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Eradicating the Knowledge Gap in Primary Care

October 19, 2017

Most people know the feeling, furtively typing into some search engine when you just don’t feel right. The hope that scepticism will kick in when the results give them symptoms aligning with that of some serious condition. You roll your eyes when you read another tabloid article about ‘milk gives you cancer’ or similar, but you get this clawing feeling that this time the site you’re reading might just be correct. Who you gonna call?


A GP becomes not just a friendly face, well in many cases someone you’ve never even met before, but the gateway between you and the unknown. In most cases the unknown is actually very well known, such as hay-fever, over work, your neighbour’s flu-ey children… However GPs across the country every minute make decisions which could change people’s lives. Such as a referral for a rare condition, or simply giving the peace of mind that all is required is more rest. At the end of the day, that is what GPs want to be doing, and what Rorytech wants to support them to do. However this is sadly only part of the picture in the daily load of a GP.


Rorytech conducted a series of interviews with GPs and healthcare professionals within Primary Care to understand what other activities and inefficiencies there were preventing them for being able to give their full energy to diagnosis. As Rorytech works within digital healthcare, GPs were also asked to reflect, where possible, how technology could improve these processes, or were currently hindering them. Interestingly though respondents did not need prompting when it came to incorporating digital innovation into their answers, it lay at the heart of what they felt needed critical improvement.The results present a unique picture of the balance of care at a primary level in the NHS.


GPs were initially asked what the most obvious inefficiencies they saw on a day to day basis were. The majority of GPs felt that the major blockage was relying on patients to provide them with information from secondary care facilities. Most people when they go to hospital are anxious and have little medical knowledge about the subject the doctor is talking to them about. Yet when they go back to their GP suddenly retaining and processing this becomes crucial, almost an exam. Many GPs stated that patients aren’t able to say accurately what was said to them at the hospital. Yet this could be simply solved if referral letters were shared between doctors at surgery and doctors at hospital. This involves ensuring systems are able to share data which already exists and is secure, in an efficient way. It would give confidence to both patient and GP.


Though some GPs stated worries about having too much information, all the GPs interviewed said that more information about a patient's condition would significantly assist  them. The practical question then arises about how this could be managed more efficiently before consultation. GPs again talked about better coordination between the different areas of care provision in the NHS. Triage before the consultation regarding what the main presenting complaint was would make it easier at consultation to prioritise issues or refer some of them to another appointment. The underlying factor is electronic access to medical records. Though there are multiple systems in place GPs feel they often do not cater for their needs when diagnosing. Many said current systems are not intuitive nor is their use supported by training. Crucial information can get lost in a series of pop-up boxes, and results in the doctor going back to square one, asking the patient what another doctor said to them.


This is not to say patients are ill-informed. Many GPs praised the level of engagement and knowledge of patients in managing their own care. However some raised the issue of patients increasing their own anxiety levels due to trying to self-diagnose off internet sites, leading to concerns that they have a major illness. Patient engagement by GPs was seen as important not in trying to understand their symptoms, but how to get their symptoms diagnosed appropriately. GPs welcomed patients who understood where to access care, for example an increasing numbers of patients who know they can access social work care through self referral. Though more knowledge of the self referral facility to physiotherapy or mental health would be welcomed, this level of engagement would greatly assist GPs. It was raised as a worry by GPs, that patients defer more and more to them, but overall they felt that greater patient awareness and accessibility of what care is available to them would mean greater load balancing of the system and more targeted care. The nurses and healthcare assistants at GP surgeries are often an underused and highly valuable resource.


That brings the question then of whether GPs feel that patients are appropriately accessing appointments. GPs felt that a lot of patients came to appointments for minor ailments that aren’t necessary to consult a GP about. In such instances patients could be better directed to say a nurse or perhaps a receptionist, to outline how to obtain their repeat routine prescriptions without having to book GP appointments. GPs further advocated a greater role for Advanced Nurse Practitioners to see and treat less concerning conditions and for them to be able to triage appointments/house calls. This though suggests a great amount of agency for the patient, to know where to go when they have certain symptoms, which is often not clear. This is because often the issue lies not with the patient understanding who to see but because of the appointment system itself not being correctly calibrated to need. GPs interviewed said that increasingly emergency appointments are being accessed for long term illnesses because of chronic shortage of routine appointments. Should the appointment booking system used within the NHS be more fit for purpose, it would be able to direct patients to the most appropriate care provider, as well as simply being electronic forms. Unfortunately the lack of more intuitive systems is the excessive workload GPs face.


This invites the question: how could such a system arise, especially when it is something GPs have been acutely aware of for a long time. In essence what are the main causes of excessive workload. GPs provided numerous answers, the most frequent being:

  • Primary Care Contract -increased health surveillance meaning many more tests requiring our input/action - computer workflow is at times overwhelming

  • Requests for supporting medical letters from non NHS sources -from housing letters to health club applications and many other variations

  • Inappropriate demand of appointments

  • Not having updated information conditions, particularly after hospital discharge

  • Lack of information flow between GP systems and hospital systems

  • Doubling up time for appointment between house calls and data held at the GP surgery

  • Having to categorise information that comes back to practice. A lot of admin and supervision


The final question, though it’s answer is already clear from the responses to the other questions, that was posed to the GPs was: what could be done to improve the system. There were two clear responses. GPs want pathways to deal with different kinds of patients more efficiently and to joined up existing knowledge between results, especially at secondary care level, and current medications.


It seems that the heart of the matter is better IT. Legacy systems that GPs use have been contributing to problems at a patient level. In order to deliver the two key outcomes GPs want, the most effective and efficient solution appears to be to implement a digital infrastructure system above the current operating ones. This does not mean wholesale renewal and replacement, which could cause massive disruption in care, but a system which uses data already held in existing systems. Thus linking up GPs with pre-existing health records and load balancing, to ensure that GPs see patients who need to see GPs. It’s a win-win. The platform Rorytech is developing will allow patients to use an app to book an appointment with the most appropriate correct healthcare professional, who has access to their complete set of medical records.  If patients are happy to use to the internet to self-diagnose, then Rorytech hopes that they’ll also use it to get the right diagnosis.


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