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Saturday 26 May 2018
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How your practice can save £15K and 260 hours of GP time by better use of a practice nurse

This case study offers insights on how a practice managed to reduce pressures on GPs through the PGP programme

NHS England, has found that your practice could save £15,000 by choosing to employ a nurse practitioner instead of a GP and free up to 260 hours of GPs’ time by simply making better use of clinical nurses. 

Linda Marquis is the practice managing partner at Mundesley Medical Centre in Mundesley, Norwich. Thanks to the Productive General Practice (PGP) Quick Start programme, she has successfully implemented a new scheme that frees up GPs’ time by shifting their tasks to clinical nurses. 

Management in Practice's reporter Valeria Fiore reveals how she has done it

Our objective

We tried to recruit another GP. We advertised for the position but we didn’t get any response, probably because of our remote location. We actually had somebody we knew of, who came to our practice and liked it, but we were too far out of Norwich for this person.   

What we did 

When our CCG offered the PGP programme to us, we analysed it and found we could take advantage of one module in particular, the ‘appropriate appointments module’. We didn’t join the programme specifically to solve our recruitment issue, but we found that the appointment module within the programme fitted nicely with our problem.

How the programme has helped us

The Productive General Practice (PGP) Quick Start programme gave us the time to think about our solution. The programme provides practices with 10 different work streams you can choose from.

Among these, we chose the ‘appropriate appointment module', through which we did an avoidable appointment audit that made us realise that a lot of stuff could be dealt with by the nurses. Our plan is that, providing that we can recruit a practice nurse, we’ll increase our nursing team so our current two senior nurse practitioners can move away from seeing long-term conditions and start dealing with more generalised conditions. 

How we implemented the solution

During the two weeks of trial, every time a clinician saw a patient they would register whether that was appropriate and if they thought someone else could have dealt with it. It turned out that, according to the data we collected, 30% of GP appointments could have been dealt with by another clinician.

One of the things that doctors raised as putting a lot of pressure on them was receiving a lot of messages from reception staff to deal with. For two weeks, we had our nurses to deal with these messages. They were able to deal with most things and if they could not, they would simply pass it onto a GP.

It freed up time for doctors to be able to concentrate on visits, paperwork, patients and it has taken the pressure off our GPs. After a two-week trial in October or November, we have successfully implemented the new scheme from 1 January.

Although we have only just started it properly now, we are looking at doing a periodic audit of the tasks that are sent to nurses to make sure what they deal with is appropriate.

The benefits

This system brings benefits to the practice in general. We have timetabled the nurses’ day, so they respond much quicker to messages; GPs get more time to focus on the most complex patients. So far, it’s going really well.

The challenges we’ve faced with the GP programme

The greatest challenge was to commit the time and the resources to the GP Programme, because a senior manager, one of our receptionists, one of our GPs and I had to attend regular meetings with a ‘facilitator’, someone from the programme that comes to the practice to help you with the modules.

We had to make sure everyone on the team aware of what was going on. We had to train our receptionists on the new scheme, because they had the habit to send every message to GPs before. Now, when they speak to a patient, there are trained to say ‘we will send a message to the duty clinician’ instead of the doctor.

Practice manager perspective 

I would probably recommend this scheme to a colleague.

Although it’s not fully implemented yet and it very much depends on recruitment of a practice nurse, the admin side of it, the tasks, and the on-the-day stuff that goes to nurses is great, the doctors love it. We wouldn’t go back to our previous system. 

Linda Marquis is the practice managing partner at Mundesley Medical Centre in Mundesley, Norwich.