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Home working and General Practice 

Home working in General practice

By Matthew Okey

Having worked in senior-level recruitment for almost a decade, I’ve seen home-working play a big part in other sectors such as technology and construction, but until the arrival of Covid-19, it was something of a non-entity in General Practice, perhaps even taboo.

If anything will shake up the status quo however, it’s a global pandemic.

GPs working from home

GPs required to shield suddenly had no option but to work from home, delivering solely telephone or video consultations whilst their in-surgery colleagues saw patients face-to-face, when circumstances allowed. I myself, though not shielding, have worked from home full-time since the onset of the pandemic and find it now second-nature.

So what about those shielding GPs who developed an affinity for home-working, enjoying the increased time with their families, the shorter days given there was no commute, the comfort of their own home to work in, the vast improvement of their dog’s morale given their human was now home all day; should all of the good that came out of something so bad be left behind?

Finding the balance

The question is not whether we should have home-working in General Practice (and other sectors for that matter), the question is one of balance. Finding a mixture that offers greater flexibility whilst not compromising on the level of care afforded to patients.

About six months ago when speaking with colleagues, we spitballed what a home-working GP role might look like; and we weren’t talking about your virtual companies like Babylon GP or Push Doctor; but traditional GP surgeries offering home-working as a contractual right.

The conclusions we drew were the same each time we talked – part home-working, part in-surgery. Telephone and video consultations are going nowhere, that much is clear. The general consensus in recent months is that post-Covid we will see some hybrid, amalgamation of the old, with the new. Most GPs still vehemently feel that face-to-face contact remains the gold standard of consultation, being able to read body language, body position and tone of voice. Those paralinguistic features are much harder to pick up over video and nigh-on impossible over the phone. Keeping face-to-face consultations isn’t a debate.

Patient preference

What about however those patients, of which I would consider myself one, who would prefer a telephone or video appointment so as not to have to take ill-afforded time off work for something that, whilst important, may not be a critical clinical issue?

Having struggled with a lower back problem for the last 12 years, I know that I myself, rightly or wrongly, would likely suffer on until it became unbearable rather than use what precious annual leave we receive. Even in companies like Menlo Park who see medical appointments as an employee’s right and not subject to ‘time lost from the business’, some employees simply won’t feel able to lose two hours from their working day.

Can there therefore be a working pattern that accommodates the patients who would prefer a remote appointment as well as those who want, or preferences aside, need to see their GP in person?

My answer is yes.

Going through the briefing calls with new clients, I painstakingly break down a routine session so as to better understand their working model, and time and time again of late I am seeing a session comprised of every type of appointment available. Six triage calls, three e-consults, five routine calls, four routine face-to-face appointments, two same-day face-to-face appointments… it’s a mish mash and whilst it offers great variety instead of the repetitive appointment-appointment-break, appointment-appointment-break of old, my heart goes out to the rota schedulers whose Excel spreadsheets would likely rival NASA’s.

Flexible working

Going back to those discussions I had with colleagues around the turn of the year, it was not until May that I saw the first such role come through from a new client, based in an attractive outer suburb of Bristol. They had a young population who had embraced the new ways of working and valued the opportunity to receive care in their place of work or at home, rather than having to travel to the surgery.

Working to a pooled list, there was the flexibility in place for patients to see whichever GP was in surgery that day, allowing others to split their time and work from home, purely doing remote consultations. With both remote and in-surgery GPs working a triage list, the in-surgery GPs always have protected slots to bring patients down, allowing the remote GPs to book in patients they triage from home to see an on-site GP. Ensuring there are enough protected slots to accommodate the entirely remote model of that day’s home workers is a challenge for sure, but only in terms of its conception. Regular audits ensure the model is still working and an active PPG continually feeds back its findings.

Now, we’re not talking about a predominantly home-based role here, rather a 1/3 to 2/3 split in favour of working in surgery. What that 1/3 does though, is allow for more time at home and out of the pressure cooker that General Practice has become, particularly in recent years.

In a few years’ time, it would be interested to compare their burnout rate to a say, an inner-city practice where flexibility is at a premium, to say the least.

GP working preferences

What about GPs who don’t like working from home though?

Simple.

Home-working is a choice, a privilege. It is not mandated and the GPs can revert to working in-surgery full-time for a period of time before returning to the 1/3 to 2/3 split as and when they choose. Perhaps a newly qualified GP would value more time around colleagues. Perhaps a GP with 20 years’ experience post-CCT would feel just as productive in their home office. This model is empowering the GPs to care for their patients how they see best, whilst maintaining their energy levels and a healthy home-life.

Needless to say, we had filled the role within a month and the practice could have done so three or four times over.

Last month brought the second such role in quick succession. A deprived, inner-city practice in an ever-difficult part of the country to recruit and retain GPs. Rather than seeing home-working as a perk, they saw it as an innovative way to attract potential candidates who would likely be out of reach otherwise.

With a core team of in-surgery GPs, they looked to blend that team with a predominantly Remote/Digital GP who would work 4-6 sessions from home with just 2 sessions a week in-surgery. The attraction for the candidates was clear – enjoy the best of both worlds with the flexibility of a Babylon GP or Push Doctor role, coupled with a day a week when you still got to enjoy relationships with colleagues, feel part of a team and offer continuity of care rather than the ‘next patient up’ model of some online providers.

Innovative working models 

A Care Navigator would sort patients each day with those unlikely to need a same-day, face-to-face appointment going to the Remote GP. Whereas the more urgent cases were instead directed to the in-surgery colleagues. In the rare event the Remote GP’s patients did need to come into the surgery that day; there are those trusty protected slots once more, built into the in-surgery GP’s template to ensure no patient was forced to wait.

For more routine matters that still required a face-to-face appointment, the Remote GP simply booked those patients into their weekly in-surgery clinics.

Neither of these models would have worked without extensive discussions amongst the existing teams. There are precedents to avoid and levels of fairness that have to be maintained; both in terms of workload and salary. That said, both of these practices have managed to attract GPs where they might have otherwise struggled.

The 71 vacancies I am currently handling in my region, one of six regions at Menlo Park with similar volumes, suggests that recruitment struggles are universal across the country.

This model is not going to work for all and I’m not suggesting it will, but General Practice needs to do what it does best and has done throughout the pandemic and that is innovate.

GP numbers are dwindling; the newer generations aren’t coming through quick enough and many of those new GPs are not working as many sessions as their predecessors; instead choosing portfolio careers offering them greater variety and that key word again – flexibility.

The paradigm is shifting and home-working is not the solution, but is it part of the solution? I would argue yes.

How can Menlo Park help? 

If you are looking for a new role that offers greater flexibility with working, or you are looking for somewhere closer to home. Or if you are looking for a role that offers partnership opportunities, contact us today. You can call us on 0113 350 1308 or email [email protected]

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