Pronto

Primary Care Training I Dunno

I'm trying to remember the phrase.  Something about what counts gets counted?  What gets measured gets done.  You can't manage what you can't measure.  I forget exactly what it is, anyway, it makes no sense.

What makes more sense, in the NHS at least, is don't measure what you don't want to change.

There are some numbers emerging that will make painful reading, others that we make no attempt to collect because they are too painful to read.  Put the two together and they add up to a acute problem.

The first set of numbers...

They relate to the success of Babylon; the talk-to-a-doctor on yer mobile, App.  In the two weeks, following launch, something like 8,000 people signed up.  Last week Pulse reported a new patient signed up every two minutes! There is a potential that millions might.

You ain't gonna stop this.  Especially if you really believe in patient choice and all the rest of the palaver we so often pay lip-serve to!

Because of the way it works, Babylon numbers are a disaster for general practice.  

To get the benefit of the any-time, anywhere App you have to leave your present practice and sign up with the London practice offering the service.  The reality of that; every time it happens the legacy practice loses about £147 in funding.

Transfer of patients, on the Babylon scale, is biblical and means practices in the home counties and commuter-belts, where the majority of Babylon demand is coming from, will find their finances hollowed out.  

They will be left with the older, more complex patients and lose the fitter, generally healthier patients who consume less practice time and attention.

When patients move, the money moves with them because GP income is predicated on bricks and mortar. 

We pay GPs as static providers.  Technology is redefining the concept of place-based-care; servicing a geographic population where the demographics and the foot-fall tell us huge chunks of it need mobile solutions.

The second set of  numbers is even scarier.  They are frightening because no on seems to have them.

We all know the pressure on GP appointments.  Time and again we hear stories of people hanging on the phone between 0823 and 0827 hoping to get lucky for an appointment in the next fortnight.  

There's a huge focus on improving GP access.  Extended hours, bungs and beatings to do more, manage demand better.

Are we doing the right thing?  Are we cracking the problem?  Is it getting worse or better?  The truthful answer is; we haven't got a clue.  

We have anecdote and gut-feel to go on.  Management by anecdote is usually persuasively wrong and management by gut-feel... you need plenty of guts to do that.

We don't know how many GP appointments there are, available, on any one day.  There is no central record.  We have no idea of capacity, demand, distribution, nothing.  In consequence we can't flex, redirect, invest in the hot-spots or learn from who is coping best.

Technically it is probably possible to extract numbers from GP practice software, probably in real time.  But we don't.  Why?  Dunno...

There are about 8,500 GP practices.  If, averagely, they employ, say, 5 GPs that might be about 42,500 doctors.  If docs see, on average, 35 people a day, I make that, on the back of a fag packet, just under one and a half million appointments and day might be available?

  • Is that right?  I dunno.  
  • Is that enough?  I dunno.  
  • Do they all have to see the GP?  I dunno.  
  • Could they be sorted out on the phone or FaceTime?  I dunno.  
  • Could the demand be spread over long opening?  I dunno.  
  • Have we got enough GPs?  I dunno.  
  • Do we need more nurses and less doctors, have we got the docs in the right place, are they all seeing the right number of people?  Dunno, dunno, dunno...

I tell you what I do know.  We need a new GP contract, pronto. 

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.