00-12:00 on Saturday morning. Could care be rendered until 9AM Monday using virtual non-visit care approaches? If doctors relaxing at home could work for 20 minutes every few hours when they were not sleeping, would it improve physician satisfaction and be financially rewarding at the same time?

    Could we assume that after regular surgery hours patients will seek care for acute symptoms rather than chronic disease follow up? Suppose an intelligent interview of symptoms much like a clinician would gather were completed on-line by the patient at home. Suppose serious “alarm” conditions were flagged and the patient advised to seek emergency services. Suppose the output were in a format that looked like a medical record. Could the clinician review these patient-generated “medical records” in 5 minutes asynchronously at his/her convenience at home and make a disposition?

    How many patients are diagnosed by history? How many patients with acute symptoms really require a clinical examination? Could a detailed history of the present illness including absence of fever, absence of purulent sputum, absence of dyspnea even in the presence of mild wheezing and pleuritic chest pain give a clinician enough confidence the 24 year old non-tobacco smoker with cough for 5 days had viral bronchitis rather than life-threatening bacterial pneumonia? Could an experienced clinician treat almost any non-emergency symptom for 24-36 hours until the patient could come in at 9:00 Monday morning? Does the evidence suggest 87% of the time that patient could be treated without going to the office at all?

    Could 13% of all GP patients seeking weekend care be seen Monday morning?

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