Failure to ask the right question produces the wrong answer.
The astonishing patient service benefits shown in this study have been overlooked by the editorial authors, who have turned to one element which the study authors called highly variable and largely based on imputed data, namely the alleged 8% rise in "workload". It is critical to understand where this came from and what it means.
8% rise in "consulting time". This is only one element of workload, It could only be measured for SystmOne practices, a minority of the subject practices supplied by ourselves GP Access Ltd. This made up around 20% of all subjects, so the rest of the data was imputed, as well as highly variable.
Workload? No, this did not include a measure of visits, which is hard to do, although many GPs tell us their visits have fallen.
DNAs have fallen by typically 80%, so increased "consulting time" results as less time is wasted.
Most significant of all, no account is taken here of unmet need. We offered the study our measures (n>200,000 audits) of demand before and after change, which show 14% of patients turned awary before change, very few after change as the rise in efficiency means close to all can be helped every day.
This means that even without other effects, a 14% rise in patients helped would be expected within the same workload.
Had the study measured EFFICIENCY instead of an error prone subset of "workload" the headline would have been quite different.
Many GPs practising the model have been mystified by this particular outcome, and the editorial. They would never go back, because they know the model is more efficient. Many other GPs have tried DIY implementations with varying degrees of success, and we see a general increase in telephone consults. This is because GPs want to save time, and are saving time through the method. Not necessarily - poor understanding and poor implementation can indeed be less efficient, and it is the whole system approach, with consistent measurement, which has been sustainable.
It is interesting to note that new entrants to the GP provider market are operating a similar model: they know where efficiency lies. The effect of this editorial will be to dissuade those who could make great gains in efficiency, and their patients meanwhile will continue the frustrating weeks of waiting to get help.
Competing interests:
Founder & Chief Executive, GP Access Ltd
Rapid Response:
Failure to ask the right question produces the wrong answer.
The astonishing patient service benefits shown in this study have been overlooked by the editorial authors, who have turned to one element which the study authors called highly variable and largely based on imputed data, namely the alleged 8% rise in "workload". It is critical to understand where this came from and what it means.
8% rise in "consulting time". This is only one element of workload, It could only be measured for SystmOne practices, a minority of the subject practices supplied by ourselves GP Access Ltd. This made up around 20% of all subjects, so the rest of the data was imputed, as well as highly variable.
Workload? No, this did not include a measure of visits, which is hard to do, although many GPs tell us their visits have fallen.
DNAs have fallen by typically 80%, so increased "consulting time" results as less time is wasted.
Most significant of all, no account is taken here of unmet need. We offered the study our measures (n>200,000 audits) of demand before and after change, which show 14% of patients turned awary before change, very few after change as the rise in efficiency means close to all can be helped every day.
This means that even without other effects, a 14% rise in patients helped would be expected within the same workload.
Had the study measured EFFICIENCY instead of an error prone subset of "workload" the headline would have been quite different.
Many GPs practising the model have been mystified by this particular outcome, and the editorial. They would never go back, because they know the model is more efficient. Many other GPs have tried DIY implementations with varying degrees of success, and we see a general increase in telephone consults. This is because GPs want to save time, and are saving time through the method. Not necessarily - poor understanding and poor implementation can indeed be less efficient, and it is the whole system approach, with consistent measurement, which has been sustainable.
It is interesting to note that new entrants to the GP provider market are operating a similar model: they know where efficiency lies. The effect of this editorial will be to dissuade those who could make great gains in efficiency, and their patients meanwhile will continue the frustrating weeks of waiting to get help.
Competing interests: Founder & Chief Executive, GP Access Ltd