We do similar and we are innercity. 
We have duty doc .Emergencies are morning only and are invited to the
duty doc in batches;after the end of the morning session the duty doc
has a clipboard of all urgent phone requests and deals personally with
em. HHE/she is in charge of didshing out any visits or if a request is
clearly nonacute referring it to "own" doc to do in off duty day
comfortably.Repeat scripts duty dr job.AS a result of not having to see
extras each partner not on duty can see an extra 40 minutes of
appointments in the morning.
We have 6000 patients and 3 partners and a registrar and usually have
one duty day a week.I know it doesn't add up! We have a small problem
with thursdays practice 1/2 day and that rotates amongst three of
us.Hence application for extra partner.
Gillian Braunold
In article <[log in to unmask]>, C-P
<[log in to unmask]> writes
>>At 08:20 10/03/98 +0000, Katie wrote:
>>>Yesterday I had 73 patient contacts - ...... etc
>
>>Where do you find the time to read GP UK?
>>
>>Some of this sounds like me 10 years ago  ... you need some control over
>>your workload before burnout hits, and so you see the kids sometimes.
>>
>>There ARE solutions - ....... etc
>>
>>Gwen
>>
>
>
>Too right there are. Lighten up Katie, and remember
>Parkinson's/Sod's/Whoever's law - nature abhors a vacuum, so that work
>expands to fill the space available.
>
>Analyse your consultations - how many really needed to be seen by you at
>that particular time? Demand can seem to be limitless, so be more proactive
>in imposing limits yourself.
>
>Priding ourselves on offering maximum availability, we ended up on a rapid
>downward spiral until we stopped and took a long, hard look at our true
>effectiveness - in simple terms we ended up being constantly available for
>the huge mountain of self-limiting minor ailments at the expense of the much
>less frequent genuinely serious pathology.
>
>So, after various attempts at alternative systems, which proved
>unsatisfactory in various ways (but at least we gave them a fair go), we
>arrived at telephone triage, and have never looked back.
>
>At the moment, the duty doc (but it can be, and hopefuly will eventually be,
>an appropriately trained nurse), calls back all those patients who insist on
>being seen the same day. This serves to:
>
>a) focus the mind of the caller in that they have to wait by the phone for
>the doc to call back, and can't wander off to do the shopping etc
>
>b) allow a reasoned (!) discussion between the doctor and the patient
>regarding the nature of the "urgent" problem and its best resolution
>
>c) allow the duty doc to agree the best time and place to see the patient if
>thought necessary
>
>d) deal with a considerable amount of the stuff over the phone without the
>need for a face to face appointment.
>
>e) allow the duty doc to appropriately educate the patient regarding the
>uses and abuses of the service.
>
>The duty doc does no visits in the morning, but shares any out between the
>other partners, nor does he have any formal stucture to the duty day other
>than to phone the patients back, rather it's left in free form for him to
>arrange as he sees fit. Any urgent problems which the patient or the doctor
>feels needs an immediate visit, and will not wait for a routine call are
>passed on to the ambulance service on the basis that we are not an emergency
>response service, nor are we equipped to be one.
>
>Result is that, although the duty doc makes a lot of phone calls, the
>surgeries are much more manageable and under his direct control, and the
>visit rate has dropped significantly. The vast majority of the patients
>appreciate being able to speak directly to the doctor, and the receptionists
>are happy because they don't cop so much of the flak.
>
>OK, so we are a large practice (6 wte), and are semirural (market town &
>surrounding villages), have good ambulance response times, and have a
>computerised appointments system which is networked, so I guess this system
>isn't going to work for everyone, but we feel we are gaining control again,
>and that's the important point.
>
>Try different ways of managing things, be prepared to be innovative, take
>control, live long and prosper!
>
>C-P
>
>***************************************************
>
>  Dr Adrian Canale-Parola
>
>"If you want a doctor I'll examine
>Every inch of you....."
>
>***************************************************
>

-- 
Dr Gillian Braunold


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