Bringing back or taking forward the ‘Family doctor’?

 GPFUQ #233 How can we bring back a modern version of the Family Doctor?

This short article suggests actions GPs can take to improve the performance of their practices through the experience of having and being the family doctor. This is not a quick solution for every problem or practice but is a choice of the path to the solutions.

https://bjgplife.com/bringing-back-or-taking-forward-the-family-doctor/

Why do we ignore important warnings?

 GPFUQ #232 Why do we ignore important warnings like the threat to Planetary Health?

Its complicated, but see this short article https://bjgplife.com/planetary-health-a-warning-from-your-future/

 

How to have better interactions with patients and staff

 

GPFUQ #230 How do you have better conversations with others?

Ask yourself (or them): Do you want to be heard, do you want to be helped or do you want to be hugged

GPFUQ #231 How can you make the most of yourself or your team with only limited talents?

Always be the best at everything that requires no special talents

Do GPs need to be kind?

GPFUQ #229 Do GPs need to be kind?

From 2024 the GMC's Good Medical Practice guidance requires doctors to be kind to patients and colleagues. 

“At the end of the day people won't remember what you said or did, they will remember how you made them feel.”  Maya Angelou. 

Kindness in a caring profession is important but difficult to judge. It is what a patient feels. We each have memories of past great kindness and daily experience of common unkindness. We value kindness. For thousands of years different traditions have advanced the same practical message about the basics of how to be kind. The principle of treating others as you want to be treated yourself is known as the Golden rule. This makes common kindness easy to self-judge. If we follow the rule, most of us can be kind to our patients and colleagues most of the time. Competent doctors must be able to cope with difficult problems. This includes choosing unpopular actions after sharing the decision-making process with well-informed patients. I may want a competent doctor more than a kind doctor but I really want a competent and kind doctor. The new GMC guidance to doctors be kind (as in the Golden rule) seems Good Medical Practice for the 21st century.   

Can we bring back or take forward the ‘Family doctor’?

 GPFUQ #228 How do we bring back or take forward the ‘Family doctor’?

In this opinion piece for BJGP Life https://bjgplife.com/bringing-back-or-taking-forward-the-family-doctor/

Sir Kier Starmer has said ‘For those who want real continuity of care – we (i.e., the next Labour Government) will bring back the family doctor, that’s what people with long-term conditions need. But for those who just want a quick appointment at their convenience, who want a digital consultation, we’ll give those patients a different route.’*

Political rhetoric is not a solution. The problems in the NHS are complex. ‘Just do it’ solutions are as helpful as, ‘The beatings will continue until morale improves.’ The Government, the NHS management and all those with responsibility for fixing the structural problems like funding, workforce and social care must provide practical solutions. These are not discussed here. Instead, this opinion piece suggests actions GPs can take to improve the performance of their practices through the experience of having and being the family doctor. This is not a quick solution for every problem or practice but is a choice of the path to the solutions.

General practices are different. All have problems but some are more dysfunctional than others. Within each practice doctors are different. Variations in the standards of care are inevitable, and are desirable when they improve care. No one wants low quality care that fails the patients, the staff and increases the burden on the rest of the NHS.

Bringing back the 20th century family doctor with better relational continuity (an ongoing interpersonal relationship between a patient and one or more practitioners) is not enough in the 21st century. Now we need better informational continuity (the use of past, recorded information to make current care appropriate for each individual), and better managerial continuity (a consistent and coherent approach to the management of health or illness). None of modern continuity and the support needed for better care will happen without changes.

What can be done? These are five low-cost steps to take forward a modern version of the family doctor.

1. Agree what you are trying to achieve. The new family doctor is the means to better performance through a better process of feedback and change. It is not the end in itself. Start with a formal business planning process. The standard of the care that you provide for your patients, the needs of your community, your staffs’ welfare, your income and expenses always need scrutiny. These help decide what you should change. For example, a high-quality practice may want to become a triple bottom line practice or set explicit standards for providing the basic ABCDEF of quality care: good Access to care, providing the Best treatments, Customer satisfaction, providing appropriate Depth of care, Efficient and effective and Fair care for all. Switching to personal lists could help improve these and the overall performance of the practice.

2. Find out what is known already about what you are trying to achieve. Personal patients lists have not been valued by the NHS and mostly fallen out of use. Research may give some evidence-based guidance and other practices may have already tackled similar problems and share their practical advice. Relational continuity can be measured and is a proxy for the doctor–patient relationship and the associated benefits that happen when patients and GPs have repeated consultations together over time. The advantages include knowing your own patients, better health outcomes, improved mortality rates and the satisfaction both of patients and GPs. Limiting your responsibility and work for the other patients who consult you but are not on your personal list is a major benefit. Personal lists simplify reviewing the performance of each GP.

3. Commit to what you can do with your limited resources.

You can start slowly the process to personalise your patient lists. Most clinical systems have the ability to set the usual GP for each patient. This means you know who are your personal patients and your patients can know who is their personal GP, and gives both patients and GPs rights and responsibilities in that relationship. This does not mean you only see these patients or these patients only see you. There are many ways to accommodate the needs of both patients, GPs and the practice. A buddy system of cross cover with another GP can allow them to look after your patients when you are not at work and vice versa.

