The New NHSE guidance ( https://www.england.nhs.uk/wp-content/uploads/2020/08/gpad-guidance.pdf) on how to record GP activity has caused a great deal of confusion.

A thread on what it means and what it doesn't mean...

The reason NHSE needs to change the way GP clinical systems record activity is that the drive to do triage and most interactions remotely has discombobulated the monthly data publications of GP activity...

This national report is derived from extracts of GP clinical systems which are designed to record appointments. This is a problem as those systems are awful at recording activity when it isn't a 10-15min f-to-f slot...

They were poor before #covid lockdown at consistently recording phone calls and have never been any good at capturing online activity...

As any decent provider of online consulting tools for GPs will know. at @askmygp we reckoned that the clinical appointment books only recorded ~1/3 of all activity reliably even before #covid lockdowns...

So it would be good if the activity reports actually recorded all interactions between GPs and their patients reliably even if they happened entirely via online messages...

But NHSE have sown confusion by saying the data they want should be recorded in the "appointment book". The data they want is not unreasonable but this description has sown major confusion with practices...

A widespread interpretation is that GPs must reinstate fixed 10 (or 15) min slots for patient activity (an assumption reinforced by the design of GP clinical systems). This is catastrophically wrong...

One of the major learning points from those of us promoting online tools for GPs managing requests from patients is that the fixed appointment slot is the enemy. It wastes capacity and leads to GP overload and long waits for patients...

Those GPs who abolished the appointment slot and became more flexible about how to respond gained a great deal of capacity and gave patients same day responses to requests >90% of the time...

And patients getting that sort of response (even pre-pandemic) started requesting f-to-f slots far less than many expected (~30% typically) with messages and calls taking up the slack...

So, if GPs start thinking they have to have a daily diary consisting of 10min slots to satisfy NHSE then they will lose many of the benefits of flexibility and speed that online tools have given them...

But this does not have to be the way forward. To be fair to NHSE, this is not what they said they wanted. But they were not very clear about this...

Ideally all that GPs should do is to record all interactions in the clinical system at the time they occur without reinstating the idea of appointment slots. That way they can retain the benefits of good online systems and processes...

and not see a reversion to the old system that was the underlying cause of many capacity problems and long waits for patients...

But the suppliers of clinical systems might have to change the way their systems are set up (they too often bake in the old 10 min slots in a diary approach)...

GPs should not revert to the old way. It is entirely possible to record online interactions with a short note in the clinical record as good online systems already generate the relevant data...

The NHSE team who issued the guidance should talk to the primary care team (the notification didn't make it clear they had perhaps @MinalBakhai or @NikkiKF) as they have a better grasp of how GPs have responded to #covid...

And should clarify that they don't expect GPs to revert to the old system of 10min appointment slots for all activity. I realise that that is not what the guidance said, bit it is how many GPs are interpreting it...

And, if GPs act on that (bad) assumption, their capacity and flexibility to respond to patients will decline drastically...

Ultimately, though, the suppliers of clinical systems will have to change they what they think about GP activity so we can have reliable measures of what GPs do that don't bake in an archaic and ineffective model of that activity.
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