Time to grow – space and clinicians
10-12 hour days, five days a week and a few hours on a weekend were not part of this plan… It was going to remain a balance between practice time and my time… But admittedly it’s got away on me this year!
Some would say but practice time IS “my” time, and they wouldn’t be completely wrong… BUT I know that’s not healthy or sustainable. Also, I do love the beach, the bush, the garden, and sight seeing with my whanau!
I’ve been physically seeing 24 patients a day on average for the past three months. That’s not including the non patient contact time. phone call, scripts, results and the great “task box”. Some might say that’s a healthy business, actually no it’s not, it’s not enjoyable and working this intensely its unsafe. There is not the attention to preventative medicine, pro active approaches to better health , it’s the ambulance at the bottom of the cliff stuff and this is not how I want to practise. I want time to look at the patient demographics and look at running clinics that focus on certain health conditions that are impacting the lives of our community. Sounds all very cliche, but actually it is how I want our service to operate.
So, a review of the situation showed the nurses were seeing many patients that required NP/GP reviews as they are complex cases, and so the nurses are feeling they are being really stretched to capacity in terms of scope. The patients are then put in to see me in amongst a fully booked day. Not ideal for all three parties involved. So … we need more NP/GP time, so patients are booked into see the most appropriate clinician, the nurses can see the patients they need to be seeing and can also see more patients for health promotion, education as this is a huge part of the PHC role. Paperwork is forever on the increase and protected time needs to be allocated for this in order for it to be done properly. A referral done at speed can result in insufficient information being sent, return of referral and time wasted! So, I need half a day and the nurses need a full day of paper work only time.
Ideally I’d have a GP one day a week, to see patients I want a second opinion on, rather than seeking advice from the specialists or sending them through to secondary services. The disability certificates, drivers licences and supported living benefits (invalids) need to be signed off by a GP (until November 2018). I also want access to a GP to discuss cases, and learn more. But the answer is not that straight forward. Finding a GP for one day a week is quite difficult in South Canterbury. But I have found where there is a will, there is a way!
BUT it’s another NP we need 2-3 days a week, so I can have a day to do home visits and paperwork, attend meetings and continue with my role on the NCNZ board that means days away in Wellington as often as every two weeks. This means a day where potentially in excess of 50 transactions are not processed. (ie: face to face appointments for NP and those RN patients i review, prescriptions, the results and other daily tasks) This one day of work doesn’t disappear, it is just added to the rest of the week. We have enough work now that we need a NP /GP clinician available full days, 5 days a week.
So this is all very well, but what about space? Currently we have two consulting rooms and one treatment room without computer access and a very small room with computer access but no examination bed. This works with our current staff but not with the extra person 2-3 days a week. So ANOTHER scheme, and here we go, Turing the large reception room into a third decent sized consult room and the reception moved to an unused space within the waiting room. A portacom bought in to act as a office/ files space and we are ready to go!
(Will update you next month with how this plan works out) I’m excited about a more manageable work load, working with a fellow NP and GP. Working solo is a challenge and is hard work. The opinion of a colleague in the next room will be SO helpful!