Pre-consultation care

The most recent patient survey has shown that patients want to be able to see the clinician sooner (ie less than 2 weeks) and on time (i.e. not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients. 

Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit.

There are some simple steps that are essential for you to understand that will help you on your journey of discovery for your health and well-being:

Get access to your GP-held electronic health record. This is a pre-requisite to getting the most from the consultation. Instead of asking us whether the blood results or letter from the hospital have come, you will then have the opportunity to check the results, understand what they mean and what you then think should happen next. Most of the time the results or letters are normal or as you expected in which case you may not even need to come to the surgery at all. Or you may find that something needs to happen and hence you need to book an appointment. When you do come to see the clinician, you will already have the answers to the rest of these questions. 

Who is the consultation with and do you know how long the consultation is for? Understanding who it is with and how long you have will mean that you get the best out of the consultation. Medicine is becoming increasingly complex and can be very time-consuming. Often developments happen over a period of time with consultations with different people inside the practice (nurse, doctor or health care professional or even counsellor, midwife, health visitor) or outside the practice (hospital doctor, specialist community nurse, pharmacist, optician or physio). Each person can help you as long as you know their expertise and what they can offer. No one person can do everything for you but we are all here to help. Different people have different amounts of time and also much depends on where you are being seen. A consultation with your nurse whilst she is assisting the doctor during a minor surgical procedure may not be the best time for you or the nurse (or doctor) even though you are altogether in one room. This is how mistakes can happen. 

What do you want covered in the consultation? Ideally each consultation should only be for one problem or issue. One of the biggest reasons why the surgery runs late is because patients often have a list of things that they need to do, each of which could take 10 minutes. The clinician then tries to squeeze 2 or 3 problems into a 10 minute slot with the result that they are not covered adequately and the surgery runs over. But we also understand that there can be times when you may have more than 1 problem which the clinician may be able to resolve within the time limit. So why don’t you write a list of the main things you want out of the consultation e.g. medication review or getting indigestion (or both). At least the clinician knows what is on your mind. But remember not to become over ambitious and it is better to try to limit the consultation to 8 minutes. That is because some things may take longer than expected (eg if the doctor decides to refer you to the hospital, we will need to have a discussion about your choice of hospital and give you information about how to book your appointment using the internet which can take time or there may be other aspects of your health that you were not planning on discussing that may need to be looked into). We want the medical record to help support your experience with healthcare. If there are things that you think are missing or that you would like to know to understand your health better then please write these down. These will be very important for us and you as we try to co-construct the medical record together so that it is useful for you and us! 

A brief summary of what has been happening until now. This may be what we have been up to in the practice – eg checked your blood pressure 3 times and had blood tests and urine test done as well as an ECG at the hospital. The results are all back because you have checked them on-line and you just need to know whether you have high blood pressure or not and whether you need to start medication. You may also add what other information you have read eg NHS Choices, recording blood pressures in HealthSpace or what you think the choices are that you wish to discuss with the clinician (eg do I need to go on tablets or can we have a go with some lifestyle changes first as per advice that you have read). This means we are both running from the starting blocks. 

Any problems with on-going treatments that you may be having? It’s always a good opportunity for you to look at your repeat medications and check that everything is in order or whether there are problems with it. Perhaps there is a medication that is not on repeat. Since repeat prescriptions are done by the receptionists, you ought to ask them first to see if it can be changed. But if they ask you to mention it to the nurse or doctor then now is the time to raise it. Tell us which medications and perhaps why. Or it may be that some drugs are causing unpleasant side effects or even that you have decided to stop taking them. It’s in your interests to tell us this so we know what you are taking and not taking. We are here to help you. But remember if this is going to be a long discussion then make it the reason for coming and not an afterthought after the list of other things you may have. 

What do you think we can do to help? This may sound silly but the chances are that if you know what you want and we think you need that then we may be able to just deliver it without too much fuss and ensure your needs are fulfilled. Note our use of your wants and needs. We are here to fulfil your needs as much as possible and not necessarily your wants. Understanding this will help us all to become more effective at achieving our shared goals and hence build “a partnership of trust” between us. 

Bring you diary with you in case we need to see you again. This may sound obvious again but if you bring this with you then you can book another appointment whilst you are still at the surgery. Of course if it is with another doctor then you could do it on-line in the comfort of your own home or when other family members eg carers are with you.

This is very important. In your journey of discovery about your health, you may come across odd things that do not make sense about the way the practice runs and you may have a better suggestion. Or you may come across something new that we have not considered that helps you even more. Tell us about it next time you see a clinician or preferably write it down and hand it in or send it as a comment to the Patient Participation Group (PPG) so that they can bring it up with the practice the next time we meet up. Even better, why don’t you join the PPG and become an active member. We are always on the look out for new members and new ideas. 

Most importantly, by working together and understanding each other’s needs better, we can help you to get the best out of the practice and the wider NHS.