Red Tape

    GPs just want to do what they are trained for... to heal the sick. "Paperwork" is the elephant in the room. The problem is so large that no one sees it. And it has grown. I expect that more than 200 years ago, no records were kept. I have seen a doctor's record book from about a hundred years ago. It had the patient's name, one or two words for the diagnosis and a description of the medicine which was made up for the patient. Now we have complex records detailing symptoms, findings, diagnosis, management plan, tests ordered, prescriptions written and the follow up recommended. All this takes time. Lots of it. Perhaps half the consultation is taken writing/typing. This means that without paperwork, twice as many patients could be seen. Could we do without paperwork? No, not in this litigious world. And not if we are looking after 2,000 patients, many of whom have complex problems. Too many to remember all the fine details. So medical records are here to stay. But not everything has to continue the way it currently does. Look at some of the issues:

The Unseen Problem with Red Tape

    The Department of Health (DoH) tells us that there are 22,005 FSEs. What are FSEs you will rightly ask? An FSE is a full service equivalent. The DoH calculates the FSE based on each doctor's billing patterns, ie the number of sessions and days a week they work. A single full service equivalent taken as a 7.5 hour day, for five days a week, so 37.5 hours per week. So 22,005 FSEs equates to 825,187.5 hours per week. Believe it or not, these are useful figures! See the examples below:

• Authority Prescriptions
      let's assume that the average GP spends a total of 6 minutes per session ringing the Authority line. That is 60 minutes a week. That means that across Australia the time wasted (1 hour per doctor per week) ringing the Authority line has the equivalent of removing 1/37.5 of a week or 586 FSEs from the workforce or 887 GPs from the workforce! Remember that the authority system is used to reduce the costs (to the government) of expensive medicines and to control restricted drugs.

• Care Plans
      Let's assume:
  • one per session
  • the practice nurse has done the initial document
  • we spend 30 minutes editing the plan, explaining it to the patient and printing it out
  This results in the equivalent of losing 2,934 FSEs from treating patients, or 4,436 GPs from the workforce. The patients get 220,050 care plans for that week, for which the government has paid a lot of money. It loses 20 patient consultations per week per doctor (assuming 15 minutes per consult). The patients get a planning document (and rebated allied health visits) and we get the opportunity of stepping back and looking at the whole patient and planning their health care. Is it worth it?
  

• S8 Drugs
  There was once a time when doctors could prescribe what they wanted for the care of the patient. Now some drugs (for better or worse) are highly restricted. In order to prescribe an S8 drug the doctor has to write the script and for most doctors (who use computerised script writing) re-write it to fulfill an antiquated rule. Another minute to write it by hand. Each minute wasted by all Australian GPs with red tape is the equivalent of taking 15 GPs off the workforce. So if GPs across Australia average one S8 script per day then the time wasted writing them by hand is the equivalent of taking 75 GPs off the workforce. But it gets worse. If you have one patient per week on an S8 for terminal cancer, then that script needed to be followed up with a one month's supply script (authority call = 3 minutes) and then another script to be written (3 minutes) and posted (2 minutes preparation) for the next two months supply. The equivalent now is 120 doctors taken off the workforce Australia wide just for this extra paperwork. So the paperwork for 1 S8 drug per day plus one long term S8 drug has the effect of taking almost 200 doctors out of healing patients. It gets worse of course. If the patient is on a long term S8 for over a year, then another opinion must be sought. This means a referral(10 minutes) and another visit (15 minutes) plus the time wasted by the other doctor (15 - 60 minutes). All because the government does not trust doctors to prescribe wisely (or because a small number of doctors have broken that trust).