Helping people talk to each other – in GP practices

From the Guardian article – GPs losing sleep over patient safety fears, says head of profession – Denis Campbell 8 October 2017

“Shattered” GPs are lying awake at night worrying they may have harmed their patients by making mistakes caused by tiredness and overwork, the leader of the profession has revealed. Family doctors are losing sleep because they are so anxious that they have put patients’ safety at risk by missing a symptom or not keeping their medication up to date, said Prof Helen Stokes-Lampard. The doctor, who is the chair of the Royal College of General Practitioners (RCGP), told the Guardian: “GPs, like many caring professionals, never completely leave their jobs behind when they go home; it’s a 24/7 responsibility.

Like everyone in healthcare GPs are time pressured, however they are particular time pressured in that their consultations are time limited. They have to listen, assess, ask the right questions, make a diagnosis, respond and act all in 10 minutes. Not only do they have clinic hours they have prescription reviews, telephone calls, home visits, hospital letters and ensuring records are up to date; all of which require people to work safely.

The clinics are invariably full or over running so a key question is…

When do GPs get time to talk to each other?

When do they get time to talk to the rest of the staff in the practice?

When do they get time to talk about working safely?

There are a number of reasons why it is hard to talk to each other in GP practices. These are a few that have been shared with us:

  • Time – clearly an obvious one but needs reiterating
  • Hierarchy – a lot of practices are very hierarchical with the most long serving doctor as the senior partner who has ultimate say and then it works its way down from docs to nurses to admin – the further down the less of a voice they have
  • Silo working – GP practices can be structured so that the different ‘groups’ work in isolation of each other; GPs work on their own, nurses on their own, admin and receptionists on their own
  • There is no ‘structure’ or time period that creates the opportunity to talk to each other
  • The interventions often associated with conversations feel clumsy; such as the use of huddles, briefings and handover tools such as SBARR
  • With the ratio targets of GP practices per population there are increasing numbers of mergers which also has the issue of split sites – these can create challenges and barriers for getting to know people

One GP we spoke to said that often GPs will arrive, go into their room, see their patients and then leave – one GP said ‘he had no idea who else worked there as he had never met them’.  A number of GP practices are trying out different ways to tackle these factors.  Local newsletters, lunchtime huddles, coffee time get together.

Prof Helen Stokes-Lampard …

“GPs are professionals’” she said. “We do everything we can to be meticulous; that’s in our nature and is part of our training. But when you’re shattered, it is possible to overlook a changed prescription request, or not update a patient’s record as comprehensively as would be ideal – things that can impact on patients’ health further down the line.

 “But there are also more sinister things we worry about. Did I miss a symptom of something that could be more serious? If I’d had more time with that patient, would my eventual diagnosis have been different? These things play on your mind, and it isn’t healthy.”

With GPs still awake at 3am or 4am wondering if, as a result of being under constant pressure, they have made errors we need to find ways in which they can talk to each other and their practice colleagues about working safely.

How do you talk to your colleagues and how you would like to see things change.  If you have just a moment spare – go and say good morning to all your colleagues, find out about their day because talking to each other can help in so many ways:

  • Bring people together to talk and in particular to focus on working safely around a cup of coffee and cake (or whatever you like to drink and eat!)
  • Discuss the links between working safely, quality of care and productivity, efficiency, effectiveness and reduced cost
  • Discuss your CQC inspections (before during and after)
  • Build on your significant event audits and talk about what is working well – building on the concepts from the ‘learning from excellence’ research – we love this positive approach which could help a little with the morale in GP practices, helping people feel valued and acknowledged for the great work they are doing
  • Help with connecting up the different sites
  • Bring together from across the patch from the CCG and other practices – not just your own

Another approach would be what we are calling ‘walking meetings’ – these are ways in which people can get out and about and can be for as little as 10 minutes.

What are the benefits?

  •  Walking with your colleagues helps people develop relationships and connect in a different way
  • Walking side by side has been shown to be less intimidating so people really feel they can open up about the things that keep them awake at night
  • The increased blood flow to the body and in particular the brain keeps you alert and can also help with creativity
  • People also feel great when they get back – not only have they had a great conversation they have stretched their legs and got a little bit of extra exercise in their day

We need to help everyone with the loneliness that some experiences when working in the NHS.  Help people unload their concerns rather than leave them with the dialogue that takes place in their head which keeps them up at night.

If you want to know more about talking to each other to help people work safely?

Thanks to colleagues from the West of England AHSN for their invaluable insights