Abstract
Organized chaos?
How does your practice plan and delegate work load? I am currently dividing my time between two very different practices that have contrasting approaches to organizing the day. One has a strict rota that plans everything down to covering for blood results when other GPs are off duty. The other has an open system with little structure, which relies on good teamwork between the clinicians. At some point in the future, I will have to decide which practice I shall choose to work in full time. I think my decision will be largely governed by my working preferences.
Many practices have an on-call system whereby tasks are delegated to a particular GP. This way of working gives receptionists and administration staff clarity. In addition, you are in control of your own workload. You know when you are on call (usually) and can expect a busier than normal surgery during that session. Some practices reduce the number of patients seen by varying degrees to allow attention to be given to the on-call duties. This system enables colleagues to get on with routine patient care. I must admit that I like to be in control of my workload and I prefer this system provided all the clinicians pull their weight regardless of seniority.
Telephone triage in another practice I work in has been shown to be very efficient. During a month of telephone triage sessions audited by the practice manager, only 40% of patients actually needed a same day appointment. I'm sure that this approach would not work in all practices but as this patient group have relatively chaotic health-seeking behaviour, it is an effective way of meeting demand. This morning session is then followed by a long routine telephone call list and a list of prescription queries. Some of these tasks are given to a named GP but many are just open. On the whole, everyone pulls their weight thanks to longstanding close working relationships. In the afternoon, it is a bit of a ‘free for all’.
In the absence of a named doctor, what you would consider ‘on-call queries’ tend to be directed to the more approachable GP. This is sometimes me—the younger GP who is keen to impress given she is looking for a more permanent job there. As this system operates daily, even if you are not telephone triaging, you tend to have a busy day full of random queries about patients you do not know well. I enjoy learning from the working relationships, but I'm not sure whether having a very busy day every day is sustainable. It feels a bit like fire fighting.
It is the GP partners who ultimately collectively decide methods of working within a practice. Good management takes notice of all voices within a team and if you have a good idea about how to change systems, speak up. If you take part in practice meetings, make sure you bring your organizational ideas to that sounding board. With a willing trainer, you may get some management experience while implementing the changes subsequently giving you invaluable skills to boost your curriculum vitae.
I have suggested a few changes in both practices I work in and am looking forward to seeing whether any of these will take effect. Competency in working with colleagues gets harder as you get further in your career. When you understand your own working patterns, you can then communicate them and later learn how to compromise with your colleagues who may have very different preferences. This is my next lesson to learn.