I guess that like me a lot of your time is spent grinding through one (damn) thing after another.  In the short days and long nights it can seem like more grind than ever.

So when plans struggled over for years suddenly work it’s a very special day.  It feels like the sun coming out on the brilliant white of fresh snow.

Dr AV, a single hander GP in Scotland with 2,900 patients emails me:  “Best Friday I have had in 2 years!?”

The reason?  He’s in control, he’s reached 50% of demand online, the rest by phone, and he and the team are dealing with everything as it comes in.  In the middle of December he writes “We have free slots – many in fact – on any given day !?”

Sorry I don’t even know how to write emojis but I think that means a cheesy grin.

Actually, he’s not the only one, Dr SA has done the same, and she has even more patients.  I’m using initials because they don’t necessarily want you all to ring them up at once.

What was it that suddenly made the difference?  Last week I promised to tell you if it continued.  Well it’s so ridiculously simple that I’m almost embarrassed to say.

We’ve had this idea on one of our powerpoint slides for months, but never really pushed it because no one had tried it so we didn’t know it would work.

The receptionists guide the patient to the practice website and get them to try askmyGP.  They are even more effective than the GP giving a telephone message.  They love it – they feel empowered too, and when the requests come in they are better equipped to deal with them – many are answered by secure email.

The GPs love it because every single one is saving minutes, and when you’ve 3,000 patients to manage, and preparing for Christmas too, that counts for a lot.

One terribly important point I must make:  there is no forcing patients online.  You may hear of other case studies where the telephone option has effectiively been removed..  We refuse to condone such an approach – in fact, telephone service improves.

Look, the vast majority of things that we try, fail.  You don’t hear about them, and we try a lot, and some of the failures are painfully costly.  So when something works, we might as well ? about it.

Anyway, you can see what the receptionists and GPs are directing patients to do on Bramley Demo Surgery.

Very best,

Harry Longman

askmyGP & GP Access Ltd

Comment on the blog

PS You might even say the struggle goes back to 1981 when the electronics lecturer is trying to explain to thicko engineering undergraduate why asynchronous communication is so much more efficient.  He wins.

Do you find yourself getting asked for feedback the whole damn time?  Ever wonder what happens to it?  I admit to being the bloke who stood in the customs area at Luton Airport for 10 minutes, hitting the Friends and Family sad face just for devilment, but please don’t do as I do…

I want to give you some insight as to how we use patient feedback because it’s a big part of our development process and we have some rather good news to report.

The first thing is to get lots of feedback, make it very easy and quick to collect, without being intrusive.  So we give every patient the chance after they’ve sent their askmyGP request online.  They get two tick box questions and one free text.

The response has been huge, over 2,200 from nearly 20,000 patient episodes, a rate over 11% of users and it shows how much they care about their experience.

We read every one and mark it positive, negative, suggestion or other.  Other is mostly don’t know yet, or issues with the practice rather than the software.  We get lots of suggestions which is useful.  Overwhelmingly the sentiment is positive, the strong themes being speed and ease of use.

The positives are uplifting but in a way they don’t help as they don’t tell you what to do.  We’ve been running at about 10% negatives, they can hurt, and sometimes they don’t pull punches

“I absolutely hate this system. Too impersonal, takes too much time.”

So we’ve taken a hard look at the themes and made a number of changes, some quite subtle, over the last few weeks.  Two weeks ago negatives fell to 7%, and last week to 4%.  It’s wonderful to see.  Positives don’t go up, but suggestions do as patients feel they have something to contribute.

Yeah, OK, I’ll end on a positive note, this from a lady last week:

“Amazing service! It has improved my experience considerably. No more calling for 30 mins at 8am and a fast response from the doctors.”

It’s a team effort.  Biggest part of the experience overall is the speed of response from the practice and the care from GPs.

Last weekend I was in London and faced all over the Tube with Babylon’s “GP at hand” adverts.  If you’re worried about them bagging 150.000 patients, don’t be.

You can do better.  Easy.

Harry Longman

How is your Monday going?  If you’re a GP, I already know the answer, it’s busy, because 28% of the week’s demand arrives on Monday, and 3/4 of that in the morning.  It’s not news.

News last week was that GP numbers have fallen by 1,300 over the last two years.  A bit of a problem when at the half way point to Jeremy Hunt’s election pledge of 5,000 more GPs, we’d have expected growth of 2,500.

We need happier GPs.

The Dutch have happier GPs.  Listen to Jako Burgers tell the RCGP conference why (20 minutes or so).  Students compete for their GP training places, they recognise it as a top choice.

