In all the work I have done on new roles in general practice, the role I have probably paid least attention to is that of “medical assistant”. They are tucked away within the Releasing Capacity in General Practice programme, under high impact change number 4, “Develop the team”, bullet point 5. It is small wonder they get overlooked!

Plus they are not really new roles. It is actually training for existing administration staff, specifically those who code, to be able to read, code and action incoming clinical correspondence according to agreed protocols, as opposed to passing everything on to the GPs.

But the impact is huge. I visited a practice recently who had implemented this system, and they were evangelical about the benefits! According to them the new system was saving each GP up to an hour a day. When the biggest pressure on GPs is workload it is not hard to understand why a change that can make a difference like this is so popular.

Not only is the GP time saved, but coding actually improves, and the administration staff undertaking the new way of working enjoy it and feel like they are contributing more to the practice.

Here is how it works. A lead GP from the practice is put in charge of working out how the different mail coming into the practice can be processed. The starting point is a set of protocols, worked out from practices where this has already been introduced. They really just require tweaking to reflect the specific needs of each individual practice, and then reviewing over time to continually refine them. The aim is to reduce the number of letters that need to be processed by a GP.

So for example if there is a letter informing the GP a patient has failed to attend a mental health appointment, the agreed action could be “book telephone appointment with the GP”. Instead of the letter going backwards and forwards between the clerical staff and the GPs, the action is implemented straight away. If the practice wants a different process to be followed for this particular pathway, it can set its own rules for the clerical staff to follow. Meanwhile letters that the GP absolutely needs to see, such as a safeguarding issue or a serious or complex diagnosis, are passed straight on to a doctor.

The other key difference is that instead of the letters going to the GP to outline what needs to be coded, and the letter then coming back to the coders, the clerical team will code directly from the letter. After the initial training, the lead GP audits and checks and feeds back very regularly at first, but then increasingly infrequently, as the clerical team develop the skill set. The wasted GP time is cut out of the loop.

The practice I visited, who had been refining the system in their practice over 3 or 4 months, estimated a reduction of 70 to 80% in the correspondence now going to GPs, compared to before the introduction of the scheme.

This new way of working, which I have seen termed “workflow redirection”, “workflow optimisation” and “document handling”, depends very much on the oversight, governance and audit within the practice from the GP lead for it, and the new skills and new way of working of the administration team, or “medical assistants”. The practice I visited did feel that it increased the administration burden on the clerical team, and they had to increase capacity to absorb the additional requirements. The team in Brighton who first developed the change suggest it requires an additional 3.5 admin hours per day per 5,000 patients. You can see the video they have produced about the change here.

Introducing medical assistants might not be the sexiest of changes developed to support the challenges facing general practice at present, but it may well prove to be one of the most useful. If you are struggling to make any change at all in your practice, I would highly recommend you start with this one. Start with just one GP’s letters. Measure the benefits. Others will soon become interested!