⭐HSJ Patient Safety Congress reflection 2024!⭐
My observation:
-Fear drives patient harm
-Staff fear mistakes & someone finding out
-Leaders fear their respect & future hinges on playing down safety incidents
-Fear itself, driving yet MORE mistakes
And yet.. 1/13





Whilst fear drives harm...
I heard very little about fear at the conference.
I didn’t hear how we break the cycle

We need new responses to patient safety events.
This is a challenge.

To change our responses needs practice.
Eg Could role play help new behaviours to sink in? 2/13

⭐What can Primary Care learn from NUKA, Alaska?⭐

NUKA is often labelled the best Primary Care system in the world.
44% reduction in ED visits
97% patient satisfaction
95% staff satisfaction
How could we learn from their approach?
7 Principles here ⬇️🧵 ⭐️1) Avoid replicating only WHAT they are doing.⭐️
Benefits come from the PROCESS that led to activity.
Otherwise its like buying a bunch of supermarket flowers & planting them in your garden.
So, what is the root system of NUKA?

🌟Our GP surgery is making BIG improvements despite national pressures🌟
⬆️Continuity/ Satisfaction/ Access
⬆️Morale & Retention
🌟First the data
🌟Then the reproducible principles that improve ANY organisation🌟
🌄Another General Practice is Possible
👭Culture is key! 1/9 🌟Continuity🌟
National data (left) = Falling
Our data (right) = Large improvement

❓Where does the potential for continuity sit?
👭 Receptionists! They allocate it!
They need the bigger teams, support & teamwork (more on TEAMWORK later)
&
🖥️Modern General Practice model
2/9

🌟GP Recovery Thread🌟
📉We're on our knees
❌This won't solve it
🤦But NO single plan can
🧐Any pledge we'll now meet demand is an unhelpful distraction
🌄BUT there ARE great ideas in here that WILL help
📈Recovery has to start somewhere!
🙋Success depends on our engagement 1/17 🌟The 2 main 'ambitions'🌟

🏋️‍♂️They are VERY ambitious
But they ARE worthy goals

🌟The 8am rush is only PARTLY a result of need outstripping capacity
📈Improvement is possible

🌟Aiming to thoughtfully organise incoming cases is a great aim
❌Managing EVERY case?
Unrealistic 2/17

🌟GP contract changes 23/24🌟
From targets to 'back to basics'
📈Significant goals on access & patient satisfaction
😬No more new funding (?Yet)
💥 Repurposed targets towards these goals
✅Rights goals?
❌Set up to fail?
🧵A thread: Summary, opinions & questions 1/13 ⬇️The big change💥
Moving away from GP surgeries asking 'Call back tomorrow'

✅Offering an initial assessment of need with a clinically appropriate outcome

Different to:
Giving patients appointments on request
Targets on appointment numbers or type

But is there capacity?!2/13

A thread response from a GP if you're listening @wesstreeting
You're right about workforce being central, esp Primary Care
⬆️Training, agree
🌟RETENTION matters more. Not hearing this from you
The NHS needs a more compassionate culture. Your language doesn't fill me with hope 1/7

https://twitter.com/wesstreeting/status/1613950053768364032

You're right that continuity matters☑️
'We will provide face-to-face appointments for all who want them'. We are working flat out, as efficiently & safely as we can.
We're struggling to manage need + preferences
Giving everyone what they want is a whole new level of resources 2/7

A patient walked in to our surgery.
🌟Because our receptionist knows red flags for cancer, she brought it straight to me & we saw her straight away🌟
They are not clinically responsible.
But the more knowledge & autonomy they have, the more they can help flag up priority patients Eg 10am. Patient wants URGENT appointment (growing list of 60 GP triage calls)
But receptionist thinks they sound v sick & gets Dr IMMEDIATELY
Or
70 y/o Patient wants ROUTINE appointment (2 weeks) for weight loss & rectal bleeding.
Receptionist ask GP if should actually be URGENT

One reason our NHS is failing?

We try to manage complex problems as if they are simple (top down targets & outcomes)
🌟We need approaches that enable our systems to actually produce results🌟

A 🧵of the solutions in this SUPERB talk @tobyjlowe ⬇️ 1/11
We are complex
Our problems are complex
The organisations impacting on our problems are complex

🌟PRETENDING it's simple so it feels easier to manage DOESN'T work🌟

Outcomes are a result of MANY factors. So if we commission/strategise to produce outcomes, we achieve gaming 2/11

How can we improve patient involvement In Primary Care?
Blur the boundaries?
Have them/ you involved in the life and decisions?
Here are 11 of my thoughts. Please add your own.
1/12

https://twitter.com/BenAllenGP/status/1514869111586709519

1) Practices to set up Facebook groups. Won't reach all, but is the most widely used social media, esp for 50+
I've written extensively on this already

https://twitter.com/BenAllenGP/status/1505232361465724932?t=v1EAGgtA7iPFfadzebpdQA&s=19

Despite the #gpcrisis we've gone from: Struggling with unmanageable 'demand', exhaustion & low morale.
⬇️
A thriving & hopeful team with excellent patient feedback.
How? Dozens of factors.
This thread describes 1 subtle essential ingredient
#TeamGP
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link.medium.com/JpbZd1BQHnb Primary care is over worked and overwhelmed. The GP crisis is exasperating for staff and patients. GP numbers continue to tumble. Part of the solution is before our very eyes: the receptionist. But perhaps not as we know them.
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