Communication, collaboration and co-ordination called for

Dr Alan Hassey, the former co-chair of the joint GP IT committee of the British Medical Association and the Royal College of General Practitioners, has called on GPs to strike a balance between the use of clinical evidence and traditional patient care.

Dr Hassey told E-Health Insider Primary Care that whilst GPs should embrace the use of clinical evidence when diagnosing patients, they should not forget their own judgement.

“The doctor-patient relationship is a very complex system. We cannot miss the key details of a patients narrative because we are busy trying to use clinical evidence on a computer to find treatment plans, in order to score Quality and Outcomes Framework (QUOF) points.”

He added that it was important for GPs to focus on the patient, and ensure that they can still notice physical signs of distress or discomfort whilst listening to the patients’ narrative of what was wrong with them.

“GP’s must remember that the patient is the key at all times – not their computers. We must focus on listening to the patients and trying to read behind the lines of their stories. It is important that we get the full picture so that we can offer the patient the best treatment available to them and make them feel more at ease.

“It’s too tempting to focus on meeting the qualitative performance targets, but with all the information, you will most likely find that patients don’t always fit the boxes, and so it is up to you then to check what treatment is suitable for the patient. Communication, collaboration and co-ordination are the keys for GPs to offer maximum patient care.”

Dr Hassey spoke at an informatics conference in Dunblane, where he stressed the need for clinician involvement with the procurement of systems. “One must remember that in the 21st century, GP practices have become a triadic consultation between the patient, clinician and information system. Connecting for Health went wrong, because they worked without consulting clinicians – we should prevent this from happening again by utilising what we have and making the best of it.”

The former GPC IT committee co-chair said: “As the UK moves towards the creation of single health records for every patient, we must work to ensure that systems are integrated well and are interoperable for all of us – everyone should help in system development so this triadic consultation relationship is not lost, and as patients cross the borders we can have access to their record at any given time or place.”

Dr Hassey stressed that in order to create interoperability, there should be two different models for the different specialties. One to be used in GP practices, and one to be used in hospitals – using common narrative free text and not clinical terminology so that both health professionals and patients can understand notes on records.

“We need to develop a new intellectual model that will weave together the traditional science clinical models, with patient narratives and any unpredictable understanding issues which might arise. It’s a challenge when a patient has complex multiple chronic conditions and GPs need a system that can help them offer the best patient care."

He added: “Bringing the triadic consultation process more closely together will result in better clinical care and offer the therapeutic alliance between patients and GPs which we should already be seeing. In a ten minute consultation, context, narrative, codes and models need to be understood and summarised with clinical evidence – it needs to be made easier.”