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We don’t have to ‘reinvent’ primary care, just unleash more of its potential
Following the release of my recent interview on the Improve Healthcare podcast about ‘unleashing the potential of primay care’, a few people have been in touch to ask me to say more about what it could look like in practice.
This is an area I’ve been passionate about for a long time, and I had the huge privilege of introducing policies, funding and improvement support to the NHS in England. There’s a great deal I could say about the needs and the opportunities for making better use of primary care, but for now here are some very practical tips I believe could have an impact almost anywhere in the world.
Much of the time, we’re so busy dealing with today’s work that we don’t step back and ask if we’re always handling it in the best way. When they pause to take stock, primary care physicians in England typically report that around 30% of their appointments today could have been avoided. How much of your time isn’t productive?
If a significant proportion of doctor appointments could have been handled by someone else, why are they reaching the doctor? With training and clear protocols, administrative staff can safely signpost many contacts to a more appropriate person or service. You’ll find patients thank you for addressing their concern quicker, and doctors will have more time for the patients who need it.
Doctors are great (I’m one!), but we’re simply not the most appropriate or even the most effective person to deal with every patient need in primary care. Bringing in more nurses, physical and mental health therapists, pharmacists and health coaches will have immediate benefits for patients AND release doctors to do more of what only they can do.
Many of our primary care practices are just too small to realise the potential of multidisciplinary care. It’s all very well talking about team-based care and the benefits of broadening the skillmix beyond just nurses and doctors. But a huge proportion of the world’s primary care teams are too small for it to be feasible to take on new roles. So why not join forces with neighbouring practices for some things like employing new specialist staff? Collaborative working can help you realise economies of scale and a whole lot more.
I hope that’s whetted your appetite. Sometimes in life and healthcare we do need to rip something up and start again. There are many reasons to feel something needs to change in primary care right now – workload is overwhelming, access is getting harder for patients, the wider system can’t provide the right kind of expert generalist care. But we can achieve a huge amount by using some fairly basic improvement science, and taking incremental steps that improve today’s pressures and serve patients better.
Do let me know if you would like me to talk with your team, network or system about these practical ways of unleashing more potential without just working harder.
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