Thursday, 16 July 2015

A plan comes together

Don't you love it when you can deliver healthcare with an efficiency and quality even the 'A' Team would struggle to match?

My patient booked an appointment on line to see me about their thumb. He/she put in the free text 'I think I need an injection. :-( '
This text appeared on my screen under their appointment booking so I had the needles / steroid ready on arrival. Yes -  typical osteoarthritis of the 1st carpo-metacarpal joint. I did the injection clean into what can be a small joint to get into. My patient went away happy and left me with the feeling of a job well done.

Appointment on-line booking time by patient three minutes.
Consultation time eight minutes.
Reception time 0.
Admin time 0.
Medical record coding time 0 (part of my 8 minutes)
Invoice processing time 0.
Insurance assessment time 0.
Patient wait 0 (first appointment of session)
Time to claim minor operation fee 0 (integrated into our EPR)

I challenge you to find another healthcare system within Pluto's orbit that could come anywhere close to diagnosing and treating this condition from a standing start in 11 minutes total. Compared to the NHS most other systems would still be in the blocks by the time we'd finished the race and completed our third lap of honour.
Private medicine? You are having a laugh - 15 minutes to complete the first tranche of bloody paperwork!

So how do we do it?
No denying it, the technology is great and primary care IT like this is world class.

But here is a formula to note
Technology + Continuity = Quality + Efficiency

This could not have worked without continuity.

I had previously injected this patient's plantar fasciitis about 7 years ago and it worked a treat. So they knew I did injections and so knew to book with me.  They also knew my injections were 'ok' - reading on NHS Choices that someone else thinks you inject ok is not the same as knowing it (almost literally!) in your bones. It means patient anxiety pre-injection is minimal and I can get on with the procedure quickly without lots of explanation, consent forms, reassurance or medico-legal worry. All this makes the procedure itself less painful by eliminating nocebo effects.

An APMS contract (NB NHS England) could not have delivered this as with 5 year contracts it's highly unlikely the same doctor would still be around. This is only possible under GMS or PMS which NHSE very, very stupidly is not actively newly commissioning.

Technology alone could not have delivered this because technology cannot manufacture the trust that comes from long term personal care.

So Mr Hunt if you have a 25 year vision, make long term personal continuity part of the plan and stop wrecking GMS/PMS!

Stop blathering on about technology - I've been using computers in General Practice since 1989. I got it 26 years ago! We all get it in GP land, that's why we lead the planet.

You can have it all but only if you get and promote continuity of personal care...

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