I think it was about a year ago, maybe a bit longer that I came across the early work of the Pathology Programme. I was eager for our practice to take part in the pilot because I had previous experience with Practice Unbound and their Workflow programme, which was really positive. Workflow has changed the work life balance of our GPs in a very positive way, and because of that my colleagues were very keen for me to champion the Pathology pilot in our practice.
In the beginning it was just me and the practice manager who sat down and planned how we would go about implementing this pilot, because we totally understood that this was the first project of its kind. With a pilot, you know what it's going to look like in the end, but how are you going to get there? So we had quite a few meetings with Dr Paul Deffley at Practice Unbound to work out how we go forward together.
I conducted an audit to see how long it took me to file my blood results - it was something between 30 – 40 minutes each day. At that point it became apparent that if we could save that time throughout the practice it
would be quite productive. With an extra 30-40 minutes per GP, per day, you can achieve a lot, that makes a big difference in a doctor’s life.
But what we achieved together has been far greater than just the time that’s been given back to the GP - we've also improved patient care and clinical coding has got even better while using the Pathology Programme.
Previously, when GPs found abnormal blood results they might not necessarily all file them the same way – some will add an explanation to the patient record, others might not. But now, because our administrative team will be picking it up and raising the abnormal ones, our GPs are consistently giving an explanation, even if it's just ‘as expected' or 'no further action needed'.
There’s still the need to audit and keep an eye on things and ask further questions like, does the patient need any further tests? So I'm really quite pleased with that outcome - it's not just for the GPs work-life balance, it is actually improving patient care.
Another example where we’ve found improvements is with the kidney function tests. When we get older our kidney function reduces - just like the wear and tear that you get in your joints. Chronic kidney disease is nothing abnormal, but a very gradual reduction in kidney function. Often it doesn't cause any problems and you don't need to do anything about it. But if the patient develops another condition that requires medication, it’s important to have it on record.
Patients with this reduced kidney function would have their previous eGFR results on their record but when we actually looked at the notes, sometimes there was no code for chronic kidney disease.
Since implementing the Pathology Programme that has all changed. Now, the administrators will look at the kidney function result and see that it hasn't changed, and if they don’t see the CKD code in the notes, they task that to the GP to add it.
This means that next time you are prescribing a drug that may have contraindications because they've got CKD the system is able to alert the prescriber to the risk. It makes it a safer prescribing process for both the patient and the doctor.
When you are giving very clinical work to a very non-clinical person it’s natural to worry. But this programme has been done in a very protected way. The decision aid flowcharts are really well designed.
When we started the pilot I would see every result that the administrators filed, which was quite time consuming but necessary as part of the early auditing process. But apart from that no, I really haven't had any worries. No patient care has been compromised.
The Workflow Programme process protects everybody. And I knew the people at Practice Unbound. They've got very good common sense and are very fastidious as well. They've got a very good way of asking questions. They wouldn't just go ahead and do things.
I have been very pleasantly surprised because to begin with, I was worried that they might struggle with one of the flowcharts as it looked busy. I thought, ‘oh my goodness, they're just going to run a mile!’
But if anything they've been very, very enthusiastic. And just last week we had a meeting and they asked if it was possible to have a decision aid flow chart for another set of blood tests because they are really excited about it. They see it as a nice challenge and change to their sometimes repetitive admin work. So they really like it.
Practice Unbound have been very, very supportive and are always on the other side of the phone and very attentive. Nothing is ever a problem.
I think it's quite exciting - I think it’s the future of general practice. We will need to work smarter. And I think the Pathology Programme is one of the big steps towards that.
We’ve spent months asking, ‘how can we do this in a sleeker way?’ So because of the work we have done jointly with Practice Unbound, the new practices that are going to be embracing this programme will benefit from the better ways of working that we have discovered.
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