Seeing red

Is red tape taking over general practice?

I HAPPENED to read recently that GPs face “death by data collection”, with 24 per cent saying they now spend more than half their time dealing with paperwork1. Reflecting on a typical day for me in primary care, I could not help but ponder on this statistic and how it applies to me and my colleagues.

We all know how challenging general practice can be from surgeries, telephone consultations, house-calls and dealing with that dreaded paperwork. The advent of electronic document management software like Docman was a revolutionary development in general practice and meant, for the first time, all patient paperwork could be held centrally and accessed easily by the GP. I am always apprehensive every morning when I arrive into my surgery and log onto Docman. I know the postman will have been and I expect to have between 40 and 60 items waiting for me each day. I wonder how I am going to have the time to perform all my other duties along with dealing with this vast amount of paperwork. I tend to quickly scan through the items to check for anything urgent that has to be dealt with before morning surgery. During the course of the morning, however, the pending items on Docman are constantly at the back of my mind and are difficult to get away from.

After clinic I take the bull by the horns and with a sigh I wade my way through this endless paperwork. I come across results and discharge letters from patients who I have never seen before. Even though they may not require any further action I still have to open the patient’s clinical records to ensure I don’t miss anything. This can take two to three minutes at a time and before you know it an hour has passed. I’m sure this is not an unfamiliar situation for most GPs nowadays.

Although most paperwork is benign and does not require any further action there are some results that must be acted on immediately. I feel my heart racing when I see abnormal results such as elevated potassium or low haemoglobin levels. I deliberate on the best course of action before trying to contact the patient, often ending up exasperated when they prove untraceable. With the urgency that goes hand-in-hand with these abnormal results, there have been times where I have had to drive to a patient’s home to notify them of these results and advise they go directly to hospital.

Hospital discharges are another source of red tape and often generate endless pieces of paper that can be totally irrelevant and difficult to interpret. When these land on my desk I do wonder how accurate they are. With patients living longer with multiple morbidities and taking significant amounts of medication it can all be bamboozling at times and make you just want to pull your hair out. (What little I have left!)

When I manage to grab lunch I use the time to trawl my email and wade through all the circulars and latest guidance issued by PCTs, NICE and SIGN along with replies from consultants who I’ve emailed directly with questions about particular patients. I also get information regarding the updates for QOF along with the generalised running of the surgery from the practice manager. Trying to comprehend all this information at times can lead to “mind-block”. This is when I know I’ve had enough and leave to take a walk around my local park to clear my head for the oncoming afternoon.

Most of you would agree that we are all staying longer at the practice as it’s less easy to take work home because of the need to access clinical records or NHS email accounts. This can lead to a poor work-life balance with weekends often spent on administrative work.

And when it comes to QOF, many GPs say they complete multiple forms that are irrelevant to patient care. One told GP magazine: “I’m spending too much time on paperwork. I’m trained to treat patients, not tick boxes. We are all suffering death by data collection of dubious validity.” Does this sound familiar?

With an ageing population with multiple morbidities, the considerable CQC requirements and other similar demands I suspect that paperwork will only increase and become more complicated. Time management is a must and it is important to delegate tasks but trying to determine what issues can wait and be dealt with routinely and those that require urgent attention can be difficult.

I think we all need to address the issue of workload and try to reduce unnecessary bureaucracy, but achieving that is no easy task. In November 2012, the government launched its Health Red Tape Challenge, seeking ideas on how to reduce the burden of bureaucracy across the health service. The results of this exercise are expected to lead to the scrapping of thousands of government regulations and we can only hope this will ease the pressure on us GPs.

Dr Peter Livingstone is editor of GPST and a GP with a special interest in diabetes

1 Quarter of GPs spend half their time on paper work. GP survey, 24th January 2012 www.bit.ly/14kOOxe  

 

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