Guest Blog – Dr Aumran Tahir: The B wordJune 25 2019
With the NAO PCSE (Capita) report still ringing in the ears of the NHS, the term ‘back-office’ has not yet made the headlines it deserves or could deliver to primary care. The report cited that GPs were left without syringes or note pads, there was an eye watering backlog of patient registration letters and a considerable number of miss-filed patient records which resulted in treatment delays. The bitter pill was somewhat sweetened by the fact that ‘this change has successfully saved taxpayers £60m’ but what was the true cost?
The report suggested that ‘it pays to have a dedicated, multi-skilled team at the heart of the project’. Frightening how obvious that sounds isn’t it? So essentially it pays to have someone who understands your business? I’m not sure you need to be a rocket scientist (or even a doctor!) to grasp that one.
Data, or more specifically, data analytics and using those learnings to positively inform and understand your business can also ‘pay’. Despite the burnt fingers of the NHS when it comes to tech we can confirm that tech is not all bad.
In implementing data analytics in our practices, it is worth making the point that our objective isn’t to simply drive down costs, even though you will be pleased to hear that this is often a welcome result. We use IT to create solutions that analyse data and provide useful insights that help improve patient care quality, or provide the infrastructure necessary to manage General Practice efficiently, supporting our front-line staff sustainably. Importantly, we also invest in the education and change management necessary to enable transformation, support GP resilience and develop a highly effective, multi-professional team. Letters, for example. GPs typically receive around 40-60 letters each day which requires us to spend, on average, 1-2 hours per day handling documents. Aside from being far from what motivated us to attend medical school it also means that there is a not-insignificant number of hours that we aren’t fully focussed on patient care.
But what should you consider before implementing data analytics into your practice.
As with any project you need to clarify what you want to achieve. There are, undoubtedly, ways in which data analytics can help better prevention, self-care and monitoring. But with the increasing drive towards BIG data we need to make sure that primary care doesn’t become more aligned with the needs of large populations rather than the needs of its patient population and the needs of its patients.
At AT we identified that we would benefit from greater insight into what services were being used across our practices and to what degree. Using this insight, we have been able to implement a shared services approach that caters for the needs of all our partners (as in it provides what each service needs without unnecessary wastage but doesn’t scrimp because the sole focus is cost saving). We have been able to maintain standards and working practices whilst saving budget that can be reallocated elsewhere. Most importantly, we are developing the workforce of the future, enabling our front-line staff to focus on patient care and experience, and removing both the variability in core administrative tasks whilst improving quality and safety through a systems approach.
We have also regularly use data analytics to benefit our patients.
Influenza remains a significant health issue for at-risk groups. Almost three times as people died in 2018 compared to 2017. In December 2018 >30,000 visited a GP due to an influenza like illness, an increase of more than 9,000 compared with the first week of January.
Knowing the significant implications in terms of patient safety, morbidity, and unscheduled care attendances, we implemented a six-factor quality improvement (QI) approach comprising to improve vaccination uptake.
We automated clear weekly performance targets for practices by flu cohort, and enabled easy performance monitoring (over 65s, pregnant women, carers, at risk, and 2/3-year olds). Data published weekly showed practice performance against targets. Support is given to practices including agile interventions such as central deployment of additional recall capacity where required. A multi-channel staff communications campaign uses performance data to engender pride, competition and delivery. Our data highlighted the need for additional staff to create sufficient capacity.
As a result, we have been able to deliver outcomes which are consistently better than the London average in all cohorts and have reduced variation across our 35 practices by 14%. 29,206 patients received the vaccination across the AT Medics organisation in 2017/18.
In the words of the NAO ‘it pays to have a dedicated, multi-skilled team at the heart of the project’. Combine that with data analytics and, we think, you’re on to a winner!
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Dr Aumran Tahir is a GP Director and Founder of AT Medics, the Chief Clinical Information Officer and leads on a range of quality improvement initiatives across the organisation.