Bursting at the seams?
On various visits to practices, one of the biggest gripes I hear is “we haven’t got enough space”. To be specific, not enough clinic space.
It’s often a reason why practices won’t take on registrars, medical students or develop the practice in other ways such as modernising the workforce by adding allied healthcare practitioners.
There’s an easier solution
It might surprise you and many practices I’ve worked with have tried it.
When considering lack of space, the first thing people think about is building work, extensions, moving, new builds etc. This is always the expensive and stressful solution to the problem.
But what if there was another, much easier way?
The first thing to do is ask the question: during working hours, are all the clinical rooms used at all times for only clinical work?
This means dealing with patients, whether face-to-face, on the phone or online, not any time of admin such as processing blood results, scripts etc.
The best way to do this is to conduct a room use audit. Start by looking at the appointment screens and noting how many hours in the day each room has not got patients booked in. Then total up the hours. This is time that could be used for clinical contact.
Practices will often find that there are a great many hours of available clinical space when patients could be dealt with, but the rooms are taken up with other tasks such as admin.
How do we utilise the space better?
To allow clinicians to conduct their admin and other non-patient-facing tasks, they still need somewhere to work with access to the clinical system. An ideal option is to create a clinical admin space or a hub, where clinicians can work together in the same room.
This has lots of benefits, not least of reducing the isolation felt by clinicians working the majority of their time on their own in practice and also the ability to cross check or ask for advice.
The space doesn’t need to be huge or palatial. It only needs enough space to house a few computer workstations and telephones, as not all clinicians will be using it at the same time. In many surgeries, there are often neglected small rooms that could fit this function perfectly with some minor investment, or why not use the neglected staff room piled high with junk, that would be ideal as a clinical admin hub?
But it’s my room!
The biggest hurdle to overcome is the ‘it’s my room’ syndrome.
I like to offer this as an option to the partners: would you rather spend £50,000 each on an extension you don’t need, or let someone use your room for a few hours a day?
It’s a no brainer really, but you’d be amazed how many people would still rather build an extension. Some GPs are very territorial over their workspace.
One way of helping your team to ‘let go’ of their claim over rooms is to de-personalise them. Removing photos, kids’ paintings and personal clutter makes the room into a neutral shared space, rather than a personal one.
This is also a perfect opportunity to standardise the rooms, so you can find the same things in the same place in each room. The use of wheeled boxes (like many reps use) to move your kit in and out of rooms at the end of a session allows you to have all your equipment and home comforts, but lets you move them easily.
What about the surgery times?
Another common barrier to utilising this system is the “we only need people to work during morning and evening surgery times” problem.
Why is that? It’s just habit. These times certainly don’t suit all patients and don’t suit quite a few clinicians.
Lots of patients would be delighted with a lunch-time appointment and some clinicians would equally be at home starting after the morning school run, perhaps doing visits or admin first and then doing the largest part of their clinical work in the middle of the day. Equally early morning or late surgeries would be music to the ears of busy commuters. There are endless combinations that could be adopted. It just takes some flexibility.
It’s all about change
The solution to most surgery’s space problems is easy. Fill your clinical rooms only with clinicians involved in patient contact, every minute, from when the surgery opens until the surgery closes. For most surgeries open from 08:00 to 18:30, that gives you a maximum of ten and a half hours of patient-facing time per room, per day.
The main problem is change.
People don’t like it, particularly GPs who have sat in the same chair, at the same time every day for the last few decades. Some will have spent more time there than at home or with their children over their lifetimes, so giving up their routine and personal space is a battle, even if it means the alternative is parting with a huge sum of money to provide clinical space elsewhere.
It’s not an easy change to make, but the potential rewards are huge.
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