Operational failures in general practice: A consensus-building study on the priorities for improvement

Why it matters

General practice is the foundation of an efficient, cost-effective, and sustainable health service, but it’s becoming harder to sustain levels of access to, and quality of, GP services. There are fewer full-time equivalent GPs working in the NHS now than before the COVID-19 pandemic, while demand for their services exceeds available resources and capabilities. Balancing these factors is leading to record high levels of GP work-related stress and fewer patients rating their experience of general practice as “good.”

Dealing with operational failures takes up valuable time that GPs could be spending with patients. Simple tasks become more complicated and take longer to carry out because general practice staff don’t always have the support they need to carry them out efficiently

Types of operational failure include:

• interruptions and disruptions
• missing materials and equipment
• problems in information-sharing between healthcare services
• challenges with making referrals to other healthcare services
• suboptimal information technology, computing resources, and electronic health records.

With operational failures accounting for at least 5% of GP’s time, and an ongoing recruitment and retention crisis, it was important to identify what operational failures mattered most to both GPs and patients, and where they thought improvements should be prioritised.

Our approach

We carried out two modified Delphi studies – this involved conducting surveys of both GPs and patients to find out what they thought were the most important operational failures in general practice to target for improvement. The surveys took place between February and October 2021 using Thiscovery, a secure online research and development platform developed by THIS Institute.

Operational failures were defined as problems in the supply of equipment, materials or information needed to complete a task or an interruption that took their attention away from a task they were already doing.

We asked 67 GPs to decide, over two rounds, which of a list of 45 possible operational failures they believed most needed addressing, and when they had reached agreement on their list of top priorities, we asked 37 patients to agree, again over two rounds, on which of the operational failures in the GPs list they thought were the highest priority.

What we found

The study identified 13 operational failures as priorities for improvement.

The top priority for GPs was having an efficient, dependable electronic health record, while failures relating to inaccurate or missing information within the electronic health record also scored highly. Problems relating to the electronic health record don’t just frustrate health professionals, they can lead to patient harms such as errors in prescribing and decision-making.

Patients’ priorities were different, although patients are understanding when it comes to operational failures. The top three highest-scoring failures overall related to:

• errors or missing information in medical records
• GPs not being able to review test results because they were missing
• problems referring a patient to hospital or other healthcare service because of missing forms.

It’s worth noting that the study took place during a time when practices were dealing with extra pressures on their services and a higher dependence on digital communications, remote consultations, and expectations for primary care to carry out functions that had been previously undertaken in secondary care. The fact that concerns about these issues persist underlines the importance of this study in planning priorities for improvement.

This study has identified the highest priority operational failures in general practice, suggesting the areas where improvement should be concentrated. The final list of 13 operational failures can now be used to guide quality improvement activities.