There are differences in funding and so on, but a lot about the system is similar to ours and they are paid about the same.  Practices are smaller, there’s no obsession with scale, and they love the independence.

Let me float this idea for the UK:  GP opening hours are too long.  For many years now more women have been joining GP, but 8am is too early to be family friendly, and a 6.30 finish is too late.  While we’re there, why shouldn’t fathers be at breakfast with their school age kids?  Of course they should.

6.30 finish?  “You’d be lucky” I hear partners say.  Yes, many GPs are working very long days, I’ve heard 12 – 14 hours.  Then taking days off.  Working with hundreds of practices we almost never come across a full time GP.

I’m not proposing to cut GP working hours, though we should cut pointless overwork.  But to spread them out evenly.  Operationally it’s much better to work a regular five days, reasonable, family friendly hours, offering better continuity to patients.

I’m not proposing to cut access to GPs, but improve it (clue’s in the name).  The difference in pushing back opening from 8 to 9 is an hour – compare with the three week wait forced on many patients. (by the way, the Austrian health department is trying to get GPs to open in the afternoon).  Extending hours to 8pm and opening weekends for routines is catastrophic – sucking GP capacity into low demand periods, destroying continuity and burning money.

Understanding demand and flow means help for patients within the hour is not just normal, it’s easy.  Minor problems we have with the Transform programme are firstly, we know that GPs starting work at the same time as reception is crucial for daily flow, and 8 is too early for many.  Secondly, part time working causes uneven capacity through the week.

While our policy makers focus on inputs, number of GPs, number of hours, we need to look the other way.  How do we make GP more professionally rewarding and practically possible?

Jako Burgers:  “Happy GPs will do a better job than unhappy GPs.”

It’s not rocket science is it?

Harry Longman

You cannot have failed to notice Babylon’s GP at hand service all over the media this week.  As a PR exercise, on the Today programme, You and Yours, TV, front page of the Times and an almost unheard of positive story in the Daily Wail, it was SIMPLY BRILLIANT.

What you may not have appreciated is the existential threat this makes to regular NHS GPs.  While presenting it as “the NHS has suggested that the service may however be less appropriate for…” the list of exclusions is in fact the engine of profit for Babylon.  Read the list.  It’s 90% of a normal GP workload.  It begins with women (twice the consult rate of men in middle years), who are or may be pregnant (more work.  And babies – lots of work).  All the usual suspects, the elderly, sick, frail, confused and multi-morbid are there.  They are work.  Babylon doesn’t want them.

Babylon has got something spot on:  patients are fed up with the often abysmal service from their current GP.  

They want the young, fit and healthy, especially men, who rarely need a GP but when they do, want help fast, and don’t want to bother with going to a surgery unless they have to.

All these patients carry the same capitation.  Think: what if you lost half your income and the easy half of your population?  But kept 90% of the work?  If it isn’t obvious yet, GPs will go under.  That may not be you, but your neighbouring practice, whose list will be dispersed… to you… and you know those dispersed will be high demand.  Nice.

They are in London so far, but Babylon’s ambition is limitless and I fear a multiplier effect from the mechanism above.  They have the law (practice boundaries abolished), the funding model, the technology, the demographics and clearly the PR on their side.   No doubt BMA is dreaming up legal challenges as I write, but they are no match for weasel words backed by £60m of VC money, while changing the law takes years, at best.

If it were simply about better GP services, I would be cheering.  But the inevitable consequence is to stoke the Inverse Care Law.  Those who most need help will find it most difficult to obtain.  General practice will be dramatically less profitable in the hardest areas, and will suffer even in the most privileged.  This undermines nothing less than the core principles of the NHS, universal, accessible and free at the point of use.

I will end on a note of hope, because this is not hopeless if we act fast.  I founded GP Access & askmyGP with the vision “to transform access to medical care” and some might say Babylon have achieved that.

But our vision is universal.  We have no exclusions. We understand the quality and safety from relationship continuity, to say nothing of the professional joy in work.

Although Babylon’s offer is getting the PR, it’s actually not that great.  2 hours for a video?  So slow.  48 hours to be seen?  So long.  Travel within zones 1 – 3?  So far to go.

You can beat it.  Faster, easier, closer, with the GP you know.

As @stevekellGP tweeted yesterday, “All patients contacting the surgery today for GP help have spoken to GP & been seen if needed. No DNAs, clean start tomorrow. No videos needed” – most of them spoken to within half an hour.

If you haven’t seen his 2 minute interview you really must.

Our vision is of a transformed general practice that you own and you run for the care of all your patients.  It is not a transformation done over you by the power of money.

I’ve been saying this for six years.  Now wake up GPs, before it’s too late.

Harry Longman