Team communication within general practice

Effective communication is essential to providing good healthcare and is pivotal to ensuring patients receive safe care. Good communication may also reduce the likelihood of patient complaints and claims. Fundamental to patient safety is effective communication between all members of the practice team, as well as between the practice team members and their patients.

Problems may arise because of a breakdown in communication within the practice. Similarly, the primary – secondary care interface is an area where communication can easily breakdown, which can also contribute to adverse incidents.

Establishing clear communication within the practice is key to underpinning safe patient care and can help to avoid adverse incidents. The GMC also advocates the importance of good communication between healthcare teams.

It states: “Multidisciplinary teams can bring benefits to patient care when communication is timely and relevant,but problems can arise when communication is poor or responsibilities are unclear.”¹

The general practice team should focus on developing and maintaining robust systems for sharing information.

According to Medical Protection’s Clinical Risk Assessment programme findings, 81% of the practices we visited between 2016 – 2018 had risks associated with internal communication within general practice.

Let’s look at these risks and how you can mitigate them.

INTERNAL MESSAGING

Many practices use sticky notes to pass messages amongst staff. This method is very risky. There is potential for the sticky note to fall off and get lost. Furthermore, conveying messages in this format does not provide an audit trail. The WHO describes how the use of a sticky note contributed to a lethal outcome of a 21-year-old man in 1992.²

The use of computer internal messaging and electronic task systems has greatly reduced the use of sticky notes. Practice staff, where possible, should be strongly encouraged to use their clinical messaging software and internal email systems for communication within the practice. These provide a full audit trail of messages transmitted and facilitate the integration of clinical messages into the patient record.

Computerised ‘instant messaging’ systems also have many advantages in general practice. Instant messaging enables urgent messages to be transmitted to clinicians without interrupting a consultation with a phone call or a ‘knock on the door’. However, overuse and inappropriate use of instant messaging is a distraction during a clinical consultation. The practice should agree how instant messaging can be effectively deployed and have clear protocols defining situations when it should be used. Always remember there is a potential breach of patient confidentiality if identifiable data about a patient flashes on the screen during a consultation. Some software systems do not retain instant messages either, so the practice needs to ensure that any patient-specific messages are integrated into the patient’s clinical record.

AVOIDING INTERRUPTIONS DURING CONSULTATIONS

Interruptions during a consultation may inadvertently cause a clinician to lose their train of thought. This may lead to a clinical error. Interruptions may breach patient confidentiality if a patient overhears staff discussing another patient. It is important that guidelines for acceptable interruptions are provided for administrative staff. These should detail reasons when interruptions are acceptable and when they are not, while ensuring that interruptions are kept to a minimum.

PRACTICE TEAM MEETINGS

Practices should aim to have regular full team meetings for all staff. Practice meetings are an ideal opportunity to improve staff engagement. They provide an excellent forum for developing and agreeing on policies and procedures within the practice.

All staff should be encouraged to contribute to the meeting agenda. It is important that the minutes of all practice meetings are dated and reviewed for accuracy, agreed and signed. Keeping minutes of practice meetings has several advantages:

• it records the organisation’s response to important events and developments
• decisions can be reviewed at a later date to ensure that action has been taken
• members of staff who did not attend the meeting can be made aware of decisions taken
• good-quality minutes demonstrate that an organisation places appropriate emphasis on careful management. This may be helpful in dealing with serious complaints, litigation or external review by a body such as the CQC.

BRIEFING SESSIONS

Challenges often arise for part-time staff working within a practice and it can be difficult keeping up to date with the day-to-day running of the practice. Research has shown that face to face communication between managers and their teams is vital to the efficient and effective operation of an organisation.³

Many large organisations use team briefings as a way of keeping staff members informed of the latest key organisational decisions and progress. These provide a forum to listen to staff feedback and answer any questions. Practices should consider having a daily quick update or ‘huddle’ – no more than five minutes – to briefly discuss the situation of the day, including any challenges such as staffing arrangements and whether there are new locum clinicians reporting to work on that day.

One practice we visited found the mnemonic ‘BRIEF’ helpful:

Brief introductions
Rota and staffing
IT
Emergencies
Forecast (or format of the day)

Briefing sessions should:

• Provide an opportunity for practice managers to meet with their team face-to-face on a regular basis.
• Ensure that staff members are well informed. This reduces the risk of misunderstandings.
• Enable two-way communication: it is not just about giving information, but listening and responding to questions and concerns from the team.

GP PARTNER MEETINGS

“General practitioners often expect partnerships to last until retirement do them part”.⁴

GP partner relations occasionally break down, which can lead to a stressful and potentially expensive outcome. Disputes can arise due to personality clashes, financial disagreements, a power struggle or workload disparity – or commonly a combination of such factors. Such experiences are stressful for all concerned,hence it is vital to address issues early and avoid escalation. Underpinning a successful partnership are regular and effective partners meetings. When things start to go wrong, partners should meet to discuss and try to resolve the issues. They should then explore options and agree a way forward.

The GMC states “You should encourage team members to cooperate and communicate effectively with each other and other teams or colleagues with whom they work. If you identify problems arising from poor communication or unclear responsibilities within or between teams, you should take action to deal with them.”¹

Good communication is fundamental to good clinical care.Communication is a complex topic. Practices should recognise the importance of regular and effective internal communication and consider how they might further enhance the communication within their own practice.

REFERENCES

1. General Medical Council. Leadership and management for all doctors. 2012. gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/leadership-and-management-for-alldoctors
2. World Health Organisation. Patient advocates use past experiences to change the future,(October 2015): who.int/features/2015/ireland-patient-advocates/en/
3. University of Exeter, The benefits of team briefing. exeter.ac.uk/staff/news/teambrief/teambriefing/
4. How to prevent GP partnerships breaking down. BMJ. bmj.com/content/346/bmj.f1346