A 'set piece' response
If you are in a pickle with an aspect of your practice population care (immunisation, cervical screening, CVRAs), Jo Scott-Jones suggests reviewing, judging and and acting on a "set piece" response.
Reviewed 02.07.2025
If you are in a pickle with an aspect of your practice population care (immunisation, cervical screening, CVRAs), Jo Scott-Jones, clinical director, suggests reviewing, judging and and acting on a "set piece" response.
Diabetic annual review numbers not looking great? Try a 'set piece' response.
An update from Dr Jo Scott-Jones, clinical director.
One of our practices had pretty dreadful DAR statistics. Like most practices, they had dropped over the height of the COVID-19 period and never recovered, in fact they were getting worse.
They held a 'set piece' practice meeting, outlined below, where the whole team went over the issues with a fine tooth comb, understanding the current way they were each doing things, and thinking about how they might improve.
This revealed two key issues.
- They had stopped recalling patients for DARS as they had lost a key staff member. The solution was to ensure everyone on the staff was able to do DARs and to make it a practice-wide focus.
- They realised the DARS they were doing weren't being recorded properly, mostly because they weren't pressing "save" on the BPAC common form but also because key bits of information weren't completed (date of retinal screen, foot examination etc).
Solving these two problems has lifted the practice's DAR statistics from less than 20 per cent to over 80 per cent over the past 3 months.
If you are in the same pickle with some aspect of your practice population care (immunisation, cervical screening, CVRAs) consider allowing a few key staff to take a few hours to see, judge and act on a "set piece" response.
Set piece: The first time
Sport teams prepare their 'set pieces' with repeated practice and trying out new and varied strategies to try and outwit the opposition.
In football (soccer), the corner and the free kick. In rugby, the scrum and line out, for example.
In theatre and film 'set pieces' are elaborate sequences where one action builds on another leading to an ultimate climax, the care chase scene, that bit in Star Wars where they blow up the Death Star (sorry, spoiler alert!).
In general practice our 'set pieces' are the consultations we can prepare and strategise for. NZ Health Surveys tell us that most people go to the GP for either a check up, or for management of short term illnesses, followed by management of longer term conditions, such as cardiovascular disease, respiratory and musculoskeletal conditions, and for issues like contraception, immunisation, and mental health conditions.
Australian health surveys suggest that around 40 per cent of a GP's time is taken up with managing one of 23 different disorders, including hypertension, asthma, URTIs, sprains, back pain, osteoarthritis, depression, skin rashes, heart failure, gynaecological issues, and heart failure.
What you consider a set piece may vary according to your practice style and population, but the lifestyle change consultation, telling bad news, admitting to an error of judgement or omission, and the common clinical situations, the respiratory tract infection, hypertension, asthma, arthralgia, the contraception consultation, back pain, and the off work certificate might be good starting places.
For most patients this may be the first and only time they come to talk to a GP about an issue, but for you as a GP these consultations can be the bread and butter of your day, or should I say the carrots and quinoa in these more enlightened and healthier eating times.
One of the joys of general practice is that every person's cold is different, the way it is effecting them, the consequences, their fears ideas and expectations. Drawing these out and addressing them in the consultation is one of the things that separates health professionals from computer generated diagnostic tools. (Check out WebMD symptom checker for an idea of where the future may take us if we don't see the value in these "simple" consultations.)
However, even though every consultation is different, there is great value in preparing your 'set pieces' to help you to use the patient-centred method, and to enable everything to be fitted into the fifteen minutes allotted.
Frameworks really help, but whenever you are applying a template, be aware that "the opposition" (if we can call the patient such) may have a different plan in mind, and be prepared to adapt.