You can set explicit practice standards and decide how you will monitor your performances. A barrier is that many of the measures of an individual GP’s working practice are never examined, so improvement is difficult. A practice can set its standards of care and measure how its doctors compare. Examples of standards for an individual GP’s performance include personal list continuity (e.g., see their own patients 60% of the time), timeliness (e.g., seeing patients within 15 minutes of their appointment time), Team building (e.g., regular attendance at the informal team building meetings like ‘lunch’), fulfilling management responsibilities (e.g., each GP writes a short report each year on each of their portfolio of practice responsibilities), forward availability (e.g., patients should be able to book an appointment with their own doctor within a set number of working days).

You can manage individual GP performances better. Many practices have regular staff appraisals but do not include their GPs. Annual NHS appraisal and GMC revalidation do not usually help manage the performance of a GP in a practice. Each GP could have an in-house appraisal each year with 360 Multisource feedback. It becomes possible to understand an individual’s performance better when each has a defined list of patients, and an agreed set of performance standards.
You can find what is already known about this and spread best practice faster if you join an effective learning network.

4. Define what success will look like? Decide how you will know if your improvements have been a success, or a failure.

5. Establish when and how will you review these changes. You should monitor practice standards and act early when any performance falters. There are many reasons why GPs may not be working as well as expected. All merit investigation. Whatever the reasons, a practice should detect a problem early and take appropriate action to resolve the problem. Discussing and understanding the barriers to providing and improving care usually helps everyone. Identifying and managing quickly any problems in a practice that undermine goodwill and trust is essential, so they are dealt with before they harm your organisation.

None of the above need extra funding or exhausting labour. They do require commitment to change and taking forward the 21st century family doctor.

Reference*

Keir Starmer unveils Labour’s mission to create an NHS fit for the future, May 22nd 2023, https://labour.org.uk/press/keir-starmer-unveils-labours-mission-to-create-an-nhs-fit-for-the-future/ (accessed 21/6/22)

What wisdom do you wish you had known earlier?

 GPFUQ #227 What wisdom do you wish you had known earlier?

In this book review for BJGP Life https://bjgplife.com/books-excellent-advice-for-living-wisdom-i-wish-id-known-earlier/

‘Collecting things benefits you only if you share it in joy with others. The opposite of this is hoarding.’

Kevin Kelly collects sage advice. These short observations contain insights from generations of lived lives. Those that stand the test of time survive as aphorisms, proverbs, maxims, adages, truisms, saws, sayings, epigrams, axioms, bromides, reflections, pearls of wisdom, and the like. Kelly edits them and adds some personal observations. His 21st century description is that they are like wisdom tweets.

‘The best way to learn anything is to try to teach what you know.’

“You can share some of your own wisdom tweets and pass them onto the next generation by adding them to the comment section after this piece.”

On his sixty-eighth birthday he gave his children 68 of these wisdoms tweets. They asked for more. He kept collecting and has published these 450 excellent bits of advice that he wished he had known when he was younger. If we find them useful then he suggests we share them with someone younger than ourselves. They cover all areas of life. Here are a sample:

• ‘Five years from now you will wish you had started today.’
• ‘Don’t worry how or where you begin. As long as you keep moving, your success will arrive far from where you start.’
• ‘You are never too young to wonder “Why am I still doing this?” You need to have an excellent answer.’
• ‘If you are not embarrassed by your past self, you have probably not grown up yet.’
• ‘A proper apology consists of conveying the 3 Rs: regret (genuine empathy with the other), responsibility (not blaming someone else), and remedy (your willingness to fix it).’
• ‘If you are the smartest person in the room, you are in the wrong room. Hang out with, and learn from people smarter than yourself.’
• ‘In all things — except love — start with the exit strategy. Prepare for the ending. Almost anything is easier to get into than out of.’
• ‘The greatest teacher is called “doing”.’
• ‘Half the skill of being educated is learning what you can ignore.’
• ‘In 100 years, a lot of what we take to be true now will be proved to be wrong. A good question to ask yourself today is “What might I be wrong about?”
• ‘Don’t reserve your kindest praise for a person until their eulogy. Tell them while they are alive when it makes a difference to them. Write it in a letter they can keep.’
• ‘Be a good ancestor. Do something a future generation will thank you for.’
• ‘Advice like these are not laws. They are like hats. If one doesn’t fit, try another.’

You can share some of your own wisdom tweets and pass them onto the next generation by adding them to the comment section after this piece.

For example:

• It does not matter how long it takes. The important thing is to start.
• You may not remember what someone says but you will always remember how they made you feel.
• Life starts again when the dog dies and the children leave home.

Featured book: Kevin Kelly, Excellent Advice for Living: Wisdom I Wish I’d Known Earlier, Bantam Press, 2023, HB, 224pp, £20.29, 978-0593654521.

How to plan a research project in general practice

 GPFUQ #226 How to plan a research project?

If you are planning any project then ask yourself

1.     What are you trying to achieve?

2.     What is already known about this subject?

3.     What can you actually do with your limited time & resources?

4.     What will success look like?

5.     How and when will you review your project plan?

 

If you are planning a research project then try to write a summary first. A ten sentence structured abstract of the completed project before you start. It's not easy but its worth doing. 

The content of each of the ten sentences is: 

 

1. What is the practical problem

2. What is the theoretical problem

The theory is an explanation +/- prediction and leads to one testable hypothesis.

The hypothesis is a set of propositions which explains or tests the theory

Each proposition has 3 concepts, each concept must be variable, and each variable must have indicator which is measurable

 

Methods

5.

6.

 

Analysis

7.

8.

 

Findings

9.What are the practical implications

10. What are the theoretical implications